Hello,

Thank You for a clear elaboration of your husband's symptoms and tests.

I would like to suggest that you go for an Endoscopic Ultrsound of the Esophagus.

This will give us a clearer idea about the constriction ring.

This is the only procedure that can demonstrate any irregularity that is within the wall of the esophagus like a subtle leiomyoma ( a muscle tumor of the oesophagus ).

I would also like to suggest a Mediastinoscopy, this involves visualization of the structures behind the breast bone, but outside the Oesophagus and Trachea.

Any mass arising from this area can compress on the Oesophagus and produce similar symptoms as you describe, and still not show up on the studies that you have done already.

I think a PET - FDG scan would be warranted in this case, as the diagnosis is not clear,
we need to consider possibilities of a primary lesion at a different site from the Esophagus, producing a secondary growth, that produces these symptoms.

The Herniated thoracic discs would not cause generally cause a difficulty in coughing,
with the exception of these being large anterior herniations of the discs causing a compression of the esophagus.

I hope this answer shows you the path to your husband's recovery.

Kindest Regards,

Dr.Joshi.

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