Symptoms Of Odynophagia Research Articles

Reconstruction of Adult Tubular Esophageal Duplication with Supraclavicular Artery Island Flap: A Rare Case Presentation.

Adult esophageal duplication (ED) is a rare congenital anomaly that is rarely encountered in clinical practice. There have been only a few reported cases of adult tubular esophageal duplication. A patient presented with symptoms of odynophagia and dysphagia. Upon examination, gastroscopy and X-ray contrast imaging revealed the formation of a fistula in the upper esophagus that connected to a sinus tract running along the esophagus. After managing the initial infection, an open surgery was performed. The esophageal tubular duplication was removed and the defect was reconstructed using a supraclavicular artery island (SAI) flap. The post-operative recovery was uneventful and the patient's odynophagia and dysphagia were relieved. In conclusion, ED can be effectively diagnosed through esophagogram and gastroscopy. Surgical excision is currently the preferred treatment option, and the use of the SAI flap technique shows great promise in reconstructing the esophageal defect after surgery.

S2416 A Case of Severe Undifferentiated Ulcerative Esophagitis as an AIDS-Defining Illness in Acute HIV Infection

Introduction: The esophagus is a common target organ in acute HIV infection (fungal or viral agents). Idiopathic esophageal ulcers are less common and we present a case of severe idiopathic ulcerative esophagitis in acute HIV infection. Case Description/Methods: 29-year-old male with no prior medical history presented with symptoms of odynophagia, dysphagia and limited oral intake for 2 weeks. Due to his symptoms, he lost 25lbs at presentation. Esophagogastroduodenoscopy (EGD) revealed long cratered ulcerations with friability to the edges in the mid and distal esophagus (Figure 1a). The mucosa between the ulcers appeared normal. Closer to the gastroesophageal junction (GEJ), there was evidence of healing ulcers without friability or cratered appearance (Figure 1b). These lesions were biopsied (edges and base). The mucosa of the proximal esophagus, stomach and duodenum appeared normal. Due to endoscopic assessment concerning for viral infection, serology (HSV, CMV and HIV) were ordered. The patient was treated with empiric Valgancyclovir for presumed CMV esophagitis. The biopsy stained positive for undifferentiated hyphae type mold elements and viral stains were negative. His viral serology were normal but HIV RNA testing was positive. With infectious disease engagement, additional tests were done to rule out any opportunistic infection and results were negative. He was started on HAART therapy. Two weeks after initiating Valgancyclovir and HAART therapy, a repeat EGD showed significant improvement in the mid and distal esophageal mucosa ulceration with only one clean base cratered ulcer noted (Fig 2a). There were new and enlarged scattered white plaques throughout the entire esophagus up to the level of the GEJ (Fig. 2b). Several biopsies obtained from the ulcer and the white plaques were consistent with candida esophagitis, see Figure 2b. He was treated with a course of fluconazole. Currently, patient is well controlled on HAART therapy with excellent immunologic and virologic response. Discussion: Idiopathic esophageal ulcers occur in about 10% of patients with acute HIV infection or AIDS. Prior reports have described giant (greater than 5cm) ulcers with profound depth usually located in the mid esophagus. The exact pathophysiology is unknown. Gastroenterologists should maintain a low index suspicion for an immunocompromised state in all patients presenting with odynophagia or dysphagia. Upon diagnosis, compliance with HAART therapy is key for treatment of HIV related esophageal ulcers.Figure 1

A RARE ASYMPTOMATIC LEFT BOCHDALEK HERNIA IN AN ADULT WITH ALLERGIC RHINOSINUSITIS: A CASE REPORT

Bochdalek hernias are extremely rare in adults with only a few cases known worldwide. This is a case of 50-year-old, male who presented at Ear, Nose and Throat clinic of our hospital with symptoms of odynophagia, sore throat, unproductive cough, sneezing, facial fullness and headache. No associated other systemic symptoms. The nasal examination revealed engorged inferior turbinates in the nose bilaterally with septal spur to the left. Chest X-ray done showed a rounded opacity of a soft tissue mass in left middle to lower zone; middle mediastinum adjacent to left lower heart border. Computerised Tomography scan showed a fairly oval hypodense non-enhancing soft mass seen in the left hemithorax with conclusion of part of omentum in the chest due to Bochdalek hernia. He was given treatment for the allergic rhinosinusitis. Due to non-availability of cardiothoracic surgeon in our hospital, the patient was counselled on the problem and danger that may arise and asked to see a cardiothoracic surgeon in the country’s capital city for possible repair of the defect.

