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A 29−year−old man presented with a 3− month history of dysphagia and chest pain. Esophagogastroduodenoscopy showed a narrowed mid−esophagus with smooth mucosa (Figure 1). Endoscopic ul− trasound (EUS) was performed, which showed loss of echo layers, esophageal wall thickening (Figure 2), and enlarged mediastinal lymph nodes (Figure 3). EUS− guided fine−needle aspiration (FNA) of these lymph nodes was not performed at this stage because the patient was agitat− ed. Endoscopic biopsies from the mid− esophagus showed eosinophilic esopha− gitis with > 15 eosinophils per high−pow− er field. He was treated with Advair (fluti− casone/salmeterol) for 1 month by his physician and the dysphagia resolved.

Endoscopic ultrasound-guided fine-needle aspiration of enlarged mediastinal lymph nodes in eosinophilic esophagitis