Differential Diagnosis

• Single most likely diagnosis
  • Panic Disorder: The patient's episodes of choking, sweating, and a "racing" heart, accompanied by a fear of choking to death, are characteristic of panic attacks. The fact that these episodes are triggered by eating and drinking, and the patient's fear of repeat episodes, further supports this diagnosis.
• Other Likely diagnoses
  • Acute Stress Disorder: The patient's symptoms began after a stressful event (his father's incarceration), and he is experiencing anxiety and avoidance behaviors, which could be indicative of acute stress disorder.
  • Generalized Anxiety Disorder: The patient's excessive worry about choking and his avoidance of eating and drinking could be symptoms of generalized anxiety disorder.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Esophageal stricture or obstruction: Although the barium swallow showed no abnormalities, it is essential to rule out any underlying medical condition that could be causing the patient's symptoms, such as an esophageal stricture or obstruction.
  • Cardiac conditions: The patient's symptoms of a "racing" heart and sweating could be indicative of an underlying cardiac condition, such as supraventricular tachycardia or hypertrophic cardiomyopathy.
• Rare diagnoses
  • Globus pharyngis: A rare condition characterized by a persistent sensation of a lump or foreign body in the throat, which could be contributing to the patient's symptoms.
  • Eating disorder: Although the patient's weight loss and avoidance of eating and drinking could be indicative of an eating disorder, such as avoidant/restrictive food intake disorder, this diagnosis seems less likely given the patient's reported fear of choking and the absence of other typical eating disorder symptoms.