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Dysphagia in an Adolescent Girl

Question:
Jiaxuan Siew, Zi Xean Khoo
Department of Pediatrics, KK Women’s and Children’s Hospital, Singapore

Address for Correspondence: Jiaxuan Siew, Department of Pediatrics, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore, SG 229899. Email: siew.jia.xuan@singhealth.com.sg

A 17-year-old girl with a history of autoimmune hemolytic anemia (AIHA) presented with acute chest pain and dysphagia. There was no giddiness, syncope or effort intolerance. On examination, she was pale, mildly jaundiced and had splenomegaly. Investigations revealed anemia with reticulocytosis, unconjugated hyperbilirubinemia and positive direct Coomb's test consistent with a relapse of AIHA. Cardiac enzymes, chest X-Ray, and electrocardiogram were normal. She was started on prednisolone and her anemia improved. A barium swallow was performed when her symptoms persisted, which revealed posterior indentation of the proximal esophagus at the level of T3-4 (Figure 1A). Computed tomographic (CT) thorax is depicted in Figure 1B and 1C. Esophagogastroduodenoscopy showed mild gastritis but confirmed the area of extrinsic compression with proximal dilatation of the esophagus.
Figure 1: Arrows indicate posterior indentation of the proximal esophagus seen on barium swallow fluoroscopy (A) and CT thorax (B and C).

What is the diagnosis?