Plummer-Vinson syndrome differential diagnosis: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{| class="wikitable" | {| class="wikitable" | ||
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!Endoscopy | !Endoscopy | ||
!Imaging test | !Imaging test | ||
|- | |- | ||
|Reflux esophagitis | |Reflux esophagitis | ||
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| | | | ||
* peptic stricture (advanced cases) | * peptic stricture (advanced cases) | ||
| | |A hiatus hernia may be present below the stricture | ||
A hiatus hernia may be present below the stricture | |||
Lower esophageal pH studies will demonstrate pathologic gastroesophageal reflux | Lower esophageal pH studies will demonstrate pathologic gastroesophageal reflux | ||
|- | |- | ||
|Esophageal carcinoma | |Esophageal carcinoma | ||
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* esophageal obstruction | * esophageal obstruction | ||
* staging of disease | * staging of disease | ||
| | |Biopsy: for definite diagnosis and tumor histology | ||
Biopsy: for definite diagnosis and tumor histology | |||
|- | |- | ||
|Systemic sclerosis | |Systemic sclerosis | ||
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ESR | ESR | ||
|- | |- | ||
|Esophageal spasm | |Esophageal spasm | ||
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* nonperistaltic contractions | * nonperistaltic contractions | ||
|Inconclusive | |Inconclusive | ||
| | |Manometry: high-amplitude esophageal contractions | ||
Manometry: high-amplitude esophageal contractions | |||
|- | |- | ||
|Pseudoachalasia | |Pseudoachalasia | ||
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Findings at endoscopy, barium swallow, and manometry may be indistinguishable from achalasia. | Findings at endoscopy, barium swallow, and manometry may be indistinguishable from achalasia. | ||
|- | |- | ||
|Chagas disease | |Chagas disease | ||
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PCR for trypanosome subtype | PCR for trypanosome subtype | ||
|- | |- | ||
|Pharyngitis | |Pharyngitis | ||
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|Inconclusive | |Inconclusive | ||
|erythema, edema and/or exudates of the pharynx; tonsillar hypertrophy may cause severe narrowing of the pharynx; lymphadenopathy of the neck is often present | |erythema, edema and/or exudates of the pharynx; tonsillar hypertrophy may cause severe narrowing of the pharynx; lymphadenopathy of the neck is often present | ||
|- | |- | ||
|Esophageal candidiasis | |Esophageal candidiasis | ||
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* tiny nodules, polypoid folds (advanced cases) | * tiny nodules, polypoid folds (advanced cases) | ||
|creamy white or yellowish plaques (thrush) in oropharynx or hypopharynx; may be normal exam | |creamy white or yellowish plaques (thrush) in oropharynx or hypopharynx; may be normal exam | ||
|- | |- | ||
|Stroke | |Stroke | ||
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* reduced larynx elevation | * reduced larynx elevation | ||
|paraplegia, aphasia, dysarthria, vertigo, staggering, diplopia, deafness | |paraplegia, aphasia, dysarthria, vertigo, staggering, diplopia, deafness | ||
|} | |} | ||
Revision as of 16:45, 3 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
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Overview
Differential Diagnosis
Disease | Signs & Symptoms | Findings on barium swallow | Endoscopy | Imaging test |
---|---|---|---|---|
Reflux esophagitis | Dysphagia (from peptic stricture)
Heartburn Hoarseness |
|
|
A hiatus hernia may be present below the stricture
Lower esophageal pH studies will demonstrate pathologic gastroesophageal reflux |
Esophageal carcinoma | Dysphagia (initially for solids, liquids develops with advanced disease.)
Weight loss Lymphadenopathy Appetite changes Cachexia |
|
|
Biopsy: for definite diagnosis and tumor histology |
Systemic sclerosis | Dysphagia
Muscle and joint pain Raynaud's phenomenon skin changes (e.g., rash, skin swelling or thickening). |
|
Mucosal damage
Peptic stricture (advanced cases) |
Serology for
Antinuclear antibodies Rheumatoid factor creatine kinase ESR |
Esophageal spasm | Chest pain (more prominent)
Dysphagia (intermittent) |
rosary bead esophagus
|
Inconclusive | Manometry: high-amplitude esophageal contractions |
Pseudoachalasia | Dysphagia
Weight loss Lymphadenopathy Appetite changes Cachexia Older patients Underlying malignancy that mimics idiopathic achalasia. Patients tend to be older, duration of symptoms shorter, and weight loss greater and more rapid. |
|
|
Gastroscopic biopsy of gastroesophageal junction and cardia may demonstrate malignancy.
Findings at endoscopy, barium swallow, and manometry may be indistinguishable from achalasia. |
Chagas disease | Dysphagia
myocarditis Blepharitis Toxic megacolon |
|
|
Giemsa stain: Trypanosoma cruzi.
PCR for trypanosome subtype |
Pharyngitis | Dysphagia
Fever Throat pain |
Normal | Inconclusive | erythema, edema and/or exudates of the pharynx; tonsillar hypertrophy may cause severe narrowing of the pharynx; lymphadenopathy of the neck is often present |
Esophageal candidiasis | Dysphagia
Immunocompromised History of corticosteroid |
|
|
creamy white or yellowish plaques (thrush) in oropharynx or hypopharynx; may be normal exam |
Stroke | progressive Dysphagia;
dysarthria; limb weakness Fatigue |
|
|
paraplegia, aphasia, dysarthria, vertigo, staggering, diplopia, deafness |