Differential Diagnosis

The patient's symptoms of choking and difficulty swallowing (dysphagia) despite a normal EGD, along with a known thyroid nodule, suggest several potential diagnoses. These can be categorized as follows:

• Single Most Likely Diagnosis

  • Esophageal Dysmotility: This condition, which includes disorders like achalasia, diffuse esophageal spasm, and nutcracker esophagus, can cause dysphagia to both liquids and solids. The normal EGD result does not rule out dysmotility disorders since they are diagnosed through manometry or other functional tests.

• Other Likely Diagnoses

  • Thyroid Nodule Causing Compression: Although the nodule is 1.8cm, which is relatively small, its location could potentially cause compression on the esophagus, especially if it is located posteriorly or has grown significantly since last measurement. This could lead to symptoms of dysphagia.
  • Globus Pharyngeus: This condition involves the sensation of a lump in the throat and can cause difficulty swallowing. It's often associated with gastroesophageal reflux disease (GERD), but the normal EGD might not capture reflux disease if it's intermittent.
  • Pill Esophagitis: Although less likely given the normal EGD, if the patient is taking certain medications that can cause esophageal irritation (like bisphosphonates, antibiotics, or NSAIDs), this could contribute to dysphagia.

• Do Not Miss Diagnoses

  • Esophageal Cancer: Although rare and less likely given the patient's age is not specified and the normal EGD, esophageal cancer can present with dysphagia and must be considered, especially if there's a significant history of smoking or alcohol use.
  • Mediastinal Mass: A mass in the mediastinum could compress the esophagus, leading to dysphagia. This would be an important diagnosis not to miss due to its potential implications for treatment and prognosis.

• Rare Diagnoses

  • Eosinophilic Esophagitis: This condition is characterized by an eosinophilic infiltration of the esophageal mucosa and can cause dysphagia and food impaction. It's more common in patients with atopic diseases but should be considered in the differential diagnosis of dysphagia.
  • Scleroderma: Part of a larger category of systemic sclerosis, scleroderma can cause esophageal dysmotility leading to dysphagia. It's a rare condition but one that significantly impacts quality of life.
  • Zenker's Diverticulum: A rare condition where a pouch forms in the pharynx, which can lead to difficulty swallowing, regurgitation of food, and the sensation of food getting stuck.