Uphill or downhill bleeding?

An 87-year-old woman presented with a 2-day history of melaena and symptomatic anaemia. Medical history included idiopathic hyperthyroidism, a gastric ulcer and diverticular disease. On arrival, vital signs were stable apart from a tachycardia (107 bpm). Her initial haemoglobin was 48 g/L and urea 32.7 mmol/L. A large anterior neck mass was observed on examination.\n\nAt endoscopy, this abnormality was identified in the upper oesophagus (figure 1). Minimal gastritis and a normal duodenum were also observed. Subsequently cross-sectional imaging of the chest abdomen and pelvis was undertaken to investigate the neck mass (figure 2).\n\n\n\nFigure 1 \nEndoscopic view of upper third of oesophagus.\n\n\n\n\n\nFigure 2 \nAxial CT image at the level of T3.\n\n\n\nWhat is the abnormality in the upper oesophagus and how should it be managed?\n\nWhat is the significance of the right sided neck mass?\n\nThe …