Woman With Dysphagia

A 70-year-old woman presented to the emergency department with progressive dysphagia, postprandial vomiting, and epigastric discomfort for 2 months. She had visited an otolaryngology clinic, but no remarkable abnormality was reported. Her vital signs were stable. On examination, an immovable mass was palpable on the left upper quadrate of the abdomen. Laboratory tests revealed hypokalemia (2.41 mmol/L). Point-of-care abdominal ultrasound was performed (Figure 1, Video). Subsequent enhanced abdominal computed tomography (Figure 2) was arranged.Figure 2Enhanced computed tomography of the abdomen revealing diffused wall thickening (arrow) and enhancement of the stomach.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Gastric linitis plastica. It is a type of gastric cancer that is characterized by diffused infiltration of tumorous tissue in the submucosa and muscularis propria layers of the stomach, resulting in a markedly rigid and thickened gastric wall.1El-Nakeep S. Kasi A. Linitis Plastica. StatPearls Publishing, 2022Google Scholar,2Jafferbhoy S. Shiwani H. Rustum Q. Managing gastric linitis plastica: keep the scalpel sheathed.Sultan Qaboos Univ Med J. 2013; 13: 451-453Crossref PubMed Scopus (14) Google Scholar This condition is often asymptomatic until the disease has progressed. The most common symptoms are dyspepsia, vomiting, and dysphagia, which are associated with esophageal regurgitation due to limitations in stomach distensibility.1El-Nakeep S. Kasi A. Linitis Plastica. StatPearls Publishing, 2022Google Scholar,2Jafferbhoy S. Shiwani H. Rustum Q. Managing gastric linitis plastica: keep the scalpel sheathed.Sultan Qaboos Univ Med J. 2013; 13: 451-453Crossref PubMed Scopus (14) Google Scholar Diagnosing linitis plastica is challenging since the disease infiltrates the submucosa while sparing the mucosa, which can lead to inconclusive results from superficial biopsies taken during upper gastrointestinal endoscopy.1El-Nakeep S. Kasi A. Linitis Plastica. StatPearls Publishing, 2022Google Scholar,3Liu Y. Chen K. Yang X.J. Endoscopic ultrasound-guided fine-needle aspiration used in diagnosing gastric linitis plastica: metastatic lymph nodes can be valuable targets.J Gastroenterol Hepatol. 2019; 34: 202-206Crossref PubMed Scopus (18) Google Scholar Endoscopy ultrasound, which is an important diagnostic tool for this disease, can identify the 5-layer structure of the gastric wall and determine the thickening and infiltration of the submucosa, which help assist in more accurate biopsy analysis.3Liu Y. Chen K. Yang X.J. Endoscopic ultrasound-guided fine-needle aspiration used in diagnosing gastric linitis plastica: metastatic lymph nodes can be valuable targets.J Gastroenterol Hepatol. 2019; 34: 202-206Crossref PubMed Scopus (18) Google Scholar, 4Aujla U.I. Jabbar S. Atique M. Gastric linitis plastica and role of endoscopic ultrasound: an under-recognised diagnostic modality.J Pak Med Assoc. 2022; 72: 174-176Crossref PubMed Scopus (1) Google Scholar, 5Khara H.S. Stewart D.M. Confer B.D. et al.The role of EUS in missed and known linitis plastica.Endosc Ultrasound. 2020; 9: 202-204Crossref PubMed Scopus (3) Google Scholar However, with the improved resolution of ultrasound technology, abdominal ultrasound can clearly visualize the stratification of the gastrointestinal wall as was observed in this patient. This patient received an endoscopic biopsy and was diagnosed with poorly differentiated adenocarcinoma. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI2MTY4YzY0MGMzOGZmN2RjYmRkYzUyMzM5MjgxNTU3MyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjk2NTYwNjY4fQ.I_VzUJhtzVPArsmvdU2vL6TaazibMSJhQgWK6P1xIq1XSensyudqiOqkGFDllOP1zeh9eznj-s3eFAMlYDHviCdaulDfIbNzZ-mU4UObQP4c_dcPqrOx1bBUIv0UkRvT63ANjLVssvRY9zt1T8E7cCTLTfT0f9gzPRCeLezBzHQ4ftw6KIzCOk6AnuP2sjuwheDH26X3m2Pjc9ckqH7nWQjJDthCoVmEhpjQoohbrM12jT7fvRztqRzF03WyRc0h-KoDGeY1ZpMYqsaogYAocd9ZaPRRSBoBp_7WmyneXyDRW9Ei6FQkfDItnabmn5rMv9IV45rg-L6fc5vqZIj4RQ Download .mp4 (2.29 MB) Help with .mp4 files VideoPoint-of-care ultrasonography of the abdomen revealing the entire thickening of the gastric wall, along with varying degrees of thickening in the different layers of the gastric wall.