Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The patient was a 65-year-old man. Preoperative computed tomography showed a ruptured thoracic aortic aneurysm that formed a submucosal hematoma in the thoracic esophagus with perforation near the esophageal-cardiac junction. A one-stage operation was performed. The aortic arch and proximal descending aorta were replaced with rifampicin-soaked synthetic grafts, followed by subtotal esophagectomy with primary reconstruction using a gastric tube. His early postoperative course was uneventful, and he started oral intake on postoperative day (POD) 15; however, dysphagia occurred on POD 20, and an esophageal fistula and mediastinitis developed more than 1 month after the operation. The patient recovered from mediastinitis after 4 months of mediastinal drainage and administration of antibiotics. Thus, a one-stage operation for esophageal perforation of a ruptured thoracic aortic aneurysm with primary esophageal reconstruction is possible in selected patients. Care must be taken to avoid postoperative compression of the reconstructed esophagus by a mediastinal hematoma.
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PMID:One-stage operation for esophageal perforation of a thoracic aortic aneurysm. 2223 40

In this article, we report a case where a videofluoroscopic swallowing study (VFSS) revealed the cause of a recently developed idiopathic dysphagia in a 66-year-old patient and enabled emergent treatment. The patient reported a 10-day history of fever, cough, sputum production, and progressive jaundice. He was then admitted to the hospital with suspicion of aspiration pneumonia. Despite treatment with antibiotics, fever and leukocytosis were persistent. As he also reported dysphagia, we performed the VFSS, which showed subglottic aspiration on all types of food and revealed a retropharyngeal mass causing mechanical compression. A contrast-enhanced computerized tomography (CT) of his neck was performed following the VFSS, which helped diagnose the mass as an extensive retropharyngeal abscess with mediastinitis. Following this diagnosis, emergent surgical incision and drainage was performed on the patient. Although the VFSS is primarily designed to evaluate swallowing function rather than to diagnose a disease, it can be used to reveal the primary medical cause of dysphagia while it studies the mechanical and structural abnormalities in the oropharyngeal and esophageal regions. This study also proposes that retropharyngeal abscess should be considered in the differential diagnosis of cases showing progressive dysphagia with fever. As confirmed through this work, the VFSS can function as a useful tool for detecting crucial diseases accompanying deglutition disorder.
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PMID:Retropharyngeal abscess initially diagnosed by the videofluoroscopic swallowing study. 2297 85

Isolated Crohn's disease of the esophagus is rare, and accurate diagnosis and treatment in its early course are difficult. Most cases are often found very late, when severe strictures or other complications have occurred. We report the case of a male 60-year-old patient with complaints of progressive dysphagia for more than two months and the sudden appearance of heartburn for seven consecutive days. Clinical examination revealed severe esophageal stricture with a suspected fistula and mediastinitis. The patient received a successful esophagectomy. The resected specimen and pathological results confirmed a deep linear ulcer, chronic and noncaseating granulomatous inflammation, as well as a circular stricture of the esophagus with fistula into the mediastinum due to isolated esophageal Crohn's disease.
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PMID:Isolated Crohn's disease of the esophagus with esophago-mediastinal fistula formation. 2303 94

Intramural esophageal dissection (IED) is a rare form of esophageal injury. We report a rare case of spontaneous IED complicated with pneumomediastinum and successfully improved by conservative management. A 46-year-old man presented to the emergency department with chest pain and hematemesis. The endoscopic diagnosis was suspicious of IED. Chest CT scan performed to rule out complication noted IED combined with pneumomediastinum. He was managed conservatively with nil per oral, intravenous antibiotics and parenteral nutrition. Follow up study after 2 weeks later showed near complete resolution of IED. IED should be included in the differential diagnosis for unexplained acute chest pain, especially, associated with dysphagia and hematemesis. IED with pneumomediastinum or mediastinitis require prompt surgery. So far, there is no case report of IED combined with pneumomediastinum which resolved without surgical treatment. In this case, IED combined with pneumomediastinum has improved by conservative management, so we present a case report.
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PMID:[A case of conservatively resolved intramural esophageal dissection combined with pneumomediastinum]. 2308 11

Propolis is a resinous substance collected by bees as a sealant for their hives. It is also used in traditional medicine as an antioxidant and antiinflammatory agent to treat ulcers, superficial burns, and microbial diseases. In this report, a 40-year-old woman who took liquid propolis for relief of her common cold experienced severe sore throat, dysphagia, and easy choking followed by fever and chills. Descending necrotizing mediastinitis and concomitant aspiration pneumonia were evident on the image studies. We performed video-assisted thoracoscopic surgery to achieve immediate and adequate drainage, and the patient resumed normal deglutition 2 months later. Early diagnosis and prompt video-assisted thoracoscopic surgery intervention are paramount to manage this life-threatening situation.
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PMID:Propolis-induced descending necrotizing mediastinitis and aspiration pneumonia. 2352 39

