Document Type

Conference Proceeding

Publication Date

5-1-2026

Abstract

Introduction: Esophageal diverticula are uncommon structural abnormalities that may present with nonspecific symptoms such as dysphagia, regurgitation, and chest discomfort. It accounts for < 5% of all cases of dysphagia. In elderly patients with significant cardiac comorbidities, chest pain and dysphagia may be initially attributed to cardiovascular pathology, potentially delaying the correct diagnosis. This case highlights the importance of comprehensive history taking in identifying esophageal diverticulum as an alternative etiology of chronic symptoms. Case presentation: A 77-year-old female with a history of atrial fibrillation, unstable angina, chronic obstructive pulmonary disease, hypertension, and diastolic heart failure presented with chest pain. Given her significant cardiac history, she underwent extensive cardiac evaluation, including serial troponins, electrocardiography, echocardiography, and stress testing, all of which showed no evidence of acute ischemia. Further history revealed intermittent dysphagia to both solids and liquids for over three years, occurring approximately twice weekly. The patient described a sensation of food getting stuck in her throat, occasionally requiring expectoration. Gastroenterology was consulted, and esophagogastroduodenoscopy revealed minimal esophagitis with a distal esophageal diverticulum. The patient was managed conservatively with pantoprazole 40 mg daily, resulting in symptomatic improvement. Discussion: Esophageal diverticula are often associated with underlying esophageal motility disorders and can present with dysphagia to both solids and liquids. Symptoms may mimic or coexist with cardiopulmonary complaints, particularly in elderly patients with multiple comorbidities. While barium esophagography remains the diagnostic modality of choice, endoscopy can identify associated mucosal pathology and confirm the diagnosis. Management is individualized based on symptom severity and diverticulum size, with conservative therapy appropriate for mildly symptomatic patients. Conclusion: This case underscores the importance of considering esophageal diverticulum in the differential diagnosis of chronic dysphagia and chest discomfort, even in patients with significant cardiac disease. Careful history taking and multidisciplinary evaluation are essential to avoid misattribution of symptoms and to ensure timely diagnosis and appropriate management.

Comments

American College of Physicians Michigan Chapter and Society of Hospital Medicine Michigan Chapter 2026 Resident and Medical Student Day, May 1, 2026, Troy, MI

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