Differential Diagnosis for Dysphagia in a 48-year-old Female Smoker
- The patient's symptoms of dysphagia for solid foods, regurgitation, and sensation of food being stuck at the suprasternal notch suggest an esophageal pathology.
Single Most Likely Diagnosis
- Esophageal Cancer: The patient's age, smoking history, and symptoms of progressive dysphagia for solids are highly suggestive of esophageal cancer. The location of the sensation of food being stuck at the suprasternal notch is also consistent with a tumor in the upper or middle esophagus.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERDES): Although the patient's symptoms are more suggestive of a mechanical obstruction, GERDES can cause dysphagia and regurgitation, especially if there is significant esophageal inflammation or stricture formation.
- Esophageal Stricture: A stricture can cause dysphagia for solids and regurgitation, and can be caused by chronic GERDES, radiation therapy, or other factors.
- Achlasa: A motility disorder of the esophagus that can cause dysphagia for both solids and liquids, although the patient's symptoms are more suggestive of a solid food dysphagia.
Do Not Miss Diagnoses
- Esophageal Perforation: Although less likely, an esophageal perforation can present with sudden onset of severe chest pain and dysphagia, and is a medical emergency that requires prompt diagnosis and treatment.
- Mediastinal Mass: A mass in the mediastinum can compress the esophagus and cause dysphagia, and can be caused by a variety of conditions including lymphoma, metastatic cancer, or a benign tumor.
Rare Diagnoses
- Eosinophilic Esophagitis: A rare condition characterized by eosinophilic infiltration of the esophagus, which can cause dysphagia and food impaction.
- Esophageal Web: A rare condition characterized by a thin, membranous structure that can cause dysphagia, often associated with iron deficiency anemia.
- Scleroderma: A rare autoimmune disorder that can cause esophageal dysmotility and dysphagia, although the patient's symptoms are not typical of this condition.