Concluded Case

Case of dysphagia

28/F, no comorbidities, under treatment for MDR-TB (Pulmonary) for last 8 months with symptomatic improvement Chief Complaints Difficulty in swallowing since 2 months, solids > liquids, without any regurgitation, without any weight loss Physical Examination Normal Investigations Barium swallow and CECT Neck attached. Management What is the diagnosis and what should be the management?

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Concluded answer

As the patient had improved with ATT (weight gain, increased appetite), MDR-TB was less likely. The CT is showing an extrinsic compression at the level of thyroid. An EGD was done which was also showing an extrinsic compression in upper esophagus. A serum PTH was done which was elevated > 5 X ULN. So, this was a parathyroid mass, most likely adenoma. Patient was referred to endocrinology for further workup and then plan surgical management.

All Answers

As the patient had improved with ATT (weight gain, increased appetite), MDR-TB was less likely. The CT is showing an extrinsic compression at the level of thyroid. An EGD was done which was also showing an extrinsic compression in upper esophagus. A serum PTH was done which was elevated > 5 X ULN. So, this was a parathyroid mass, most likely adenoma. Patient was referred to endocrinology for further workup and then plan surgical management.

CT scan showed enlarged lymph node pressing on oesophagus, that is the cause of dysphagia Barium swallow reveals narrowing of oesophagus at the site of lymph node enlargement Enlarged lymph node in a case of MDR tuberculosis may represent progression of disease in spite of treatment Excision of lymph node and sending it for tuberculosis culture and sensitivity can be planned in order to get direction for future treatment of tuberculosis

Disphagia Narrowing /Dry Esophagus /Blockage Esophagus... Chewing food thoroughly, eating smaller meals and trying food with softer textures may make it easier to swallow. Avoid caffeine, nicotine, alcohol and foods that are hard to swallow may also help. Consult with Gastroenterologist if.. Breathing trouble, Food stuck in throat, Can't swallow anything. I think better treatment and management given to the patient.

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