Tuberculosis Presenting as Dysphagia: Clinical,Endoscopic, Radiological and EndosonographicFeatures

Objective: Dysphagia as a presenting manifestation of tuberculosis is rare and there is paucity of data on the clinical, endoscopicand endosonographic features of these patients. We present our data related to the features over last four years.Methods: We analyzed retrospectively the clinical, endoscopic, radiological, endosonographic and cytological findings in 14 patients(male: 10; mean age: 37.7 ± 10.4 years) with dysphagia due to tuberculosis presenting to us over last 4 years.Results: Nine patients (64.3%) had Grade 1 dysphagia, 4 (28.6%) patients had Grade 2 and 1 patient (7.1%) had Grade 3. Midesophagus was the commonest site of involvement. Endoscopic findings were extrinsic bulge (50%), linear ulcers (28.6%) and polypoidalulcerated lesion (7.1%). Endoscopic biopsies were inconclusive. Endoscopic ultrasound (EUS) demonstrated mediastinallymph nodes being responsible for endoscopic bulge and their infiltration into esophageal wall leading on to ulcers. EUS-guidedfine needle aspiration from these nodes established diagnosis in all patients.Conclusion: Dysphagia in tuberculosis is most commonly caused by compression by the surrounding mediastinal lymph nodes.EUS is a useful investigation for assessment of these patients.