Choking with Eating

An 83-year-old man with a history of chronic obstructive pulmonary disease, congestive heart failure, and hypertension presents with a 6-week history of choking while eating. He reports difficulty swallowing both solids and liquids. The patient mentions that he has a chronic productive cough, but he is unsure if it contributes to his difficulty with swallowing. He denies having experienced any fever, chills, sore throat, pleuritic chest pain, or acute worsening of his baseline dyspnea.

On physical examination, the patient appears well and in no general distress. His blood pressure is noted as 135/89 mm Hg, with a heart rate of 65 beats/min. His oral temperature is 98.6°F and his oxygen saturation while breathing room air is 94% (baseline, given his pulmonary condition). He has normal breath sounds, his cardiac examination is normal, and he has normal bowel sounds in the setting of a soft, nontender abdomen.

A barium swallow study is performed (see Images 1-2) on suspicion of an esophageal pathology for his condition.

What is the diagnosis?

What is the diagnosis?
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The barium collection in the esophagus resembles a common kitchen tool.