Acute urticaria with angioedema in the setting of coronavirus disease 2019

This is the case of a 30-year-old female physician with no relevant past medical history except for pine seeds allergy, following a strict nut-free diet since she was diagnosed. Lipid transfer protein syndrome was ruled out at diagnosis. She did not have a family history of hereditary angioedema, and she was not on any medication. In March 2020, she presented with symptoms of odynophagia and dry cough, with rapid onset of fever. The day after the symptoms appeared, a PCR of upper-airway secretions (by nasopharyngeal swab) was performed, revealing severe acute respiratory syndrome coronavirus 2 infection.

428 Esophageal Food Bolus Impactions: Predictors of Persistent Impaction at Endoscopy and Strategies for Disimpaction

INTRODUCTION: Esophageal food bolus impaction is a true gastrointestinal emergency. While most cases resolve spontaneously, up to 20% require emergent upper endoscopy (EGD). No prior studies have been done in the United States to explore how patient symptoms may predict persistent obstruction at the time of endoscopy. Our aim was to determine symptoms that reliably predict complete impaction in efforts to quickly recognize those who need emergent EGD at time of presentation. METHODS: This is a retrospective cohort study of 83 patients who presented to the emergency room with suspected food bolus impaction between 1/2013 and 5/2018 at a tertiary care academic medical center. Electronic health records were reviewed to determine presenting symptoms and initial treatment course. Exclusion criteria were age < 18, history of esophageal malignancy, or presence of an esophageal stent. Descriptive statistics, univariate and multivariate analysis were performed. RESULTS: During the study period 52 of 83 (63%) patients underwent an EGD for suspected food bolus impaction. Patients who underwent EGD were more likely to have received glucagon (P = 0.004) and to have presented with sialorrhea (P = 0.001), as compared to patients who did not undergo EGD. 42 of 52 (81%) patients who underwent EGD had an overt food bolus impaction identified. Predictors of overt impaction at EGD were glucagon administration (P = 0.02), underlying esophageal pathology (P = 0.01), and sialorrhea on presentation (P = 0.01). 30 of 42 (71%) patients with overt food impaction were found to have complete obstruction. These patients were more likely to have received glucagon (P = 0.04), have an earlier EGD (P = 0.04), and have symptoms of odynophagia (P = 0.003), sialorrhea (P = 0.001), and regurgitation (P = 0.006), as compared to patients with partial obstruction. On multivariate analysis, sialorrhea (P = 0.001) and odynophagia (P = 0.023) were symptoms predictive of EGD, and only sialorrhea (P = 0.01) was predictive of persistent food impaction at EGD. CONCLUSION: Sialorrhea and glucagon administration were independently associated with the need for EGD during admission. Sialorrhea was the only symptom predictive of persistent impaction found on EGD. Sialorrhea along with odynophagia were most predictive of complete obstruction as compared to partial. These symptoms on presentation may help triage patients in need of more emergent EGD.

