dysphagia to liquid and solid

A 48 y/o male presented with dysphagia to liquid and solid for 4 weeks. Pain is more on lying down. The patient looks weak, pale, and ill. He has a smoking history of 20 pack years. No past medical or surgical history. He complained of a hoarse voice. Pharynx and tonsil & epiglottis inflamed. Pulse, BP WNL. What investigations should be ordered? Please give your opinion.


Recent onset progressive dysphagia to both solid and liquid with loss of general well being with h/o tobacco use: first differential should be an esophageal carcinoma. Hoarseness of voice may be due to RLN involvement. Also rule out a immunodeficiency state with opportunistic infection of esophagus like CMV, HSV, candida. Do a barium swallow followed by Endoscopy with biopsy and sos CECT Thorax+ abdomen

A CECT of neck focusing on larynxand pharynx is the most important imaging technique to allow early diagnosis of larynx or pharynx . An upper G.I endoscopy should be followed to rule out esophageal malignancy and biopsy to be taken if present. Once - a clue to diagnosis is there - further investigations like MRI or PET scan maybe needed

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