Dysphagia due to oesophageal obstruction: A case report of unusual occupational aetiology

• The rare case of a large obstructive vertebral osteophyte in an elderly gentleman is described.
• Rarer still is the significant occupational history given, providing a strong case for aetiology.
• The importance of a thorough and systematic assessment in patients with dysphagia is emphasised.
• The importance of Barium swallow to investigate position and nature of obstruction is illustrated.

IntroductionWe report the rare case of a patient presenting with dysphagia secondary to a large vertebral osteophyte, which formed from his previous occupation.Presentation of caseA 76-year-old gentleman presented with a year-long history of dysphagia to solids, at the laryngeal level. He was otherwise well, with no red-flag symptoms. Nasoendoscopy showed a left-sided bulge obstructing the piriform fossa. Barium swallow demonstrated a large C4/C5 vertebral osteophyte. Excluding other abnormalities the patient's dysphagia was determined to be due to the osteophyte. The patient mentioned carrying large (50 kg) bags of coal for his previous occupation. This chronic trauma was concluded to be the cause for the osteophyte.DiscussionWe use this case as an opportunity to outline mechanism of swallowing, and the causes and classification of dysphagia are additionally described. We also review the literature regarding vertebral osteophytes to contextualise the rarity of this case, especially in regard to the strong occupational association.ConclusionA structured and thorough history and examination in dysphagia is emphasized. It is important to enquire about ‘red-flag’ symptoms, suggestive of head and neck or upper gastrointestinal malignancy. Barium swallow is a critical investigation in dysphagia-it can also demonstrate large bony abnormalities, which is a rare causative factor.