Case 4: Chronic Dysphagia and Weight Loss in a 3-year-old Boy

Sarah Mancone; Neelima Tummala; Thomas Pranikoff; Drew P. Plonk

doi:10.1542/pir.2017-0335

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Download PDF

Sarah Mancone, MD*
Neelima Tummala, MD*
Thomas Pranikoff, MD^†
Drew P. Plonk, MD*

^*Department of Otolaryngology and
^†Department of Pediatric Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC

AUTHOR DISCLOSURE
Drs Mancone, Tummala, Pranikoff, and Plonk have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Dr Mancone’s current affiliation is Department of Internal Medicine, Yale-New Haven Hospital, New Haven, CT.

Presentation

A 3-year-old boy presents to the emergency department with a 1-year history of dysphagia. Per his father, the boy has developed “strange eating habits” where he will place both juice and food into his mouth, swallow the liquid component, and spit out the solid components. Other associated symptoms include spitting up of saliva and progressive weight loss. There is no known history of throat pain, breathing problems, choking episodes, or witnessed foreign body ingestion. The boy has been previously seen by multiple pediatric providers, who attributed his spitting up, decreased oral intake, and weight loss to severe reflux, leading to repeated trials of antacid therapy without improvement in symptoms. Physical examination findings are normal except for the patient appearing malnourished and small for his age.

Discussion

Differential Diagnosis

The differential diagnosis of a child presenting with gastrointestinal (GI) complaints such as dysphagia, recurrent emesis or spitting up, and weight loss is broad and includes gastroesophageal reflux disease, mechanical obstruction, migraine headaches, and food allergy, among other etiologies. A cause more commonly encountered in the acute setting but possible in the chronic setting is esophageal foreign body (EFB).

Actual Diagnosis

For this patient, the decision was made to proceed with an upper GI radiologic study, and a scout film revealed the presence of a radiopaque EFB that had the typical, circular shape of a coin but an unusual moth-eaten appearance (Fig 1). With this finding, a diagnosis of a chronic EFB after unwitnessed foreign body ingestion was made.

Figure 1.

Scout film demonstrating a foreign body in the esophagus.