Plummer-Vinson syndrome differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Overview

Plummer-Vinson syndrome must be differentiated from other diseases that cause dysphagia such as reflux esophagitis, esophageal carcinoma, systemic sclerosis, esophageal spasm, pseudoachalasia, stroke, esophageal candidiasis and Chagas disease.

Differential Diagnosis

Plummer-Vinson syndrome must be differentiated from other diseases that cause dysphagia such as reflux esophagitis, esophageal carcinoma, systemic sclerosis, esophageal spasm, pseudoachalasia, stroke, esophageal candidiasis and Chagas disease.

Disease	Signs & Symptoms	Findings on barium esophagogram	Findings on endoscopy	Other findings
Reflux esophagitis	Dysphagia (from peptic stricture) Heartburn Hoarseness	Poor clearance Free reflux of barium	Peptic stricture (advanced cases)	Lower esophageal pH studies will demonstrate pathologic gastroesophageal reflux A hiatus hernia may be present below the stricture Manometry shows decreased tone of lower esophageal sphincter
Esophageal carcinoma	Dysphagia (initially for solids, liquids develops with advanced disease.) Weight loss Lymphadenopathy Cachexia	Irregular stricture Pre-stricture dilatation	Endoscopy with biopsy is the most accurate test for diagnosis and tumor histology. It may be used to depict: Esophageal obstruction Staging of disease	CT scan and PET scan of the chest and abdomen is an optional test for staging of the disease
Systemic sclerosis	Dysphagia Muscle and joint pain Raynaud's phenomenon Skin changes (rash, skin thickening)	Dysmotility Patulous esophagus	Mucosal damage Peptic stricture (advanced cases)	Positive serology for Antinuclear antibodies Rheumatoid factor Creatine kinase ESR
Esophageal spasm	Chest pain (more prominent) Dysphagia (intermittent)	Nonperistaltic and nonpropulsive contractions Corkscrew or rosary bead esophagus	Inconclusive	Manometry shows high-amplitude esophageal contractions CT scan may show show hypertrophy of esophageal muscle wall
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	Endoscopy with biopsy is the most accurate test for diagnosis and tumor histology. It may be used to depict: 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 Toxic megacolon Myocarditis Blepharitis	Esophageal dilatation Stasis of barium	Dilated esophagus Thickened LES (muscular ring)	Giemsa stain will show Trypanosoma cruzi. PCR may be done to determine trypanosome subtype
Pharyngitis	Dysphagia Fever Throat pain	Normal	Inconclusive	Rapid antigen detection test positive for group A streptococccus Tonsillar hypertrophy may cause severe narrowing of the pharynx Physical exam may show: Erythema, edema and/or exudates of the pharynx Lymphadenopathy
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