Esophagograms of 35 patients were interpreted without knowledge of clinical history by four diagnostic radiologists. Six esophagograms were of normal esophagi, 16 were of various benign disorders, and 13 were examples of small (less than 3.5 cm) esophageal carcinomas. Overall diagnostic accuracy averaged 58%. Small esophageal carcinomas were initially diagnosed accurately in 73% of cases. Of the 27% false negative diagnoses, 6% were interpreted as normal and 21% as benign abnormalities. Esophageal lesions in the form of ulceration surrounded by a mass were most often diagnosed correctly as carcinoma. The most common error was interpretation of esophagitis, stricture, and ulcerated benign lesions as carcinoma. Esophagography was found to be a good screening procedure for detection of esophageal disease but not for accurate diagnosis of small carcinomas.