Image Diagnosis: Plummer-Vinson Syndrome: An Unusual Cause of Dysphagia

CASE PRESENTATION A 50-year-old woman was referred to our gastroenterology clinic for an upper gastrointestinal endoscopy for mechanical dysphagia. She presented with 25 years of dysphagia predominantly to solids without any significant loss of weight or appetite. On examination she had pallor and koilonychia. Blood tests revealed a hemoglobin of 7.8 gm/dL with peripheral blood film and iron studies suggestive of iron-deficiency anemia. She denied any history of blood loss. She had been dewormed with albendazole twice in the preceding 6 months. Her immunoglobulin A tissue transglutaminase serology was negative. Barium swallow revealed a short segment filling defect in the midcervical esophagus with narrowing (Figure 1) and a jet effect of the barium passing distally to the lesion (Figure 2). Upper gastrointestinal endoscopy showed a postcricoidal web with marked narrowing of the esophagus (Figure 3). A Savary-Gilliard guidewire (Cook Medical, Bloomington, IN) was passed under endoscopic vision through the esophageal narrowing, and the web was fractured using a conventional gastroscope. Successful dilatation was confirmed by the presence of blood at the site of the web and by the gastroscope passing distally to the esophageal narrowing (Figure 4). The rest of the esophagus, stomach, and duodenum appeared normal (normal fold height and number with no grooving or scalloping). No immediate or delayed complications were seen. We made the diagnosis of PlummerVinson syndrome. The patient was started on oral iron supplementation and counseled regarding the need for surveillance endoscopy. At last follow-up six months after diagnosis, she was doing well without any dysphagia.