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  #1  
Old 06-25-2011
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GIT Chest Pain and Esophageogram Case!

A 55 year-old man presents to the emergency room because of intermittent episodes of chest pain. He first began having episodes of chest pain 6 months ago that would occur spontaneously without apparent association to activity or food intake and would last for approximately 20 to 40 minutes. His current episode began 20 minutes ago as he was walking to his car, and he describes the pain as a tight band of pressure over his entire chest. It does not radiate and is not altered by position or respiration. A review of systems is positive for episodic dysphagia only to food and negative for dyspnea and weight loss. He has been previously healthy and does not take any regular medications. He does not smoke tobacco and drinks 10 g of ethanol weekly. Physical examination is unremarkable. A barium esophagram is performed, and the results are shown. What is the most likely diagnosis?

Chest Pain and Esophageogram Case!-esophagus.jpg
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Answer Choices
A. Achalasia
B. Diffuse esophageal spasm
C. Nutcracker esophagus
D. Schatzki ring
E. Zenker diverticulum
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  #2  
Old 06-25-2011
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i m with b Diffuse esophageal spasm ..
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Old 06-25-2011
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answer is A...
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Old 06-25-2011
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Default B!

B) Diffuse esophageal spasm
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Old 06-25-2011
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B) DES and the CXR finding is called Corkscrew esophagus
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Old 06-25-2011
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what difference between

Diffuse esophageal spasm
Nutcracker esophagus


they r similar in symptoms
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Old 06-26-2011
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Quote:
Originally Posted by kemoo View Post
what difference between

Diffuse esophageal spasm
Nutcracker esophagus


they r similar in symptoms
According to Kaplan qbank: Diffuse esophageal spasm has normal resting LES pressure and nutcracker esophagus has increased resting LES pressure. In NE, the mean distal esophageal peristaltic amplitude is >180 mm Hg, with elevated baseline pressure of the lower sphincter.

The main difference of Diffuse Esophageal Spasm from Nutcracker Esophagus is that the latter has an organized manner of contraction in pushing foods down to the stomach- meaning, segments of esophagus contract progressively. In DES, contractions are erratic. There are simultaneous contractions in various esophageal segments. Thus, dysphagia is more characterized and presented in DES than in NES.
http://www.esophagealspasm.org/diffu...phageal-spasm/

Diffuse esophageal spasm is a primary esophageal motor disorder in which deglutitions cause vigorous nonsequential pressure peaks, although some deglutitive responses are peristaltic and most are associated with LES relaxations. Diffuse esophageal spasm differs from, but is probably related to the so-called "nutcracker esophagus" or "supersqueezer". The nutcracker esophagus is characterized solely by an increase in duration and amplitude of esophageal contraction.
http://www.hon.ch/OESO/books/Vol_4_P...es/ART288.HTML
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Old 06-26-2011
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Thumbs Up answer is B

it's.. diffuse esophageal spasm........
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Option B (Diffuse esophageal spasm) is correct. Chest pain and dysphagia suggest a diagnosis of either diffuse esophageal spasm or nutcracker esophagus. The two are differentiated by findings on barium swallow and esophageal manometry. In diffuse esophageal spasm, there is normal pressure peristalsis combined with high-pressure nonperistaltic contractions. This produces the classic “corkscrew” appearance demonstrated on the barium swallow.

Option A (Achalasia) is incorrect. Achalasia typically produces dysphagia to solids and liquids. Barium swallow shows widening of the esophagus combined with reduced esophageal transit and a smooth tapering at the lower esophageal sphincter called the “bird's beak.” Manometry reveals increased resting lower esophageal sphincter pressure.

Option C (Nutcracker esophagus) is incorrect. A nutcracker esophagus also produces noncardiac chest pain. Peristalsis is normal but is very high pressured resulting in pain. Diagnosis is made with esophageal manometry where contractions are, on average, greater than 180 mmHg.

Option D (Schatzki ring) is incorrect. A Schatzki ring typically causes episodic dysphagia to solids and is not usually associated with chest pain. A small ring may be seen on barium swallow.

Option E (Zenker diverticulum) is incorrect. Zenker diverticulum usually presents with regurgitation of undigested food, dysphagia, and severe halitosis. Barium swallow reveals the diverticulum.
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Gastroenterology-, Internal-Medicine-, Radiographs-, Step-2-Questions

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