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A case of cough and dysphagia

Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XB, UK

Correspondence to:
Correspondence to:
Dr Smyth;
colin.smyth@tesco.net

Submitted 23 January 2001
Accepted 15 May 2001

Keywords: malignant broncho-oesophageal fistula

A 70 year old women was referred to the accident and emergency department by her general practitioner with a three month history weight loss of two stone (13 kg) and progressive dysphagia for solids. This had worsened to the extent that over the week before presentation, she had difficulty swallowing soft food and fluids. She also reported recent onset of cough productive of purulent sputum, and cough on attempted swallowing. She had a past history of resection of aDukes's stage B colon carcinoma eight years earlier. She was a smoker of 15 cigarettes a day, and drank little alcohol. She took no regular medication.

On examination she appeared thin and dehydrated. Cardiovascular and abdominal examination was unremarkable. Chest auscultation revealed crackles at both lung bases.

Blood tests revealed a urea of 13.7 mmol/l (normal 2.5–7.0) and a neutrophilia of 9.1 x 10⁹/l (normal 2.0–7.5). Chest radiography . . . [Full text of this article]