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CC BY-NC-ND 4.0 · Journal of Digestive Endoscopy 2020; 11(04): 297
DOI: 10.1055/s-0040-1722386
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Tubercular Ulcer: Not so Uncommon Cause of Odynophagia

Manoj Kohle
1   Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
,
Vikas Singla
2   Department of Gastroenterology, Sir Ganga Ram Hospital, New Delhi, India
,
Shivam Khare
1   Institute of Liver, Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, New Delhi, India
,
Nishant Wadhwa
3   Department of Paediatrics, Sir Ganga Ram Hospital, New Delhi, India
,
Pooja Bakshi
4   Department of Cytopathology, Sir Ganga Ram Hospital, New Delhi, India
,
Anil Arora
5   Department of Gastroenterology and Hepatology, Sir Gangaram Hospital, New Delhi, India
› Author Affiliations
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    These images are from a 13-year-old girl, who presented with odynophagia. Upper gastrointestinal (GI) endoscopy revealed longitudinal ulcer in the mid esophagus ([Fig. 1]). CT chest [Fig. 2] and endoscopic ultrasound (EUS) ([Fig. 3]) showed a node in the left paratracheal region. Cytology examination showed necrotic granulomas ([Fig. 4]), and stain for acid-fast bacillus (AFB) was positive. Midesophageal ulcers have varied etiology such as viral diseases, pill esophagitis, corrosive injury, submucosal lesions, or malignancy. In endemic places, tuberculosis should be considered as differential diagnosis. Subepithelial bulge with ulcer (summit ulcer) has been explained in tuberculosis.

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    Fig. 1 Longitudinal ulcer in the esophagus over the underlying bulge.
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    Fig. 2 CT image of the chest showing enlarged node in left lower paratracheal region.
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    Fig. 3 Endoscopic ultrasound examination from mid esophagus showing homogeneous hypoechoic node in left lower paratracheal region.
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    Fig. 4 Cytology examination of the EUS FNA sample showing epithelioid granuloma, MGG stain, 20X.

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    Address for correspondence

    Vikas Singla, DM
    Department of Gastroenterology, Sir Ganga Ram Hospital
    New Delhi
    India   

    Publication History

    Article published online:
    31 December 2020

    © 2020. Society of Gastrointestinal Endoscopy of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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       Permissions and Reprints
    Zoom Image
    Fig. 1 Longitudinal ulcer in the esophagus over the underlying bulge.
    Zoom Image
    Fig. 2 CT image of the chest showing enlarged node in left lower paratracheal region.
    Zoom Image
    Fig. 3 Endoscopic ultrasound examination from mid esophagus showing homogeneous hypoechoic node in left lower paratracheal region.
    Zoom Image
    Fig. 4 Cytology examination of the EUS FNA sample showing epithelioid granuloma, MGG stain, 20X.