Unusual Cause of Dysphagia

A 54-year-old man was referred to our center with complaint of dysphagia since 1 year ago. Before admission to our center, esophagogastroduodenoscopy (EGD) had been done by general internist, which was reported normal. The patient had mentioned discomfort with solid and liquid diets. He suffered from cough and sometimes nausea during swallowing. Nasal regurgitation was not reported. Because of such complaints, thorough gastrointestinal and pulmonary investigations were performed and eventually he was discharged with medical treatment. The patient’s dysphagia exacerbated over the last month, so more investigations were done. No weight loss was detected. Drug history revealed consumption of amiodarone and captopril for longstanding hypertension. Medical history showed surgery of cervical vertebrae due to car accident and fixation of fracture by cervical plate 10 years earlier. After surgery, the patient had developed abscess formation, therefore another surgery for drainage of abscess collection had been done. Physical examination was otherwise normal, except the scar at the site of previous surgery. Barium swallow was ordered and the results showed soft tissue widening and dislocation of cervical plate (due to loosening of cervical plate) in prevertebral space. After ingestion of barium, leakage of contrast material from esophagus (around the device) was visible. This confirmed esophageal wall defect and probably infection in prevertebral / retroesophageal space. No evidence of obstruction along the esophagus was seen. Further investigations by cervical computed tomography (CT) with contrast and magnetic resonance imaging (MRI) did not verified abscess collection, although the other findings were compatible with the results of barium swallow. Cervical plate dislocation into prevertebral space and invasion into lumen of esophagus in the distance of 20 cm from incisors were confirmed by endoscopy. Neurosurgery consultation was done and elective surgery in cooperation with otolaryngologists was scheduled. After the surgery, the patient’s symptoms relieved. Views related to barium swallow, CT, MRI, and endoscopy are attached to this report (figures 1-4).