Ivor Lewis Esophagectomy on Chest X-Ray aka Gastric Pull-up
Ivor Lewis procedure is a type of esophagectomy performed for mid or distal esophageal carcinoma.

The stomach is pulled up into the thoracic cavity and joined to the esophagus leading to this striking appearance that may remind you of Achalasia. The fundic gas shadow is thus notably absent below the left hemidiaphragm.

Often the presence of surgical clips and rib deformity offer clues when trying to distinguish it from achalasia.

Dr. Devpriyo Pal @drdevrad

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