An 87-year-old woman presented with a 2-day history of melaena and symptomatic anaemia. Medical history included idiopathic hyperthyroidism, a gastric ulcer and diverticular disease. On arrival, vital signs were stable apart from a tachycardia (107 bpm). Her initial haemoglobin was 48 g/L and urea 32.7 mmol/L. A large anterior neck mass was observed on examination. At endoscopy, this abnormality was identified in the upper oesophagus (figure 1). Minimal gastritis and a normal duodenum were also observed. Subsequently cross-sectional imaging of the chest abdomen and pelvis was undertaken to investigate the neck mass (figure 2). Figure 1 Endoscopic view of upper third of oesophagus. Figure 2 Axial CT image at the level of T3. What is the abnormality in the upper oesophagus and how should it be managed? What is the significance of the right sided neck mass? …

中文翻译：

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上坡还是下坡出血？

一名 87 岁女性因黑便和症状性贫血 2 天就诊。病史包括特发性甲状腺功能亢进、胃溃疡和憩室病。抵达时，除心动过速（107 bpm）外，生命体征稳定。她的初始血红蛋白为 48 g/L，尿素为 32.7 mmol/L。检查时观察到一个大的颈部前部肿块。在内窥镜检查中，在上段食道中发现了这种异常（图 1）。还观察到轻微的胃炎和正常的十二指肠。随后对胸腹和骨盆进行横断面成像以研究颈部肿块（图 2）。图 1 食管上三分之一的内窥镜视图。图 2 T3 水平轴位 CT 图像。食管上段有什么异常，应该如何处理？右侧颈部肿块有什么意义？…