Differential Diagnosis for a 21-year-old Female with a Persistent Sensation of Food Being Stuck in the Throat

• Single most likely diagnosis:
  • Esophageal food impaction: This is the most likely diagnosis given the patient's history of choking on a burger and the persistent sensation of food being stuck in the throat. The inability to swallow saliva and the need to spit frequently support this diagnosis, as they indicate a mechanical obstruction.
• Other Likely diagnoses:
  • Esophagitis: Inflammation of the esophagus could cause difficulty swallowing and a sensation of something being stuck, although it might not fully explain the acute onset after eating.
  • Anxiety-related globus sensation: While the patient's anxiety has been partially managed, a globus sensation (feeling of a lump in the throat) could be exacerbated by or contribute to the perception of food being stuck, especially if there's an underlying anxiety disorder.
  • Dysphagia due to other causes (e.g., muscular or neurological issues): Conditions affecting the coordination of swallowing could lead to a sensation of food being stuck, though these would typically have a more gradual onset.
• Do Not Miss diagnoses:
  • Esophageal perforation: Although less likely given the patient's ability to breathe without difficulty, an esophageal perforation is a medical emergency that could occur if the food impaction causes a tear in the esophagus. Prompt diagnosis and treatment are crucial.
  • Foreign body aspiration: Even though the patient denies difficulty breathing, it's essential to consider the possibility that the food bolus or a part of it might have been aspirated, potentially leading to respiratory complications.
• Rare diagnoses:
  • Eosinophilic esophagitis: An inflammatory condition of the esophagus that could cause difficulty swallowing and a sensation of food being stuck, though it's less common and typically associated with atopic diseases or food allergies.
  • Esophageal stricture or ring: A pre-existing narrowing of the esophagus could cause food to get stuck, but this would likely have caused symptoms prior to this incident.
  • Zenker's diverticulum: A condition where a pouch forms in the pharynx, potentially causing difficulty swallowing and a sensation of food being stuck, though it's more common in older adults.