Clinical Presentation

A 35-year-old man presents to the gastroenterology clinic with chronic, mild midepigastric pain.

(A) Double-contrast esophagogram shows a prominent squamocolumnar mucosal junction (Z line; arrowhead) and a small submucosal mass (arrow) at this level. (B) The mass (arrow) is well circumscribed and makes obtuse angles with the esophageal wall, identifying it as submucosal.

Differential Diagnosis

• Leiomyoma: This is the most likely diagnosis for a smoothly marginated, submucosal (intramural) esophageal mass, based purely on statistical probability. The imaging findings are nonspecific.

• Neural tumor: Schwannoma, neurofibroma, or granular cell tumor may be submucosal. Neurofibromas typically occur in patients with von Recklinghausen disease.