Esophageal hamartoma as an unusual cause of neonatal apnea and bradycardia

March 1, 2010     Jeffrey Coury, DO, Jonathan Steinfeld, MD, David Zwillenberg, MD, and Seth Zwillenberg, MD


Esophageal hamartoma is a rare entity, as only 7 cases have been previously reported in the English-language literature. Common symptoms include dysphagia, weight loss, and vomiting. Life-threatening airway obstruction can also occur. Because of the nonspecific nature of the symptoms, patients with these dangerous polyps are often misdiagnosed as having more common entities such as gastroesophageal reflux, peptic ulcer disease, or achalasia. Most of these tumors are missed on esophagoscopy and radiologic studies, and they can go undiagnosed for years. We diagnosed an esophageal hamartoma in an infant girl who had first presented when she was 8 days old with symptoms of apnea and cyanosis. The patient had undergone a multitude of tests since her birth, and she was eventually diagnosed with episodic bradycardia. When the patient was 6 weeks old, we discovered a polyp on nasopharyngolaryngoscopy, and we removed it by microdirect laryngoscopy and esophagoscopy. This patient was the youngest of the 8 who have now been reported to have been diagnosed with a hamartomatous polyp, and she was the only one to have presented with apnea (secondary to airway obstruction) and bradycardia. We recommend microdirect laryngoscopy and esophagoscopy to remove these pedunculated cervical esophageal lesions. A transcervical approach is warranted for sessile distal esophageal polyps. Esophageal polyps are an interesting entity in view of their rarity and intriguing presentations. Because esophageal obstructions can be life-threatening, further evaluation by laryngoscopy, bronchoscopy, and esophagoscopy is warranted when symptoms of dysphagia, vomiting, intermittent apnea, bradycardia, and weight loss persist despite conventional treatment.

An island of normal mucosa in a sea of Barrett metaplasia

February 1, 2010     David A. Knuff, MD and Albert L. Merati, MD

Eosinophilic esophagitis

December 1, 2009     Kristin Kucera Marcum, MD, Ryan T. Mott, MD, and Catherine J. Rees, MD

Partial esophageal obstruction from anterior cervical spine hardware

August 31, 2009     Carissa Portone, CCC-SLP, Justin S. Golub, BA, and Michael M. Johns III, MD

Proximal esophageal amyloidoma presenting with life-threatening dysphagia

May 31, 2009     Laura Chin-Lenn, MBBS, Caroline Ryan, MBBS, Alison Skene, MBBS, and Aliasghar A. A. Mianroodi, MD


Amyloidoses are abnormal deposits of insoluble proteins in tissues that can lead to tissue dysfunction. Although elderly patients often have amyloid deposition in the gastrointestinal tract, they are usually asymptomatic. When symptoms are present, they are most often functional in nature; rarely are they caused by a localized amyloid deposition (amyloidoma). We report the case of an elderly man who presented with severe dysphagia secondary to an upper esophageal amyloidoma. Unfortunately, the patient died of his disease before management could be instituted.

Three-dimensional computed tomography for detection and management of ingested foreign bodies

April 30, 2009     Rabia Shihada, MD, Moshe Goldsher, MD, Sliman Sbait, MD, and Michal Luntz, MD

Cervical esophagotomy for an impacted denture: A case report

March 1, 2009     Sardar Zakariya Imam, MD, Mubasher Ikram, FCPS, Saulat Fatimi, MD, and Moghira Iqbal, FCPS


We present the case of a 46-year-old woman with an impacted denture and an impending esophageal perforation. Her family physician initially missed the diagnosis but during a subsequent visit reviewed her x-ray and was able to see the shadow of the denture's wire attachment in her esophagus. The patient was then referred to a tertiary care hospital, where esophagoscopy confirmed the location of the denture, but the surgeon there was unable to remove it. Eighteen days after she had swallowed her denture, she was referred to our hospital. Attempts at removal via rigid esophagoscopy were unsuccessful, but the denture was successfully removed via a cervical esophagotomy. A Gastrograffin swallow performed 1 week postsurgically showed no extravasation of the contrast medium, and subsequent follow-ups were unremarkable. We conclude that cervical esophagotomy is a safe method for removing foreign bodies impacted in the cervical esophagus when they cannot be removed endoscopically.

Aortoesophageal fistula: A case report

February 1, 2009     David Tighe, MBChB, Andy Wood, MB, and Savita Kale, MRCS(Eng)


Patients with impacted foreign bodies in the upper aerodigestive tract present commonly to ENT clinics. This case report highlights two important issues in the management of these patients. First, if the evidence of esophageal perforation is strong and contrast swallow is negative, the physician must consider further imaging, such as contrast computed tomography. Second, ENT physicians must beware of the complications of esophageal trauma, including major vascular injury and aortoesophageal fistula, in patients with retained sharp foreign bodies in the mid-esophagus.

Acquired vascular compression of the esophagus

December 1, 2008     Adriana Hachiya, MD, Neil N. Chheda, MD, and Gregory N. Postma, MD

Giant esophageal lymphangioma

August 31, 2008     Melanie W. Seybt, MD and Gregory N. Postma, MD

Granular cell tumor of the esophagus presenting as a duplication cyst

March 1, 2008     Stacey L. Halum, MD and Charles Yates, MD

Management of hypopharyngeal and esophageal perforations in children: Three case reports and a review of the literature

January 1, 2008     Eric D. Baum, MD, Lisa M. Elden, MD, Steven D. Handler, MD, and Lawrence W. C. Tom, MD


We report 2 cases of pediatric hypopharyngeal perforation that occurred during endoscopy and 1 case of esophageal perforation that developed during nasogastric tube insertion at a tertiary care academic medical center. These cases were identified during a retrospective chart review. All 3 patients were treated with intravenous antibiotics and nasogastric tube feedings, and none experienced further sequelae. Perforations of the hypopharynx and esophagus in children during endoscopy or insertion of endotracheal and nasogastric tubes are not uncommon. Many affected children can be managed conservatively without surgical drainage, depending on the cause and specific location of the perforation and the timing of the diagnosis. We discuss the clinical criteria for various management options, and we offer an algorithm that outlines important clinical considerations in the decision-making process. Our aim in presenting these cases is to increase awareness of the management options for children with hypopharyngeal and esophageal perforations and to demonstrate the effectiveness of nonsurgical management in selected cases.

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