A Rare Cause of Esophageal Stenosis in an Infant Bart G. P. Koot, 1 Wendela G. Leeuwenburgh-Pronk, 2 and John Vlot 3 1 Department of Pediatric Gastroenterology and Nutrition, 2 Department of Pediatrics, Emma Children’s Hospital/Academic Medical Center, and 3 Department of Pediatric Surgery, Sophia Children’s Hospital/Erasmus Medical Center, Rotterdam, the Netherlands Question: A boy, 5 months of age, presented with pro- gressive refusal to drink, regurgitation, and sporadic vomiting since 1 month. He was fed mostly by naso- gastric tube feeding to guarantee adequate intake. Solid food had not yet been introduced. The boy had a history of a very large congenital cystic lymphatic malfor- mation on his left thorax, shoulder, and upper arm (9 Â 8 Â 8 cm) with sec- ondary hypoplasia of left thorax and left lung owing to compression by the lymphatic malformation in utero. After several debulking surgeries and sclerotherapy sessions, a limited reduction in size of the malformation was achieved. No cause for the lymphatic malformation was identified. The suspicion of an esophageal stenosis as the cause of the feeding difficulties and vomiting in the boy was confirmed by a contrast-enhanced study of the esophagus using liquid contrast (Figure A) showing a long stenosis in the distal esophagus (white arrow) with prestenotic dilatation. Subsequently a computed tomography scan of the thorax and abdomen was performed (Figure B), showing a large structure (black star) in the left upper abdomen displacing the caval vein (large black arrow) and encasing the nasogastric tube (small black arrow). What is the cause of the esophageal stenosis? Look on page 272 for the answer and see the Gastroenterology website (www.gastrojournal.org) for more in- formation on submitting your favorite image to Clinical Challenges and Images in GI. Conflicts of interest The authors disclose no conflicts. © 2018 by the AGA Institute 0016-5085/$36.00 https://doi.org/10.1053/j.gastro.2018.01.046 CLINICAL CHALLENGES AND IMAGES IN GI Gastroenterology 2018;155:271–272