Fig. 4

a A 66-year-old male presented with chronic anemia; a contrast-enhanced CT (arterial phase with oral contrast) axial scans showing diffuse thickness of the gastro esophageal junction reaching the lower esophagus with maximum thickness about 2.5 cm. b Contrast-enhanced CT arterial phase mediastinal window axial scans show bilateral pleural effusion more at the left side with no pulmonary nodules detected. c CT abdomen sagittal scans bone window showing multiple lytic and sclerotic bony metastasis of the spine. Final diagnosis: stage T4NxM1 gastric carcinoma