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A 37-Year-Old Man with Dysphagia for Solids

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BACKGROUND
A 37-year-old man 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 he has lost 30 lb in the past year. He has no history of fevers or chills, and he denies any trauma, 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.

On physical examination, the patient appears thin but not emaciated. His vital signs, including temperature, are normal. A conjunctival pallor is noted. 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.

A single-contrast, barium upper-gastrointestinal radiograph series (see Images 1-2) and a contrast-enhanced computed tomography (CT) scan of the chest (see Image 3) are performed.

What is the diagnosis?
CASE DIAGNOSIS
HINT
This is an uncommon cause of dysphagia.
Author:
Gautam Dehadrai, MD,
Staff Physician,
Department of Radiology,
Veterans Administration Medical Center,
Albuquerque, NM

eMedicine Editor:
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, Conn
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