Case

A 5 year old patient is brought into your clinic complaining of a sore throat with pain and difficulty when swallowing. Their parent describes that the child accidentally swallowed a small lego that was later expelled after vomiting one day ago. A CT scan with oral barium contrast which shows extraluminal (i.e. outside the lumen of the esophagus) collection of contrast posterior to the esophagus against the vertebral body of T6 to T7.

Question 1/3 - What region is barium accumulating within?

Click on your selected option(s) below  (correct = 1,  over-thinking = 2+)

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Incorrect. The anterior mediastinum is in front of the heart distant from the esophagus.

Incorrect. The middle mediastinum contains the pericardium and heart, not the esophagus.   

Correct! The esophagus travels through the posterior mediastinum (posterior to the trachea in the superior thorax then posterior to the heart more inferiorly in the thorax).

Incorrect. For barium to enter the pleural space it would have to rupture the parietal pleura, as the plural space is the region between the visceral (on the lung) and parietal (body wall and mediastinum) layers of pleura.

Incorrect. For barium to enter the costodiaphragmatic recess it would need to rupture the parietal pleura, as the plural space is the region between the visceral (on the lung) and parietal (body wall and mediastinum) layers of pleura, and then flow to the costodiaphragmatic recess (lowest point in a standing or supine patient).