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Chest pain in a patient with coronary artery disease taking clopidogrel.

Question: A 63-year-old man presented with severe chest pain and a 10-year history of diabetes mellitus. He had undergone coronary arteriography and stent placement in the left anterior descending artery 5 years previously, and had been taking clopidogrel. He had not been taking aspirin because of aspirin allergy. He had a stabbing chest pain radiating to his back that had begun 15 days earlier and had got worse the previous day. On examination, vital signs were stable. Electrocardiogram showed nonspecific ST-T wave changes, and cardiac enzymes were normal. Other laboratory tests showed a hemoglobin level of 13.7 g/dL; platelet count, 187,000/mm3; and prothrombin time (International Normalized Ratio), 0.88. Computed tomography of the chest evealed a long segmental, eccentric mass-like lesion of the upper-to-lower esophagus (Figure A [sagittal view], B [coronal view], C, , [axial view]), and esophagography showed several patches of filling defects of the esophagus owing to a kissing artifact of extrinsic ompression (Figure E). What is the diagnosis?