Acute esophageal perforations by foreign body ingestion result in complications such as mediastinitis and retropharyngeal or parapharyngeal abscesses. Because the mortality of esophageal perforation is up to 22%, immediate treatment is critical. Herein, we report a case of successful endoscopic band ligation of esophageal perforation. A 68-year-old man was admitted complaining of substernal pain and dysphagia after ingesting a fish bone. Immediately emergency endoscopy was performed, and the fish bone was observed lodged in the lower esophagus. Although the fish bone was easily removed by an endoscopic rat-tooth forceps, esophageal perforation was found after the procedure. Endoscopic band ligation for perforation was performed. Initial chest computed tomography (CT) showed pneumomediastinum and local inflammation, but follow-up CT showed improved pneumomediastinum. The patient was given oral nutrition 2 weeks after procedure, and he was discharged without any complications. This case report emphasizes for the first time the availability of immediate endoscopic band ligation for acute esophageal perforation.
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PMID:Successful endoscopic band ligation of esophageal perforation by fish bone ingestion. 2356 Jun 57

The goal of the study was to find out the risk factors for the development of mediastinitis in patients with deep neck infections (DNI) and describe the differences in symptoms and clinical image between uncomplicated DNI and infections with mediastinal spread. Our study represents the retrospective analysis of 634 patients with DNI. The file was divided into two groups. There were 619 patients (97.6%) in the first group who had an uncomplicated course of DNI without spread of infection into mediastinum (DNI group). The second group included 15 patients (2.4%) with descending mediastinitis as a complication of DNI (mediastinitis group). The most frequent comorbidities were cardiac and pulmonary diseases, which were more frequent in the mediastinitis group comparing to DNI group. Dental origin of the infection was more frequent in DNI group than in the mediastinitis group. On the other hand, tonsillar origin of the infection was more frequent in the mediastinitis group than in DNI group. In both mediastinitis and DNI groups, the typical presenting symptoms were pain, oedema and dysphagia. Furthermore, dysphagia, dyspnoea, dysphonia and restriction of neck movements were more significant in the mediastinitis group than in DNI group. The incidence of airway obstruction, sepsis, pneumonia and death was significantly higher in the mediastinitis group than in DNI group. Due to our results, the predisposing factors for mediastinal extension of DNI are cardiovascular and pulmonary diseases. Mediastinitis is associated with higher morbidity and mortality than DNI. The most common complications are airway obstruction, pneumonia and sepsis.
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PMID:Deep neck infections: risk factors for mediastinal extension. 2392 95

Esophageal pseudodiverticulosis is a rare clinical entity with a slight male predominance (1). The condition is caused by cystic dilation of the sub mucosal glands and hence is not true diverticulosis. This is usually a benign condition, affecting the distal third of esophagus. It has been associated with reflux esophagitis, strictures and candidiasis. Patients with esophageal pseudodiverticulosis may present with progressive dysphagia, though most cases are asymptomatic. Perforation (2), bleeding (3) and mediastinitis have rarely been described. To the best of our knowledge, the occurrence of this rare disease in HIV patients has been described only once before (4). We report the second case of esophageal pseudodiverticulosis occurring in a HIV patient.
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PMID:A rare cause of dysphagia in a HIV patient--esophageal pseudodiverticulosis. 2426 Oct 30

Actinomyces meyeri is a Gram-positive anaerobic forming bacterium of the genus Actinomyces, part of the oral cavity's flora, and its classification remains an unresolved issue. It is an extremely rare cause of disease, occurring in middle-aged immunocompetent patients and frequently misdiagnosed as malignancy or lung abscess. A 56-year-old man diagnosed with oesophageal squamous cell carcinoma had an endoscopically placed stent to palliate his dysphagia. Two weeks later he presented with thoracalgia and fever, interpreted as a common lung infection. Owing to lack of improvement, additional examinations were undertaken revealing mediastinum involvement. Unlike the good prognosis usually associated with this infection, the patient eventually died, reflecting the aggressive nature of his underlying condition. To our knowledge, this is the first report of mediastinitis by A. meyeri, supporting the described propensity of this agent to disseminate, particularly to the thoracic cavity, although probably in this case with an iatrogenic contribution.
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PMID:Mediastinitis by Actinomyces meyeri after oesophageal stent placement. 2490 27

Unintentional foreign bodies' swallowing is a fairly common occurrence in ENT consultation especially among children. They usually pass through the gastrointestinal tract without complications. Migration of a foreign body through the esophageal wall is rare. It represents about 1% to 4% of all cases of foreign bodies' ingestion. A 16 year's old female patient has presented to ENT emergency with a painful dysphagia following an accidental ingestion of a metallic pin. Cervical X ray confirmed the presence of the pin while endoscopic investigations have shown no foreign body. Cervical CT scan revealed the migration of the foreign body through the esophageal wall with left vertebral artery dissection. Endoscopic management has been sufficient with an uneventful post operative follow up. Esophageal foreign bodies are very diverse mainly dominated by fish bones (60%) and chicken bones (16%). Metallic pins are rare. The major risks of migration of those foreign bodies are cervical abscess, mediastinitis and oeso-vascular fistulae. Cases of self extrusion through the skin have been reported. Migration of a foreign body through the esophageal wall is rare. Endoscopic management has been sufficient.
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PMID:Vertebral artery dissection due to an esophageal foreign body migration: a case report. 2501 33


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