Man in his 70s with difficulty in swallowing

A man in his 70s visited an outpatient gastroenterology clinic due to difficulty in swallowing. Physical examination showed no significant abnormality of vital signs. The majority of laboratory tests were normal. The chest roentgenogram showed no cardiac dilatation. The ECG showed a slight ST-segment depression in II, III and aV F leads. Upper gastrointestinal endoscopy suggested oesophageal cancer, which could be the cause of the symptom. Initial transthoracic echocardiography as a preoperative examination for oesophageal cancer showed a membrane-like structure, separating the cardiac lumen into two compartments in the apical four-chamber view (figure 1A) and blood flow in both compartments in apical three-chamber view (figure 1B, online supplemental video 1). Significant pulmonary hypertension was not detected by echocardiography.