dysphagia – beyond malignant pathology

Introduction. Esophageal dysphagia can be caused by functional or structural abnormalities of the esophagus like esophageal strictures due to acid reflux disease, eosinophilic esophagitis, tumors and extrinsic compression, or by neuromuscular disorders like achalasia and diffuse spasm. The true prevalence of esophageal dysphagia is unknown, although epidemiological studies estimate a prevalence rate of 16% to 22% among individuals over 50 years of age. Case presentation. We present the case of a 55-year-old man, admitted to our hospital with progressive dysphagia for solids and important weight loss over the last two months. The upper endoscopy revealed an extrinsic compression of the middle esophagus. At this point, a thorax and abdomen computed tomography scan was performed, that showed a retrohilar mass of 58/44/38 mm, which compressed the right inferior lobar bronchus at the origin and the thoracic esophagus in the middle part. Endoscopic ultrasound and fine needle aspiration were performed. The anatomopathological examination of the biopsy reveals elements of chronic inflammation with neutrophils and lymphocytes, and granulomas with areas of necrosis, highly suggestive for tuberculosis. Conclusions. Dysphagia is a rare manifestation of tuberculosis, most commonly caused by an extrinsic compression mechanism due to mediastinal adenopathies. The particularity of this case is related to the contradicting imaging studies, that suggested either an esophageal or a pulmonary tumor, with mediastinal adenopathies, and the importance of endoscopic ultrasound with fine needle aspiration in determining the benign or malignant nature of injuries that are hardly accessible to non-invasive diagnostic methods.