A 61-year-old woman sought medical attention after experiencing throat irritation,
chest pain, and difficulty swallowing for 1 week. Chest computed tomography (CT) showed
diffuse wall thickening in the upper and middle esophagus, as well as an esophageal
stricture ([Fig. 1]), suggestive of esophageal carcinoma. An esophagogastroduodenoscopy (EGD) was performed.
Before the endoscopy, a slightly tender swelling was observed on the right side of
the neck. The endoscopy revealed swelling in the left side of the pharynx ([Fig. 2 a]) and at the entrance to the esophagus ([Fig. 2 b]), and a stenosis was also apparent; however, the lumen and mucosa exhibited normal
elasticity and the lumen distended normally after air inflation. Some regions of the
esophageal mucosa appeared purplish-blue ([Fig. 2 c]), although the mucosal surface was smooth with no abnormalities.
Fig. 1 Computed tomography (CT) scan showing diffuse wall thickening in the upper and middle
esophagus.
Fig. 2 Endoscopic views showing: a swelling of the left side of the pharynx; b the entrance to the esophagus; c the esophageal mucosa, which in places appeared purplish-blue.
The patient was given a semi-liquid diet and mucosa-protecting treatments, including
esomeprazole, magnesium hydroxide, enteric-coated tablets, and Talcid. Her symptoms,
including the difficulty swallowing and chest pain, gradually improved. A repeat upper
gastrointestinal endoscopy performed 6 weeks later showed that the pharyngeal swelling
had disappeared ([Fig. 3]), the esophageal mucosa had become pink, and there were no unstained areas observed
after dyeing with Lugol dye. An endoscopic ultrasound (EUS) clearly showed the esophageal
mucosal layer, within which no abnormal thickening or other abnormalities were observed
([Fig. 4]).
Fig. 3 Repeat endoscopy 6 weeks later showing that the pharyngeal swelling had disappeared.
Fig. 4 Endoscopic ultrasound (EUS) showing a normal appearance of the esophageal mucosal
layer.
The patient’s medical history indicated that she had ingested chicken bone soup containing
very small but sharp bones 2 days before her symptoms appeared. She had immediately
experienced throat discomfort but had ignored this. Damage to the pharynx and esophagus
by foreign bodies usually manifests as a mucosal injury; however, this patient exhibited
mainly pharyngeal submucosal swelling, diffuse esophageal submucosal edema, and submucosal
congestion. We believe this is because the tiny scars in the mucosa damaged by the
small sharp bones had healed up by the time of endoscopy, so that no damage was found
on the mucosal surface although there were still submucosal hematomas. Therefore,
in addition to endoscopic diagnosis, evaluation of the medical history and follow-up
observations were required in order to distinguish between melanoma of the esophagus
and diffuse esophageal spasm.
Endoscopy_UCTN_Code_CCL_1AB_2AC
