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Image challenge: chronic dysphagia, wheezing and poor weight gain in a 2-year-old male patient

What caused the patient to wheeze whenever he cried or consumed solid food?

Gastroenterology image challenge: A 2-year-old boy was transferred to our hospital for a four-day history of frequent vomiting after consuming solid food. His mother reported wheeze in the patient over the past one year whenever he cried or consumed solid food. During these activities, he often experienced a transient choking episode, which caused his face to become cyanotic. Although his birth weight was normal, deceleration in weight gain was observed after age 4 months. His weight was 5.5 kg at age 4 months and 8.5 kg at age 2 years, corresponding to a standard deviation of –1.8 and –2.8, respectively, on the Japanese growth curve.

Physical examination findings were unremarkable except for the wheezing with supraclavicular and intercostal retractions. A chest radiograph revealed tracheal compression toward the right by a round gas pocket in the upper thorax (figure A).

Based on these physical and radiological findings, what is the most likely diagnosis?

To find out the diagnosis, read the full case in Gastroenterology.

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