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Clinical Challenge
July 21, 2016

An Unusual Cause of Anemia and Positive Fecal Occult Blood Test Screening

Author Affiliations
  • 1Department of Gastroenterology, Clinical Hospital Center, Sisters of Mercy, Zagreb, Croatia
  • 2Departments of Ear, Nose, and Throat and Head & Neck Surgery, University Hospital, Sisters of Mercy, Zagreb, Croatia
  • 3Department of Radiology, Clinical Hospital Center, Sisters of Mercy, Zagreb, Croatia

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JAMA Otolaryngol Head Neck Surg. Published online July 21, 2016. doi:10.1001/jamaoto.2016.1671

A man in his 70s with long-standing diabetes, coronary artery disease, and chronic renal failure presented with edema of the right lower leg and suspected venous thrombosis (which was not confirmed by subsequent Doppler ultrasonography). Blood tests revealed serious iron deficiency anemia (hemoglobin level, 8.6 g/d [86 g/L]) and a positive result for a fecal occult blood test. His appetite was intact; he had not lost weight; and no dysphagia, stomach pain, or stool irregularity was reported. Initially, we performed an upper endoscopy that revealed normal esophageal mucosa with folding of the posterior esophageal wall through the entire length of the esophagus. Distal ending of the folding was not clearly seen in forward viewing, but in retroflexion, a necrotic polypoid lesion was observed protruding from the esophagogastric junction. A computed tomographic scan of the chest with oral contrast revealed an esophageal intraluminal tubular mass of soft-tissue density, about 15 mm in diameter originating just below the pyriform recessus and extending through the esophagus in the stomach lumen for about 20 mm (Figure 1). The patient was referred to an ear, nose, and throat specialist who performed esophagoscopy of the hypopharynx with the patient under endotracheal anesthesia.

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