An elderly male presents with history of dysphagia, regurgitation, foul breath, hoarseness and cough. Right sided lung crepts are noted on examination. The most likely diagnosis is:
(b) Zenker's diverticulum(Ref. Scott Brown, 8th ed., Vol 3; 812)The given clinical presentation, where dysphagia is mentioned along with regurgitation (hoarseness, cough, lung crepts) is consistent with an oropharyngeal cause, i.e. Zenker's diverticulum. Here the collected food in the diverticulum leads to foul breath.Schatzki ring and Corkscrew oesophagus can also lead to dysphagia but they being distal oesophageal conditions are characterised by associated symptoms like retrosternal chest pain and heart burn. In these oesophageal pathologies the chances of regurgitation are far less.Schatzki ring is a narrowing of the lower part of the esophagus that can cause intermittent dysphagia especially during hurried ingestion of solid food.Corkscrew esophagus also known as nutcracker esophagus, is a spastic motility disorder in which uncoordinated contractions of the esophagus occur because of which food cannot be effectively propelled to the stomach.Plummer-Vinson syndrome (PVS), also called Paterson-Brown-Kelly syndrome, however is a proximal oesophageal condition and presents as a triad of postcricoid dysphagia, upper esophageal web and iron deficiency anemia. Regurgitation can occur due to the proximal location of oesophageal web. However, it usually occurs in postmenopausal women.
Schatzki ring
Zenker's diverticulum
Corkscrew esophagus
Plummer-Vinson syndrome
Pharyngeal Pouch