Douglas D M, Brown J S
Department of Internal Medicine, Madigan Army Medical Center, Tacoma, Washington.
Ann Allergy. 1993 Aug;71(2):100-2.
Intermittent throat tightness with dysphagia can be a complaint with numerous potential underlying causes. It was useful to think of this patient's complaints as secondary to an allergic, neuromuscular, or mechanical/structural disorder. Dysphagia can usually be separated into two broad categories according to location: oropharyngeal or esophageal. The patient typically can help one localize the area of involvement by pointing to the area where the difficulty in swallowing is felt to be present. This patient pointed to the throat area. Helpful diagnostic studies in the evaluation of oropharyngeal dysphagia include barium swallow with cine-esophagogram, rhinopharyngoscopy, or upper gastrointestinal endoscopy. It was interesting that this patient was referred to the Allergy Service because a physician felt that intermittent laryngeal angioedema was also a possible consideration. It is known that dysphagia, hoarseness, and sensations of throat tightness or closing frequently accompany this entity. The finding of a palpable thyroid was the clue that further evaluation of this organ was also indicated. Alfonso et al have reported on tracheal or esophageal compression secondary to benign thyroid disease. In their series, goiter, though previously felt to be associated with a low incidence, was reported to have an overall high incidence. Of the several types of thyroid disease encountered, they noted thyroiditis was associated with the highest likelihood of compression and a 67% frequency of associated obstruction. Our patient's scan and uptake findings are consistent with thyroiditis although multinodular goiter may occasionally show similar results. This case reminds us that in the differential of laryngeal angioedema and complaints associated with the throat or referred in the throat area, local extrinsic compression secondary to masses should be included. In this patient, a goiter, of which the extent of gland enlargement may not be fully appreciable on physical examination, was determined to be the etiology of her complaints. She was placed on a thyroid hormone suppression treatment regimen. At a followup visit several months later, she noted marked improvement of her symptoms with resolution of her dysphagia and episodes of throat tightness.
间歇性咽喉发紧伴吞咽困难可能是由多种潜在病因引起的一种症状。将该患者的症状视为继发于过敏、神经肌肉或机械/结构紊乱是有帮助的。吞咽困难通常可根据部位分为两大类：口咽性或食管性。患者通常可以通过指出感觉吞咽困难的部位来帮助确定受累区域。该患者指向了咽喉部位。评估口咽性吞咽困难的有用诊断检查包括吞钡造影、鼻咽喉镜检查或上消化道内镜检查。有意思的是，该患者被转诊至过敏科，因为一位医生认为间歇性喉血管性水肿也是一种可能的考虑因素。众所周知，吞咽困难、声音嘶哑以及咽喉发紧或堵塞感常伴随这种情况。可触及甲状腺这一发现提示也需要对该器官进行进一步评估。阿方索等人报道过良性甲状腺疾病继发气管或食管受压的情况。在他们的系列研究中，甲状腺肿虽然之前被认为发生率较低，但据报道总体发生率较高。在遇到的几种甲状腺疾病类型中，他们指出甲状腺炎与受压的可能性最高相关，且伴有梗阻的频率为67%。我们患者的扫描和摄取结果与甲状腺炎一致，尽管多结节性甲状腺肿偶尔也可能显示类似结果。这个病例提醒我们，在鉴别喉血管性水肿以及与咽喉相关或咽喉区域转诊的症状时，应考虑肿物继发的局部外部压迫。在该患者中，经确定甲状腺肿是其症状的病因，而甲状腺肿腺体增大的程度在体格检查中可能无法完全察觉。她接受了甲状腺激素抑制治疗方案。在几个月后的随访中，她注意到症状有明显改善，吞咽困难和咽喉发紧发作消失。
