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BACKGROUND
A 37-year-old male army veteran presents with a
9-month history of food sticking in his throat. He
states that he has had pain behind his sternum when he
swallows and has halitosis. The patient has more
difficulty swallowing solid food than liquids and lost
30 lb in the past year. He has no history of fevers or
chills, and he denies any trauma or nausea or vomiting.
He is currently taking a proton-pump inhibitor for
severe gastroesophageal reflux disease (GERD) that
another physician prescribed to him several months ago
when his symptoms first began; this medication offers
some symptomatic relief. He reports having at least 1
episode of pneumonia in the past.<br><br> On physical
examination, the patient appears thin but not emaciated.
He has normal vital signs, including a normal
temperature. Conjunctival pallor is observed. Findings
from the cardiac and respiratory portions of the
examination are unremarkable. He has a soft,
nondistended abdomen with normal bowel sounds. The
remainder of the examination yields unremarkable
results.<br><br> A single-contrast, barium
upper-gastrointestinal series (see Images 1-2) and
contrast-enhanced chest CT (see Image 3) are performed.
What is the diagnosis? |
Hint
This is an uncommon cause of dysphagia. |
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Author:
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Gautam Dehadrai, MD, Staff Physician, Department of Radiology, Veterans
Administration Medical Center, Albuquerque, NM |
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eMedicine Editor:
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Rick G. Kulkarni, MD, Assistant Professor, Yale School of Medicine,
Section of Emergency Medicine, Department of Surgery, Attending
Physician, Medical Director, Department of Emergency Services, Yale-New
Haven Hospital |
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