when considering a patient with dysphagia an attempt should be made to determine whether the patient has difficulty only with solid boluses ( suggestive of mechanical dysphagia ) or with liquids and solids ( suggestive of a motility dysphagia ) . anatomical lesions , such as an oesophageal tumor and external pressure effect from a lung tumor or aberrant vessel , can lead to mechanical dysphagia . gastroscopy and / or a barium swallow help identify the culprit anatomical lesion . in this study a patient with progressive mechanical dysphagia is presented that finally diagnosed by as lung squamous cell carcinoma . diagnosis was made by a computerized tomography scan of the thorax , bronchoscopy and bronchial biopsy . a 63 years old iranian woman admitted in our hospital due to progressive solid dysphagia and 10 kilogram weight loss in the past three months.she had a history of heart valve replacement surgery at 3 years ago . physical examination revealed mild temporal muscle atrophy and abnormal heart sound secondary to her known valvular heart disease . vital signs , lungs , abdomen , pelvic , central nervous , and the musculoskeletal examination were all normal . the patient 's laboratory findings including blood cell count , erythrocyte sedimentation rate , and kidney and liver function tests were also normal . as the patient history was suggestive for an esophageal malignancy , an upper gasteroenterointestinal endoscopy was carried out . endoscopy revealed a short ( two centimeters ) circumferential symmetrical smooth narrowing in the mid part of the esophagus ( from 25 to 27 cm of incisors ) ; the gross appearance of this stricture was normal suggesting external compression . barium swallow confirmed the endoscopic findings but did n't reveal more diagnostic information ( figure 1 ) . barium swallow and endoscopy showing short symmetrical smooth stricture in middle part of the esophagus . contrast computerized tomography ( ct ) scan of the chest was performed for further clarifying the nature of the lesion . ct scan revealed an abnormal soft tissue density with irregular borders in the posterior mediastinum that was encircling the carina , left main bronchus , esophagus and the mid thoracic aorta ( figure 2 ) . ct scan shows an abnormal soft tissue mass with irregular borders around the esophagus , aorta and left main bronchus . due to the external pressure the lumen of the involved segment of esophagus did not appear in ct scan . the upper segment of the esophagus proximal to the lesion was dilated and had air - fluid ( oral contrast ) level . other parts of thorax including the lungs , pleura , ribs , sternum , and thoracic spines were normal . the patient had no respiratory symptoms but since mediastinal lesion seen on the ct scan was taking over the left bronchus and was in close contact to it , bronchoscopy was performed ; there was fine mucosal irregularity with about 50% narrowing without apparent mass lesion in the left main bronchus . biopsy from this trivial bronchoscopic finding revealed bronchial squamous cell carcinoma ( figure 3 ) . bronchoscopy showing 50% narrowing and mucosal irregularity in the left main bronchus ( left image ) and normal right main bronchus ( right image ) the clinical history is very important for diagnosing the underlying disease ; progressive dysphagia to the solid material can be a sign of esophageal malignancy . dysphagia to the both solids and liquids ( motor dysphagia ) usually occurs in systemic or esophageal neuromuscular disorders . space - occupying lesions such as foreign body within the lumen of the esophagus or tumor originated from wall of this organ and external pressure effect of a lung tumor can lead to mechanical dysphagia . diagnosis depends upon procedures such as esophagus endoscopy , barium swallow radiology or ct scan may be needed in approach to mechanical dysphagia . both some esophageal motor diseases such as achalasia and systemic neuromuscular diseases such as scleroderma can cause dysphagia to liquids and solids without obvious anatomical culprit . esophagus manometry , barium esophagogram , and swallow video - fluoroscopy may be required for identifying the cause of motor dysphagia . as mentioned above endoscopy revealed a short circumferential and symmetrical smooth narrowing with normal mucosa in the mid part of the esophagus that was due to an external pressure effect . barium swallow confirmed the endoscopic findings but did not reveal more diagnostic information ( figure 1 ) . one of the metallic sutures was seemed to be around the narrowed segment of esophagus at radiograph and so seemed to be cause of this narrowing . but this was mistaken , because the oesophagus is located