Paraesophageal Bronchogenic Cyst

Bronchogenic cysts are congenital abnormalities along the bronchial tree and are usually found in the mediastinum. Upper endoscopy and endoscopic ultrasound may be used to establish the diagnosis. A 52-year-old female with history of hypertension, presented with chest pain. As part of cardiac work up, a calcium scoring CT scan was done which showed an incidental mediastinal mass. Patient denied any dysphagia or odynophagia symptoms. A dedicated CT chest with contrast demonstrated a lobulated soft tissue mass within the azygoesophageal recess measuring 34 x 18 mm with the lateral aspect of the mass appearing confluent with the distal esophagus. The lateral aspect of the mass extended into the medial right lung base. The remainder of the lungs were clear with patent central airways (Figure 1). Given concern for malignancy, a PET CT was obtained and demonstrated a mediastinal soft tissue mass inseparable from the distal esophagus without significant FDG update. Further evaluation was donw by EGD and EUS. Endoscopically a mild extrinsic impression was noted in the lower third esophagus which was easily transversed. EUS revealed a 28 x 20 mm hypoechoic mass with well-defined borders in the mediastinum, at about 34cm from the incisors (Firgure 2). It was soft and compressible. FNA with a 22 G needle was performed. Histological examination showed clusters of benign bronchial epithelial cells and squamous epithelial cells in a background of abundant mucin, suggestive of a bronchogenic cyst (Figure 3). Patient underwent robotic resection of the mass, which appeared as a bluish brown cyst in the lower posterior mediastinum and was distinct from the esophagus and mediastinum, but intimately attached to the lower lobe of the right lung. Surgical pathology confirmed a benign bronchogenic cyst. Patient remained asymptomatic since resection. Bronchogenic cyst is a rare cause of a paraesophageal mass. Cross sectional imaging may be helpful in evaluation but tissue acquisition is essential for further evaluation of any malignancy and to determine appropriate surgical planning. EUS is useful modality to further characterize a cyst and FNA provided adequate tissue diagnosis in case of a paraesophageal bronchial cyst.2114_A Figure 1. A, B and C. Coronal, sagittal and cross sectional CT images of the paraesophageal bronchogenic cyst (yellow arrow)2114_C Figure 3. A and B: Fine needle aspiration showed clusters of benign bronchial epithelial cells and squamous epithelial cells in a background of abundant mucin, suggestive of a bronchogenic cyst, HE stain, 100X. C: Surgical resection showed a cyst lined by benign bland ciliated columnar epithelium with cartilage and submucosal glands in the wall, consistent with a bronchogenic cyst.2114_B Figure 2. Endosonography demonstrating a hypoechoic mass with well-defined borders arising from the mediastinum.v

Malformación arteriovenosa cerebelosa en paciente pediátrico. Presentación de autopsia


 Se presenta un paciente masculino de 6 años de edad, quien consultó por cefalea de inicio súbito posterior a un acceso de tos y asociado con síntomas comportamentales. Comentan los padres que en los dos días previos se quejó de odinofagia y tos seca ocasional, sin alteraciones al examen físico de ingreso ni antecedentes clínicos de importancia con posterior fallecimiento. A continuación se presentan los hallazgos de autopsia tanto macroscópica como microscópicamente y una breve discusión teórica del tema.

Tuberculose primária do esófago

The authors present a case of 38 year old woman with symptoms of odynophagia, retrosternal pain and weight loss. Diagnostic workup revealed the presence of an esophageal ulcer as the first manifestation of primary esophageal tuberculosis.Esophageal tuberculosis is a rare disease, estimated to account for 0,15% of deaths from tuberculosis. Moreover, primary esophageal tuberculosis without active extraesophageal tuberculosis, just like our case, is even more uncommon.Most cases of primary tuberculosis of the esophagus can be treated successfully with antituberculous chemotherapy and delay in diagnosis and in the start of treatment may cause a poor prognosis.

Esophageal candidiasis in non-immune suppressed patients in a semi-urban town, southern India.

Prevalence of Esophageal Candidiasis in non-immune compromised patients in a semi-urban town, was investigated. Further, various investigation procedures to detect the candidal pathogen were compared. A total of 933 patients with odynophagia and dysphagia were included in this study. Upper GI endoscopy was performed in all these patients and biopsy specimens were taken from the site of lesions. Oral swabs were also taken. Both these specimens were analyzed for the presence of fungal pathogen through, direct microscopic examination and culture method. Among the diagnostic techniques, culture of biopsy in Sabouraud's media was found to be the most reliable method. Of the 933 trialists, 61 were found to have lesions of varied degree of severity. Among these, 56 were positive for fungal pathogen, which was confirmed by germ tube test, cultural characteristics, auxanogram, etc., Candida albicans (87.5%) was the most predominant pathogen followed by C. tropicalis (8.9%). Men in the age group of 40 years and above were observed to have higher frequency of candidal infections compared to other groups of trialists. This investigation strongly suggests the possibilities of candidal infections in patients even in the absence of predisposing factors such as HIV infection or immune compromised conditions. Hence, patients with symptoms of odynophagia and dysphagia shall be considered for possible esophageal candidiasis.