Too hard to swallow!

Introduction

An 80-year-old woman presented with a 4-month history of intermittent oropharyngeal dysphagia and aspiration, particularly after eating peas. She had no significant medical history and denied additional symptomatology. Gastroscopy revealed a smooth lesion arising in the pharynx abutting the epiglottis (figure 1) but was otherwise unremarkable. Pillow sign was negative. No neck masses were palpable on examination after endoscopy.

Question

What is the endoscopic finding and what are the differential diagnoses?

How will you manage it?

Answer

Endoscopically, there was an extrinsic posterior hypopharyngeal mass with normal mucosa. Differential diagnoses include: lymphoma, lipoma, cystic lesions, schwannoma and anterior cervical osteophyte. The patient underwent barium swallow and X-ray (figure 2), which confirmed pharyngeal compression by anterior cervical osteophytes at the level of C3-C4 with ossification of the anterior longitudinal ligament (ALL) down to C7. ALL ossification affecting ≥4 contiguous vertebrae,...

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