Differential Diagnosis for 31 YOM with Throat Symptoms
The patient presents with a sensation of something stuck in the throat and intermittent swelling at the base of the neck on the left side, with no abnormal findings on ultrasound of the neck/soft tissue, including the thyroid. Here's a categorized differential diagnosis:
Single Most Likely Diagnosis
- Globus pharyngeus: This condition is characterized by a persistent sensation of having something stuck in the throat, which matches the patient's primary complaint. It's often associated with stress, anxiety, or gastroesophageal reflux disease (GERD), and the absence of structural abnormalities on ultrasound supports this diagnosis.
Other Likely Diagnoses
- Thyroglossal duct cyst: Although the ultrasound did not show any abnormalities, a thyroglossal duct cyst could cause intermittent swelling, especially if it becomes infected or inflamed. These cysts are usually midline but can be slightly off-center.
- Branchial cleft cyst: This congenital anomaly can present as a lump or swelling in the neck, typically along the anterior border of the sternocleidomastoid muscle. It might not always be visible on ultrasound, especially if it's small or not currently inflamed.
- Reactive lymphadenopathy: This condition involves the enlargement of lymph nodes, which could be due to various causes, including infection or inflammation. The swelling could be intermittent if the cause is periodic or if the lymph nodes fluctuate in size.
Do Not Miss Diagnoses
- Thyroid cancer or other thyroid malignancies: Although the ultrasound was reported as normal, it's crucial to consider the possibility of a malignancy, especially given the location of the swelling. Some thyroid cancers can be subtle on ultrasound, and clinical correlation with further diagnostic tests (like a fine-needle aspiration biopsy if a nodule is palpable) is essential.
- Carotid body tumor: This rare tumor can present as a neck mass, typically at the bifurcation of the carotid artery. It's essential to consider due to its potential impact on surrounding structures and the need for specific management.
- Lymphoma: Both Hodgkin's and non-Hodgkin's lymphoma can present with lymphadenopathy, which might be intermittent. Given the potential severity of lymphoma, it's a diagnosis that should not be missed.
Rare Diagnoses
- Eagle syndrome: This condition involves an elongated styloid process or calcified stylohyoid ligament, which can cause a sensation of a foreign body in the throat, among other symptoms. It's relatively rare and might not be immediately considered but could explain some of the patient's symptoms.
- Plunging ranula: Although more commonly associated with the floor of the mouth, a plunging ranula (a type of mucous cyst) could theoretically cause intermittent swelling in the neck if it extends into the neck tissues. However, this would be an unusual presentation.