Differential Diagnosis for Swallowing Issues in a 42-year-old
Single most likely diagnosis
- Esophageal dysmotility or spasm: This condition is characterized by abnormal muscle contractions in the esophagus, which can cause pain and difficulty swallowing solid food. The normal CT neck suggests that there are no obvious structural abnormalities, making a functional issue like dysmotility more likely.
Other Likely diagnoses
- Gastroesophageal reflux disease (GERD): GERD can cause inflammation and irritation in the esophagus, leading to pain and difficulty swallowing. Although the CT neck is normal, GERD is a common condition that can cause these symptoms.
- Esophagitis: Inflammation of the esophagus, often caused by acid reflux or infection, can cause pain and swallowing difficulties. The normal CT neck does not rule out esophagitis, as it may not be visible on imaging.
- Eosinophilic esophagitis: A chronic immune system disease in which a type of white blood cell, the eosinophil, builds up in the esophagus in response to an allergen or irritant, leading to inflammation and swallowing difficulties.
Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Esophageal cancer: Although less common in a 42-year-old, esophageal cancer can cause pain and difficulty swallowing. A normal CT neck does not completely rule out cancer, and further evaluation with endoscopy or other tests may be necessary.
- Infectious esophagitis (e.g., due to HIV or other immunocompromised states): Certain infections can cause esophagitis, particularly in immunocompromised individuals. These infections can be serious and require prompt treatment.
Rare diagnoses
- Achalasia: A rare disorder of the esophagus that makes swallowing difficult, caused by abnormal muscle contractions and a failure of the lower esophageal sphincter to relax.
- Esophageal ring or web: A rare condition in which a ring or web of tissue forms in the esophagus, causing swallowing difficulties.
- Scleroderma: A chronic autoimmune disease that can cause esophageal dysmotility and swallowing difficulties, although it is a rare condition.