Esophageal Disease

Dilated Esophagus Dilated esophagus extends from pharynx to diaphragm. It has cervical and intrathoracic portion. Intrathoracic portion is in posterior mediastinum in front of vertebrae and cannot be evaluated by physical exam. The cervical portion is behind the trachea. Dilated esophagus at the cervical portion can be picked up by physical exam.

Focused Exam

1. Forward Displacement of Trachea
   Dilated esophagus can push trachea forward and can be at the level of sternum at the suprasternal notch.
2. Ballottement
   When the trachea is pushed back it will yield and return to original site. In one patient ballottement elicited a severe bout of aspiration.
3. Tracheal Click
   Grab the trachea and try to roll over cervical spine. A click will be felt and heard. In dilated esophagus this click will disappear.