Differential Diagnosis for Acute Onset of Difficulty Swallowing

The differential diagnosis for acute onset of difficulty swallowing can be categorized into several groups based on likelihood and potential impact.

• Single Most Likely Diagnosis
  • Acute esophageal food impaction: This is often the most common cause of sudden difficulty swallowing, especially if the patient has a history of eating certain types of food like meat. It's a mechanical obstruction that can occur suddenly.
• Other Likely Diagnoses
  • Stroke or cerebral vasculature accident (CVA): A stroke can affect the brain's ability to coordinate swallowing, leading to dysphagia. The onset is typically sudden.
  • Acute esophagitis: Inflammation of the esophagus, often due to gastroesophageal reflux disease (GERD), infections, or chemical injury, can cause pain and difficulty swallowing.
  • Pneumonia or other respiratory infections: While not directly causing dysphagia, severe respiratory infections can lead to discomfort or pain that exacerbates or mimics swallowing difficulties.
• Do Not Miss Diagnoses
  • Esophageal perforation: A hole in the esophagus, which can be caused by severe vomiting, instrumentations, or diseases like cancer. It's a medical emergency.
  • Myocardial infarction (MI): Sometimes, chest pain associated with a heart attack can be mistaken for or accompanied by difficulty swallowing.
  • Epiglottitis: Inflammation of the epiglottis, which can be life-threatening if not promptly treated, as it can lead to airway obstruction.
• Rare Diagnoses
  • Esophageal spasm: Abnormal muscle contractions of the esophagus, which can cause chest pain and difficulty swallowing.
  • Achalasia: A rare disorder of the esophagus that makes swallowing difficult, caused by degeneration of the myenteric plexus.
  • Oropharyngeal or esophageal tumors: Although less common as an acute presentation, tumors in the throat or esophagus can cause difficulty swallowing.
  • Neurological disorders (e.g., Parkinson's disease, multiple sclerosis): While these conditions typically have a more gradual onset, in some cases, they can present with or worsen to include significant swallowing difficulties over a short period.

Each of these diagnoses has a different approach to management and treatment, emphasizing the importance of a thorough diagnostic evaluation to determine the underlying cause of acute difficulty swallowing.