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A rare cause of dysphagia

Published:November 02, 2019DOI:https://doi.org/10.1016/j.ejim.2019.10.005

      Keywords

      1. Introduction

      An 80-year-old male patient, with a history of Alzheimer's disease and recurrent idiopathic angioedema, was evaluated at the emergency room for another episode of angioedema. He also mentioned slowly increasing dysphagia and cervical discomfort, which had started 3 years earlier. Physical examination showed regressing oropharyngeal angioedema and manifest hyperkyphosis. Cervical computed tomography (CT) was performed, revealing compression of the proximal esophagus (Fig. 1). Subsequent fluoroscopic evaluation confirmed extrinsic esophageal compression with reduced patency, laryngeal contrast stasis and mild tracheal aspiration.
      Fig 1
      Fig. 1Sagittal CT image, revealing a giant anterior cervical osteophyte on level C3-C4 with compression of the proximal esophagus.

      2. What is the diagnosis?

      Following identification of a large cervical osteophyte at level C3-4 and clear fluoroscopic signs of esophageal dysfunction, a diagnosis of osteophytic dysphagia was made. Although predominantly caused by direct pharyngo-esophageal compression, cervical osteophytes can induce deglutitive dysfunction in several ways, such as esophageal dysmotility, provoked by inflammation of the surrounding tissue, and epiglottis dysfunction through mechanical interference. Meanwhile, thoracic osteophytes are less likely to cause osteophytic dysphagia, as increased thoracic esophageal mobility prevents direct esophageal compression. Surgical resection will lead to immediate relief, although local regrowth has been reported in non-fused intervertebral segments [
      • Miyamoto K.
      • Sugiyama S.
      • Hosoe H.
      • Iinuma N.
      • Suzuki Y.
      • Shimizu K
      Postsurgical recurrence of osteophytes causing dysphagia in patients with diffuse idiopathic skeletal hyperostosis.
      ].
      A surgical intervention was also proposed to our patient. However, on specific request of the patient and family, surgery was deferred indefinitely, owing to the patient's limited functional and cognitive status. A conservative treatment with dietary modifications was therefore implemented. This case illustrates that osteophytic dysphagia has to be included in the differential diagnosis of dysphagia, especially in elderly patients.

      Funding

      None

      Declaration of Competing Interest

      None declared.

      References

        • Miyamoto K.
        • Sugiyama S.
        • Hosoe H.
        • Iinuma N.
        • Suzuki Y.
        • Shimizu K
        Postsurgical recurrence of osteophytes causing dysphagia in patients with diffuse idiopathic skeletal hyperostosis.
        Eur Spine J. 2009; 18: 1652-1658