Case 22-1995

Presentation of CaseAn 82-year-old woman was admitted to the hospital because of odynophagia and a large superior mediastinal mass.The patient had severe kyphoscoliosis, with extensive intervertebral disk disease and associated degenerative changes. She had had intermittent heartburn for many years; an upper gastrointestinal series performed 41/2 years before admission was normal. Two-and-a-half months before admission the patient again reported heartburn, which was not relieved by small doses of antacid medication, and she began to have increasingly severe back pain centered around the first lumbar vertebral body. Examination showed a satisfactory and largely painless range of spinal motion . . .