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Case 163

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Male patient, 63 years old, seeks medical assistance due to progressive dysphagia for one year, accompanied by foreign body sensation on the cervical region, regurgitation of undigested foul-smelling food and halitosis. Also refers weight loss of 10 kg during this time. Patient with hypertension, without other comorbidities. An esophagogram with barium sulfate was done.

Based on the clinical data and the image, what is the most likely diagnosis?

a) Achalasia of the cricopharyngeal

25%

b) Esophageal Ring

25%

c) Carcinoma of the esophagus

25%

d) Zenker\'s diverticulum

25%
   

Image Analysis

Image 1: esophagogram with barium sulfate showing saccular massive accumulation of ingested contrast medium, posterior to the pharyngoesophageal region (highlighted in red).

Highlights

- Main symptoms are dysphagia, cough, halitosis and regurgitation.

- Diagnosis is done ​​by esophagogram with barium sulfate.

- Possible complications include aspiration pneumonia and ulceration or carcinoma of the Zenker Diverticulum.

- Treatment can be surgical or endoscopic.

References

- Chris J J Mulder, MD, Stijn J B van Weyenberg, MD . Zenker's diverticulum .Nicholas J Talley, MD, PhD, editor. UpToDate: 2014

- Sabiston, David C.; Townsend, Courtney M. Sabiston tratado de cirurgia: a base biológica da prática cirúrgica moderna. 18. ed. Rio de Janeiro: Elsevier, 2010. 2v.

- Ronnie Fass, MD. Mark Feldman, MD, MACP, AGAF, FACG, editor. Overview of dysphagia in adults. UpToDate: 2014 

- D’Ipolito G, Caldana RG – Gastrointestinal. Colégio Brasileiro de Radiologia. Rio de Janeiro. Ed. Elsevier, 2011.

Authors

Thais Salles Araujo, 6th year medical student at UFMG School of Medicine.

E-mail: thaissalles9[at]gmail.com

Supervisors

Marco Antônio Gonçalves Rodrigues, surgeon of the digestive system and professor of the Surgery Department of UFMG Medical School.

E-mail: magro.mg[at]terra.com.br

José Nelson Mendes Vieira, Radiologist, Professor of the Department of Anatomy and Imaging at UFMG School of Medicine.

E-mail: zenelson.vieira[at]gmail.com

Reviewers

Ana Luiza Mattos Tavares, Hércules Riani Silva, Luanna Monteiro, Janaína Chaves Lima and Viviane Parisotto.

Translated by

Barbara de Queiroz e Bragaglia, 6th year medical student at UFMG School of Medicine.

Email: barbara.bragaglia[at]gmail.com

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