Differential Diagnosis for Heartburn with Dysphagia and Regurgitation and Retrocardiac Air Fluid Level
- Single Most Likely Diagnosis
- Hiatal Hernia: This condition is characterized by the protrusion of the stomach into the thorax through an esophageal hiatus, which can cause symptoms like heartburn, dysphagia, and regurgitation. The presence of a retrocardiac air fluid level on imaging is highly suggestive of a hiatal hernia, as it indicates the presence of stomach contents in the thoracic cavity.
- Other Likely Diagnoses
- Gastric Perforation: Although less likely than hiatal hernia given the specific combination of symptoms, gastric perforation can lead to free air in the thoracic cavity and could potentially cause a retrocardiac air fluid level if the perforation is contained and communicates with the esophagus or if there's associated gastroesophageal reflux.
- Esophageal Varices: While esophageal varices are more commonly associated with bleeding, large varices can cause dysphagia and regurgitation. However, they would not typically cause a retrocardiac air fluid level unless there was an associated condition like a hiatal hernia or severe reflux.
- Do Not Miss Diagnoses
- Boerhaave Syndrome: This is a severe condition involving a spontaneous rupture of the esophagus, which can present with sudden onset of chest pain, dysphagia, and potentially an air fluid level if there's communication between the esophagus and the stomach or if there's leakage into the mediastinum or pleural space. It's critical to diagnose promptly due to its high mortality rate if left untreated.
- Gastric Perforation: Included here as well because, although mentioned under other likely diagnoses, its severity and potential for rapid deterioration make it a "do not miss" diagnosis. Prompt recognition and treatment are crucial to prevent severe outcomes.
- Rare Diagnoses
- Zollinger-Ellison Syndrome: This is a rare condition characterized by excessive gastric acid production due to a gastrin-secreting tumor. While it can cause severe heartburn and regurgitation, it would not directly cause a retrocardiac air fluid level unless there was an associated condition like a hiatal hernia or severe esophagitis leading to stricture and dysphagia. It's less likely to be the primary diagnosis given the specific findings but could be a contributing factor in some cases.