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A 52 year old man presented to the emergency department with a complete inability to swallow (absolute dysphagia) and pain in his throat. He described an acute onset of pain while eating “a nice piece of steak” three hours earlier. After this time he could not swallow without pain in the middle of his throat and was unable to manage fluids without regurgitation. He arrived in the emergency department carrying a bowl and was spitting out his own saliva. He reported no changes to his voice and no difficulty with breathing. He was otherwise fit and well, with no recent trauma, weight loss, or history of a similar presentation. Neck examination in the emergency department was unremarkable except that he regurgitated test drinks of water. Radiography was performed (fig 1⇓). ### 1. What radiographic view is shown? #### Short answer A lateral soft tissue radiograph of the neck. #### Long answer Figure 1 shows a lateral soft tissue radiograph of the neck. ### 2. What does the radiograph show? #### Short answer An opacity consistent with soft tissue in the upper oesophagus measuring about 2 cm in width, lying anterior to the C5-C6 vertebrae with air below. There is also mild loss of lordosis. #### Long answer Within the distal pharynx-proximal oesophagus at the level of C5-C6, there is a soft tissue opacity measuring 2 cm in width (fig 2), which may represent a wedged food bolus at about the level of the cricopharyngeus muscle. There is mild loss of lordosis (due to muscular spasm) and air below the mass in the oesophagus. No prevertebral soft tissue swelling or surgical emphysema (suggestive of perforation) is visible. Fig …