A 42-year-old woman presents with progressive difficulty swallowing solid food and a burning tongue. Examination shows pallor, smooth shiny tongue, and brittle spoon-shaped nails. CBC: Hb 9.1 g/dL, MCV 68 fL, ferritin 5 ng/mL. Which finding on barium swallow would confirm the underlying syndrome?

• A Bird beak deformity with dilated proximal esophagus
• B Web-like filling defect in the cervical esophagus ✓
• C Ring-like narrowing at the gastroesophageal junction
• D Diffuse tertiary contractions with corkscrew appearance

Explanation

Iron deficiency anemia with koilonychia, glossitis, and dysphagia defines Plummer Vinson (Paterson Kelly) syndrome, caused by a postcricoid esophageal web seen as a shelf-like filling defect in the cervical esophagus on barium swallow. The key fact killing the distractors: a Schatzki ring sits at the squamocolumnar junction near the GE junction, while achalasia gives a bird beak and diffuse spasm gives a corkscrew pattern. The syndrome carries an increased risk of postcricoid squamous cell carcinoma.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.