A high stricture

This patient is attending for dilatation of a high oesophageal stricture but there is a surprise. 
WHAT IS THE CAUSE OF THE STRICTURING?

■ Corrosive ingestion

Yes, a likely cause of 2 high oesophageal strictures

■ Peptic ulceration

In the high oesophagus?!?

■ Lichen planus

Possible but never seen two !

■ Eosinophilic oesophagitis

They are not short and membrane-like!

■ SCC

The mucosa is unremarkable!!!

explanation

​The 'surprise finding' is of course that there are TWO strictures some 2-3cm apart in the high oesophagus.  All of the above could be the cause, I guess. Of course, the stricture does not look malignant. Eosinophilic oesophagitis gives smoother, long tapering strictures, not short membrane-like strictures like this. Peptic ulceration would be unlikely in the high oesophagus (unless there is a long stretch of Barrett's below). Lichen planus is a possibility but the fact that there are more than one strictures, makes corrosive ingestion the most likely diagnosis.  Actually, the patient had been admitted after swallowing a lot of toilet cleaner a few months earlier. 

in the images below you can see what her oesophagus looked like after that alkaline burn.  I wonder if giving a reducing dose of steroid, like we do after large oesophageal EMR's could have prevented her stricture?