Diagnosis
Esophagoscopy and laryngoscopy can give direct view of lumens. Esophageal motility study is useful in cases of esophageal achalasia and diffuse esophageal spasms. Exfoliative cytology can be performed on esophageal lavage obtained by esophagoscopy. It can detect malignant cells in early stage. Ultrasonography and CT scan are not very useful in finding causes of dysphagia, but can detect masses in mediastinum and aortic aneurysms. FEES (Fibreoptic endoscopic evaluation of swallowing), sometimes with sensory evaluation, is done usually by a Medical Speech Pathologist or Deglutologist. This procedure involves the patient eating different consistencies as above. Swallowing sounds and vibrations could be potentially used for dysphagia screening, but these approaches are in the early research stages. Differential diagnosis
All causes of dysphagia are considered as differential diagnoses. Some common ones are:
Esophageal atresia
Paterson-Kelly syndrome
Zenkers diverticulum
Esophageal varices
Benign strictures
Achalasia
Esophageal diverticula
Scleroderma
Diffuse esophageal spasm
Polymyositis
Webs and rings
Esophageal cancer
Eosinophilic esophagitis
Hiatus hernia, especially paraesophageal type
Dysphagia lusoria
Stroke
Fahrs disease
Wernicke encephalopathy
Charcot–Marie–Tooth disease
Parkinsons disease
Multiple sclerosis
Amyotrophic lateral sclerosis
Rabies
Cervical SpondylosisEsophageal dysphagia is almost always caused by disease in or adjacent to the esophagus but occasionally the lesion is in the pharynx or stomach. In many of the pathological conditions causing dysphagia, the lumen becomes progressively narrowed and indistensible. Initially, only fibrous solids cause difficulty but later the problem can extend to all solids and later even to liquids. Patients with difficulty swallowing may benefit from thickened fluids if the person is more comfortable with those liquids, although, so far, there is no scientific study that proves that those thickened liquids are beneficial.
Perforating granuloma annulare is a skin condition of unknown cause, usually appearing on the dorsal hands, presenting as papules with a central keratotic core. : 704 These lesions are often seen on the hands, arms, and ankles. Granuloma Annulare is characterized by rings of closely set, small, smooth, firm papules, usually skin colored, but they also may be slightly erythematous or have a purplish hue. Lesions vary in size from 1cm to 5cm. They are generally asymptomatic and nonpruritic (Fairlie, 2004). Reports of associations between Granuloma Annulare and diabetes mellitus, thyroid disease, malignancies, drug allergies, hypertension, arthritis, AIDS, and other conditions are being evaluated, but to date, no consistent association has been found (Rigopoulos et al., 2005). See also
Granuloma annulare
Skin lesion

References


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