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DIS 5.4.0 DTD YGAST60629 proof 3 January 2017 12:59 pm ce Gastroe 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 Question: A 50year-old male patient with squamous cell carcinoma and a previous esophagogastroduodenoscopy revealing a stenotic and infiltrative lesion at 21 to 30 cm from the incisors was admitted with history of intermittent upper gastrointestinal bleeding for 84 85 86 87 88 the last 6 days, presenting as hematemesis and melena (Figure A). A computed tomography scan demonstrated a luminal narrowingof the esophagus at themiddle third,with air andfluid in the proximal esophagus,whichwasmildly dilated (FigureB). What is the diagnosis? How the patient should be managed? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. 89 90 91 92 93 94 95 Conflicts of interest The authors disclose no conflicts.