in the posterior mediastinum and observed radiopaque sutures are on the sternum , the most anterior part of the chest . some extra - esophageal diseases can produce external pressure effect on the esophagus in the neck , mediastinum , or abdomen , causing narrowing of the esophagus and mechanical dysphagia ; these diseases include : abscesses or tumors of the pharynx , osteophytes or osteomyelitis of the cervico - thoracic spine , thyromegaly , zenker 's diverticula , solid or cystic mediastinal masses ( benign or malignant ) , aberrant right subclavian artery ( 1 ) , left atrial enlargement due to mitral stenosis , large arterial aneurysms , cystic esophageal duplication ( 2 ) , large para - esophageal hiatal hernia , fundoplication surgery , mediastinal lymphadenopathy due to sarcoidosis , pulmonary tuberculosis and or fungal infection . in cases that the mechanical dysphagia was due to an external pressure effect outside of the esophagus , an imaging method that can show the structure of the tissues around the esophagus is necessary ; endoscopic ultrasonography and or ct scan are useful for this purpose . space - occupying lesions such as foreign body within the lumen of the esophagus or tumor originated from wall of this organ and external pressure effect of a lung tumor can lead to mechanical dysphagia . diagnosis depends upon procedures such as esophagus endoscopy , barium swallow radiology or ct scan may be needed in approach to mechanical dysphagia . both some esophageal motor diseases such as achalasia and systemic neuromuscular diseases such as scleroderma can cause dysphagia to liquids and solids without obvious anatomical culprit . esophagus manometry , barium esophagogram , and swallow video - fluoroscopy may be required for identifying the cause of motor dysphagia . as mentioned above endoscopy revealed a short circumferential and symmetrical smooth narrowing with normal mucosa in the mid part of the esophagus that was due to an external pressure effect . barium swallow confirmed the endoscopic findings but did not reveal more diagnostic information ( figure 1 ) . one of the metallic sutures was seemed to be around the narrowed segment of esophagus at radiograph and so seemed to be cause of this narrowing . but this was mistaken , because the oesophagus is located in the posterior mediastinum and observed radiopaque sutures are on the sternum , the most anterior part of the chest . some extra - esophageal diseases can produce external pressure effect on the esophagus in the neck , mediastinum , or abdomen , causing narrowing of the esophagus and mechanical dysphagia ; these diseases include : abscesses or tumors of the pharynx , osteophytes or osteomyelitis of the cervico - thoracic spine , thyromegaly , zenker 's diverticula , solid or cystic mediastinal masses ( benign or malignant ) , aberrant right subclavian artery ( 1 ) , left atrial enlargement due to mitral stenosis , large arterial aneurysms , cystic esophageal duplication ( 2 ) , large para - esophageal hiatal hernia , fundoplication surgery , mediastinal lymphadenopathy due to sarcoidosis , pulmonary tuberculosis and or fungal infection . in cases that the mechanical dysphagia was due to an external pressure effect outside of the esophagus , an imaging method that can show the structure of the tissues around the esophagus is necessary ; endoscopic ultrasonography and or ct scan are useful for this purpose . if there is no intraluminal or mucosal lesion in the esophagus endoscopy of the patients with mechanical dysphagia , attention to the other organs that are adjacent the esophagus is useful ; imaging techniques such as thorax ct scan or endosonography of the mediastinum may be needed . because of the close proximity between esophagus with trachea and main bronchi , the tumoral lesions in these respiratory organs may present as dysphagia ; in such cases bronchoscopy is necessary for identifying the cause of dysphagia .
when considering a patient with dysphagia , an attempt should be made to determine whether the patient has difficulty only with solid boluses ( suggestive of mechanical dysphagia ) or with liquids and solids ( suggestive of a motility dysphagia ) . 
 lesions such as an oesophageal tumor and external pressure effect from a lung tumor or aberrant vessel can lead to mechanical dysphagia . 
 endoscopy and / or a barium swallow are helpful in identifying the anatomical disarrangement . in this study a patient with progressive mechanical dysphagia is presented that finally diagnosed by as lung squamous cell carcinoma . there were no respiratory symptoms . 
 diagnosis was made by a computerized tomography scan of the thorax , bronchoscopy and bronchial biopsy .