Descending thoracic aorta dissection associated with esophageal carcinoma
A 45-year-old hypertensive male was admitted with complain of chest pain, dry cough along with dysphagia for 1 month. He was a diagnosed case of chronic obstructive pulmonary disease (COPD) on the basis of spirometry findings (postbronchodilator FEV1/FVC 65%, predicted FEV1 69% and absence of any significant postbronchodilator FEV1 reversibility) for past 3 years. On physical examination, patient had grade II clubbing with mediastinal percussion being dull and on chest auscultation bilateral vesicular breath sound with prolonged expiration and polyphonic rhonchi. Chest X-ray showed widening of mediastinum. Contrast-enhanced computed tomography (CT) scan of thorax showed presence of right upper paratracheal, right lower paratracheal, aortopulmonary, subcarinal lymphadenopathy. Lymph nodes were enlarged so massively so that it almost compressed surrounding structures. Esophagus was compressed and became almost like a slit-like opening with proximal dilatation as visible by water soluble contrast gastrograffin. On CT thorax there was an intra-esophageal growth projecting inside the lumen [].\nAnother striking feature was presence of a large dissecting aneurysm in descending thoracic aorta extending distally up to the origin of left renal artery. Both true and false lumen was clearly visible with a clot inside the false lumen. There was also presence of erosion of vertebral body due to pressure by dissecting aneurysm []. Fine needle aspiration cytology (FNAC) from vertebral erosion showed metastatic deposits in vertebra. Upper gastrointestinal endoscopy done for dysphagia showed an intra-esophageal fungating growth; from which biopsy was taken. Esophageal biopsy revealed squamous cell carcinoma of esophagus []. It was a rare case of squamous cell carcinoma of esophagus associated with dissecting aneurysm of aorta and vertebral metastasis visible on same CT scan thorax. Patient was managed conservatively for dissecting aortic aneurism with antihypertensive and statin. Patient was in advanced stage of cancer with metastasis to vertebra; hence, chemotherapy (5-fluorouracil and paclitaxel) and radiotherapy for dysphagia was given.