Edward LeVert, MDSeries Editor: Richard Goodgame, MD


November 05, 2002

Case Presentation

This 82-year-old woman had a 2-year history of progressive dysphagia and weight loss.

She was admitted to the cardiothoracic service for management of an 8-cm nonleaking abdominal aneurysm. The patient was a very poor historian, but reported a history of progressive dysphagia for about 2 years. Her dysphagia was related primarily to solids, but she occasionally had difficulty with pills. She pointed to her mouth and throat when describing her difficulty swallowing. There was occasional regurgitation of undigested food. She denied odynophagia or halitosis. She had lost approximately 30 lb over the last year. She has had no heartburn, abdominal pain, hematemesis, early satiety, or changes in bowel habits.

The past medical history is positive for hypertension and depression. She had a stroke 8 years ago, myocardial infarction 5 years ago, and pneumonia 9 months ago. Medications include antihypertensive agents, antidepressants, and occasional ibuprofen. She has smoked cigarettes for 60 years.

Physical examination showed normal vital signs. There was no wasting, pallor, or jaundice. The head and neck were normal. There was a pulsatile mass in the abdomen compatible with a known aneurysm. The neurologic examination, including the cranial nerves, was normal.

Routine laboratory studies were normal.