A 45-year-old male presents to the ED complaining of chest pain and drooling that staed immediately after eating a steak. His past medical history is significant for ingestion of a caustic solution, 5 years ago . On physical examination, patient can talk normally and breaths without effo. He is drooling. The chest pain is vague and constant. A chest X-ray shows no subcutaneous emphysema. An endoscopy confirms the presence of a retained bolus of meat 25 cm beyond the incisors where a stricture is identified. The bolus is removed and the stricture is dilated. Which of the following anatomic spaces contains the stricture
The aoic arch leaves an imprint in the right anterior edge of the esophagus in the superior mediastinum at about 23 (+-3 cm) beyond the upper incisors. This is the 2nd most common location of injury and stricture formation. Option 1: The esophagus is compressed by the left main bronchus in the posterior mediastinum. Although this area can also be damaged from caustic ingestions, it resides lower down, at 30 cm beyond the incisors. Option 3: The anterior mediastinum, limited laterally by the pleura, posteriorly by the pericardium, anteriorly by the sternum, the left transversus thoracis muscle and the fifth, sixth, and seventh left costal cailages, contains only the superior and inferior sterno-pericardial ligaments and remnants of the thymus. These structures do not come into contact with the esophagus. Option 4 :The abdominal poion of the esophagus is variable in length (0.5-2.5 cm). The junction of the esophagus and the stomach lies inferior to the esophageal hiatus of the diaphragm. The phreno-esophageal ligament anchors the esophagogastric junction to allow movement with respiration but to prevent significant (more than 1-2 cm) proximal movement of the superior margin of the stomach.
Posterior mediastinum
Superior mediastinum
Anterior mediastinum
Epigastrium
Pharynx, larynx and trachea and cranial nerves 3,4,6