Differential Diagnosis
- Single most likely diagnosis
- Acute esophageal obstruction or dysphagia: The patient's complaint of a lump in her throat with swallowing, especially after eating, suggests an issue with the esophagus. Given her history of GERD, although she reports it as well-controlled, and the recent onset of symptoms after eating, this could be related to an esophageal spasm, stricture, or another obstructive process.
- Other Likely diagnoses
- Thyroiditis or thyroid nodules: The patient has a history of ongoing throat issues and multiple evaluations for thyroid problems. The feeling of a lump in the throat could be related to thyroid pathology, especially given her past medical history.
- Eosinophilic esophagitis: This condition is characterized by difficulty swallowing and can be associated with atopic diseases. The patient's recent onset of hives and history of taking medications like Vyvanse, which can cause or exacerbate allergic reactions, make this a plausible diagnosis.
- Pill esophagitis: Given the patient's recent course of antibiotics and steroids, pill esophagitis is a possibility, especially if the medications caused direct injury to the esophageal mucosa.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Esophageal cancer: Although less likely given the patient's age and presentation, esophageal cancer can cause dysphagia and a sensation of a lump in the throat. It's crucial to consider this diagnosis to ensure timely intervention if present.
- Angioedema: The patient's history of hives and the recent onset of throat symptoms could suggest angioedema, which can be life-threatening if not promptly treated.
- Rare diagnoses
- Foreign body obstruction: Although the patient mentions the onset of symptoms after eating pizza, a foreign body obstruction is less likely unless she has a history of dysphagia or eating quickly. However, it's a rare but possible cause of her symptoms.
- Sjögren's syndrome: This autoimmune disorder can cause dry mouth and dysphagia, among other symptoms. Given the patient's history of throat issues and recent hives, this could be a rare consideration, especially if she has other systemic symptoms.