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A 58-year-old male patient with a history of Parkinson's disease and solitary cervical spinal sarcoma underwent corpectomy, a fusion of C3-C6 with cervical fixation plate placement, and stereotactic body radiation therapy, presented 18 months following surgery with dysphagia, concomitant with weakness, diplopia. The initial workup in cervical magnetic resonance imaging (MRI) revealed aerodigestive tract soft tissue enhancement. Dysphagia progressed during hospitalization, and the patient was intubated due to aspiration pneumonia and respiratory failure. Further evaluations with esophagogastroduodenoscopy (EGD) revealed posterior pharyngeal wall, upper cervical esophageal erosion, and the presence of a cervical fixation plate in the hypopharynx.

Introduction:The incidence of esophageal perforation following anterior cervical spine surgery is reported to be between 0.02% and 1.49% with mortality rate around 6 percent. Although most esophageal erosions occur in intraoperative or immediately following surgical intervention, few cases reported with delayed presentation. Diagnosis can be made with cervical radiographs, however negative imaging does not rule out esophageal injury and further evaluation with surgical exploration warranted in the presence of high clinical suspicion. Case Description/Methods: A 58-year-old male patient with past medical history significant for Parkinson's disease, and solitary cervical spinal sarcoma who underwent corpectomy, fusion of C3-C6 with cervical fixation plate placement and stereotactic body radiation therapy, presented with 3 weeks history of dysphagia, concomitant with weakness, diplopia, and weakness. Initial work up, revealed aerodigestive tract soft tissue enhancement in the cervical magnetic resonance imaging (MRI). Dysphagia progressed during the course of hospitalization and complicated with aspiration pneumonia and respiratory failure requiring intubation and mechanical ventilation. Patient subsequently underwent endoscopic gastroesophageal duodenoscopy (EGD) for further evaluation and PEG placement, which revealed posterior pharyngeal wall, and upper cervical esophageal erosion and presence of cervical fixation plate in the hypopharynx. Patient underwent surgical exploration of cervical spine, and the anterior cervical fixation plate removed with flap reconstruction and cervical dural tear repaired with resolution of his symptoms. Discussion: Our patient presented with progressive dysphagia as delayed manifestation of posterior pharyngeal wall erosion. EGD revealed the diagnosis and patient underwent surgical exploration of cervical spine, and the anterior cervical fixation plate removed with flap reconstruction and cervical dural tear repaired with resolution of his symptoms. There are few cases reported in the literature with esophageal perforation following anterior cervical spine surgery. Although most esophageal erosions occur in intraoperative or immediately following surgical intervention, few cases reported with delayed presentation.

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A 65-year-old male with a 25-year history of chronic alcoholism presented to the emergency department for a two-week history of non-radiating right upper quadrant abdominal pain associated with pruritus, nausea, coffee-ground emesis, and clay-colored stools. The exam was notable for icteric sclera, right upper quadrant abdominal tenderness, ascites, and hepatomegaly. Initial workup revealed new-onset unexplained elevated liver enzyme. The CT scan revealed diffuse liver cirrhosis, periportal lymphadenopathy, and stigmata of portal hypertension including hepatosplenomegaly, ascites, and varices. Esophagogastroduodenoscopy (EGD) with endoscopic ultrasound was performed, which showed gastritis and enlarged porta hepatis, which was ultimately biopsied and revealed extracellular amyloid deposition in peri-sinusoidal spaces consistent with amyloidosis. Transesophageal echocardiogram raised suspicion for cardiac involvement with amyloid deposit. The patient was started on steroids and chemotherapy with daratumumab, however his condition was complicated by septic shock, which led to an admission in the ICU followed by endotracheal intubation and multi-organ failure and eventual palliative care. Our case highlights the importance of clinical suspicion of GI amyloidosis in patients with constitutional symptoms including fatigue, weight loss, and unexplained liver disease. Once amyloidosis is considered, the diagnosis can be obtained by tissue biopsy from either the GI tract or subcutaneous adipose tissue.