Endoscopy shows Barrett esophagus in the distal esophagus with an infiltrating adenocarcinoma causing a malignant stenosis at the esophagogastric junction. With gentle pressure the mechanical radial ultrasound endoscope is able to traverse the lesion. A 5 mm rounded lymph node is seen first in the gastrohepatic ligament. The tumor is seen to involve the full thickness of the esophageal wall and extend into the surrounding fat (T3). An additional lymph node is seen in the mediastinum just above the tumor at the level of the left atrium and descending aorta (N1).