This 58 year old milkman presented to the ear, nose, and throat outpatients' department complaining of slight difficulty in swallowing over the previous six weeks. He did not complain of pain on swallowing. He also mentioned incidents in which he seemed to bring up food which looked undigested. On examination you notice that this otherwise presentable man has strikingly bad breath and there is a slight swelling on the right side of the neck which seems to gurgle on palpation.
A barium swallow procedure was undertaken 10 days later which is shown here.