Differential Diagnosis
- Single most likely diagnosis
- Postnasal drip or gastroesophageal reflux disease (GERD): The patient's symptoms of dysphasia, choking when coughing, and inability to lay flat could be related to postnasal drip or GERD, which can cause irritation and inflammation in the throat, leading to these symptoms. The recent sinus-like infection could have contributed to the development of postnasal drip.
- Other Likely diagnoses
- Laryngopharyngeal reflux (LPR): Similar to GERD, LPR can cause symptoms such as dysphasia, coughing, and throat irritation. The fact that laryngoscopy didn't show much doesn't rule out LPR, as the symptoms can be intermittent.
- Allergic rhinitis: The patient's recent sinus-like infection could be related to allergic rhinitis, which can cause postnasal drip, coughing, and throat irritation.
- Vasovagal syncope or cough syncope: The patient's symptoms of choking and coughing could be related to a vasovagal response, which can cause syncope or near-syncope.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Epiglottitis: Although the CT head and neck was relatively unremarkable, epiglottitis is a life-threatening condition that requires prompt diagnosis and treatment. The patient's symptoms of dysphasia and choking could be related to epiglottitis.
- Lung cancer or other malignancies: Although the CT head and neck was unremarkable, it's essential to consider the possibility of lung cancer or other malignancies, especially if the patient has a history of smoking or other risk factors.
- Pulmonary embolism: The patient's symptoms of coughing and dysphasia could be related to a pulmonary embolism, which is a life-threatening condition that requires prompt diagnosis and treatment.
- Rare diagnoses
- Eosinophilic esophagitis: This rare condition can cause symptoms such as dysphasia and choking, especially in patients with a history of allergies or asthma.
- Zenker's diverticulum: This rare condition can cause symptoms such as dysphasia and choking, especially in older adults.
- Laryngeal cleft: This rare congenital condition can cause symptoms such as dysphasia and choking, especially in patients with a history of recurrent respiratory infections.