An Office Worker With Abdominal Cramps, Burning Chest, Dyspnea

Emily Weng, DO; John W. Birk, MD


June 06, 2022

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 41-year-old African American man is referred to the emergency department by his primary care physician after outpatient laboratory studies revealed a low hemoglobin level. He initially presented to his primary care physician with a history of several months of fatigue; worsening shortness of breath; and diffuse, intermittent abdominal cramping that food consumption sometimes worsens and defecation occasionally improves. The abdominal cramping radiates on occasion to the chest with a burning sensation, which he has been treating empirically with 325 mg/d of aspirin. He has had an approximately 8-lb weight loss in recent months. He has not had any nausea or emesis and has not noticed a change in bowel habits or stool color.

The patient has no other significant past medical history and no prior surgeries. The only medication he takes is aspirin. His grandfather may have had either esophageal cancer or neck cancer; the patient does not clearly remember. He knows of no other cases of cancer in the family. He uses tobacco daily but does not consume alcohol or use illicit drugs. He lives in the Northeast, works in an office, and has not recently traveled.


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