An unusual cause of dysphagia
A 79-year-old Indian male patient presented to a tertiary centre in Melbourne with 3 months of progressive dysphagia, which significantly worsened over the 3 weeks prior to admission. He was admitted under the upper gastrointestinal surgical unit for further evaluation and consideration of an elective Heller myotomy.

The patient presented with the primary complaint of dysphagia; unable to tolerate any solids or liquids without regurgitating it back up. The vomit contained undigested food with no apparent features of haematemesis such as coffee ground appearance. The patient did however complain of mild epigastric pain while vomiting. This dysphagia was accompanied by substantial weight loss of 5 kg over the preceding 2 weeks. He denied any associated fever, cough or other coryzal symptoms. He also denied symptoms of bowel obstruction such as new constipation or significant abdominal distension.

A CT abdomen and pelvis (CTAP) revealed a large left intrarenal multiloculated lesion of simple fluid density measuring 110×201×212 mm which appeared to be arising from the renal pelvis, was compressing and displacing the stomach and other abdominal organs. The left distal ureter was not dilated and had no evidence of calcification or mass. There was marked dilation of the oesophagus with air fluid level. It was suggested that the large cystic renal mass was most likely secondary to a chronic pelviureteric junction obstruction. Small right-sided renal cysts were also observed.

This patient presented as a diagnostic dilemma with an atypical clinical history that only became clear after further imaging. As there are no other case reports with similar presentations, this would serve as a good eye opener for other clinicians—in terms of when to consider CT abdomen and pelvis in patients presenting with vague gastrointestinal symptoms.

Source: BMJ case reports

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