Answer for BIR CoW 10 May 2026
Cervical esophageal web
Findings
Patient clinical pictures shows Iron deficiency anemia. Findings: Thin circumferential radiolucent ring noted in cervical esophagus with proximal dilatation at the level of C5-C6. The shelf like filling defect projects into lumen causing partial narrowing is noted. The margins are smooth and well defined. Distal esophagus,GE junction,stomach shows normal flow of contrast. No evidence of irregularity/shouldering/outpouring is noted. Impression: F/S/O Cervical esophageal web likely Plummer Vinson syndrome
Discussion
Our patient had longstanding anaemia, koilonychia, glossitis and dysphagia, which recently increased in severity.
Upper GI Endoscopy confirmed the presence of web.
Plummer-Vinson Syndrome also called as Paterson-Brown-Kelly syndrome presents as a triad of dysphagia(due to oesophageal webs), glossitis and iron deficiency anaemia. These patients are at risk of developing squamous cell carcinoma of the oral cavity, hypopharynx and oesophagus. Webs are thin folds of mucosa seen along anterior wall of hypopharynx and proximal cervical esophagus. On barium swallow, they manifest as shelf-like filling defect (1--2 mm in thickness) along the anterior wall of cervical. In cases of partial obstruction, jet phenomenon can be seen. Occasionally, prominent cricopharyngeal muscle, seen as protrusion from posterior pharyngeal wall, can be confused for esophageal web.
REFERENCES
1.Debi U, Sharma M, Singh L, Sinha A. Barium esophagogram in various esophageal diseases: A pictorial essay. Indian J Radiol Imaging. 2019 Apr-Jun;29(2):141-154. doi: 10.4103/ijri.IJRI_465_18. PMID: 31367085; PMCID: PMC6639862. 2.Rubesin SE. Structural abnormalities of the pharynx. In: Gore RM, Levine MS, editors. Textbook of Gastrointestinal Radiology. 3rd ed. Philadelphia, Pa: Saunders; 2008. pp. 271–308. [Google Scholar] 4.Shauffer IA, Phillips HE, Sequeira J. The jet phenomenon a manifestation of esophageal web. AJR. 1977;129:747–8. doi: 10.2214/ajr.129.4.747. [DOI] [PubMed] [Google Scholar] 3.Taylor AI, Stewart ET, Dodds WJ. The eophageal jet phenomenon revisited. AJR. 1990;155:289–90. doi: 10.2214/ajr.155.2.2115253. [DOI] [PubMed] [Google Scholar] Chhabra P, Khurana H. Image Diagnosis: Plummer-Vinson Syndrome: An Unusual Cause of Dysphagia. Perm J. 2018;22:18-035. doi: 10.7812/TPP/18-035. PMID: 30005727; PMCID: PMC6045507.
Findings
Patient clinical pictures shows Iron deficiency anemia. Findings: Thin circumferential radiolucent ring noted in cervical esophagus with proximal dilatation at the level of C5-C6. The shelf like filling defect projects into lumen causing partial narrowing is noted. The margins are smooth and well defined. Distal esophagus,GE junction,stomach shows normal flow of contrast. No evidence of irregularity/shouldering/outpouring is noted. Impression: F/S/O Cervical esophageal web likely Plummer Vinson syndrome
Discussion
Our patient had longstanding anaemia, koilonychia, glossitis and dysphagia, which recently increased in severity.
Upper GI Endoscopy confirmed the presence of web.
Plummer-Vinson Syndrome also called as Paterson-Brown-Kelly syndrome presents as a triad of dysphagia(due to oesophageal webs), glossitis and iron deficiency anaemia. These patients are at risk of developing squamous cell carcinoma of the oral cavity, hypopharynx and oesophagus. Webs are thin folds of mucosa seen along anterior wall of hypopharynx and proximal cervical esophagus. On barium swallow, they manifest as shelf-like filling defect (1--2 mm in thickness) along the anterior wall of cervical. In cases of partial obstruction, jet phenomenon can be seen. Occasionally, prominent cricopharyngeal muscle, seen as protrusion from posterior pharyngeal wall, can be confused for esophageal web.
REFERENCES
1.Debi U, Sharma M, Singh L, Sinha A. Barium esophagogram in various esophageal diseases: A pictorial essay. Indian J Radiol Imaging. 2019 Apr-Jun;29(2):141-154. doi: 10.4103/ijri.IJRI_465_18. PMID: 31367085; PMCID: PMC6639862. 2.Rubesin SE. Structural abnormalities of the pharynx. In: Gore RM, Levine MS, editors. Textbook of Gastrointestinal Radiology. 3rd ed. Philadelphia, Pa: Saunders; 2008. pp. 271–308. [Google Scholar] 4.Shauffer IA, Phillips HE, Sequeira J. The jet phenomenon a manifestation of esophageal web. AJR. 1977;129:747–8. doi: 10.2214/ajr.129.4.747. [DOI] [PubMed] [Google Scholar] 3.Taylor AI, Stewart ET, Dodds WJ. The eophageal jet phenomenon revisited. AJR. 1990;155:289–90. doi: 10.2214/ajr.155.2.2115253. [DOI] [PubMed] [Google Scholar] Chhabra P, Khurana H. Image Diagnosis: Plummer-Vinson Syndrome: An Unusual Cause of Dysphagia. Perm J. 2018;22:18-035. doi: 10.7812/TPP/18-035. PMID: 30005727; PMCID: PMC6045507.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!