Differential Diagnosis for 81-year-old Female with Recurrent Choking Episodes
- Single most likely diagnosis:
- GERD (Gastroesophageal Reflux Disease): The patient's symptoms of coughing and feeling like she was choking while eating, followed by spitting out saliva/phlegm, and the initial inability to burp, are suggestive of GERD. The symptoms resolving without intervention and recurring at a similar time (during lunch) also support this diagnosis, as GERD can be exacerbated by eating.
- Other Likely diagnoses:
- Dysphagia: The patient's feeling of choking while eating could indicate difficulty swallowing, which might be due to various causes such as esophageal stricture, esophagitis, or a motility disorder.
- Esophageal spasm: This condition could cause chest pain and difficulty swallowing, but the patient denies chest pain. However, it's still a possibility given the choking sensation and initial inability to burp.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Pulmonary embolism: Although the patient denies shortness of breath and chest pain, pulmonary embolism can sometimes present atypically, especially in the elderly. The sudden onset of symptoms could be a red flag for this condition.
- Myocardial infarction: Similar to pulmonary embolism, myocardial infarction can have atypical presentations, especially in women and the elderly. The absence of chest pain does not rule out this diagnosis entirely.
- Esophageal rupture or perforation: This is a medical emergency that could present with severe chest pain and difficulty swallowing. Although the patient's symptoms seem milder, any suspicion of esophageal rupture requires immediate attention.
- Rare diagnoses:
- Achalasia: A rare motility disorder of the esophagus that can cause difficulty swallowing, regurgitation of food, and sometimes a feeling of choking.
- Eosinophilic esophagitis: An inflammatory condition of the esophagus that can cause difficulty swallowing, food impaction, and sometimes a feeling of choking, although it's more common in younger populations.
- Zenker's diverticulum: A rare condition where a pouch forms in the pharynx, which can cause difficulty swallowing, regurgitation of food, and sometimes a feeling of choking.