Plummer-Vinson syndrome differential diagnosis: Difference between revisions

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==Differential Diagnosis==
==Differential Diagnosis==
{| class="wikitable"
!Disease
!Signs and Symptoms
!Diagnostic test
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|Anemia of chronic disease
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|Peripheral smear:
* Normocytic and normochromic (initially)
* Microcytic, hypochromic (later in disease)
* Anisocytosis, and poikilocytosis
CBC will show:
* Low hemoglobin
* Low MCV
* Low MCHC
Increased ferritin
Normal transferrin
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{| class="wikitable"
{| class="wikitable"
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!Endoscopy
!Endoscopy
!Imaging test
!Imaging test
!
!
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|-
|Reflux esophagitis
|Reflux esophagitis
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|
* peptic stricture (advanced cases)
* peptic stricture (advanced cases)
|Barium swallow: show up strictures and hiatus hernias
|A hiatus hernia may be present below the stricture
Endoscopy: with or without a peptic 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
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|-
|Esophageal carcinoma
|Esophageal carcinoma
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* esophageal obstruction
* esophageal obstruction
* staging of disease  
* staging of disease  
|Barium swallow : esophageal constriction
|Biopsy: for definite diagnosis and tumor histology
Endoscopy:  esophageal obstruction by the tumor.
 
Biopsy: for definite diagnosis and tumor histology
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|Systemic sclerosis
|Systemic sclerosis
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ESR  
ESR  
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|-
|Esophageal spasm
|Esophageal spasm
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* nonperistaltic contractions
* nonperistaltic contractions
|Inconclusive
|Inconclusive
|Barium swallow: Inconclusive
|Manometry:  high-amplitude esophageal contractions
Endoscopy: Inconclusive
 
Manometry:  high-amplitude esophageal contractions
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|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.
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|Chagas disease
|Chagas disease
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PCR for trypanosome subtype
PCR for trypanosome subtype
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|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
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|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
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|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
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Revision as of 16:45, 3 November 2017

Plummer-Vinson syndrome Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Plummer-Vinson syndrome from other Diseases

Epidemiology and Demographics

Risk Factors

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Natural History, Complications and Prognosis

Diagnosis

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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

  • Poor clearance
  • Free reflux of barium
  • peptic stricture (advanced cases)
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

  • irregular stricture
  • pre-stricture dilatation
  • Most accurate test for diagnosis
  • esophageal obstruction
  • staging of disease
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).

  • Dysmotility
  • Patulous esophagus
Mucosal damage

Peptic stricture (advanced cases)

Serology for

Antinuclear antibodies

Rheumatoid factor

creatine kinase

ESR

Esophageal spasm Chest pain (more prominent)

Dysphagia (intermittent)

  • Corkscrew or

rosary bead esophagus

  • nonperistaltic contractions
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.

  • More marked mucosal irregularity
  • Temporary patency of LES
  • Most accurate test for diagnosis
  • esophageal obstruction
  • staging of disease
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

  • oesophageal dilatation
  • stasis of barium
  •  dilated esophagus
  • thickened LES (muscular ring)
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

  • shaggy" appearance (plaques)
  • irregular contours in the lower third
  • ulceration 
  • plaques and pseudomembranes
  • tiny nodules, polypoid folds (advanced cases)
creamy white or yellowish plaques (thrush) in oropharynx or hypopharynx; may be normal exam
Stroke progressive Dysphagia;

dysarthria;

limb weakness

Fatigue

  • pooling of contrast in the pharynx
  • aspiration of the barium contrast into the airway.
  • reduced opening of upper esophageal sphincter
  • reduced larynx elevation
paraplegia, aphasia, dysarthria, vertigo, staggering, diplopia, deafness

References