Patients with primary diffuse esophageal spasm usually appear normal. Physical examination of patients with DES is usually remarkable for findings related to secondary diseases.

• Physical examination of patients with DES is usually remarkable for presence of features related to secondary diseases.

• Patients with primary DES usually appear normal.

• High-grade / low-grade fever in infectious cause of DES
• Hypothermia / hyperthermia may be present
• Tachycardia with regular pulse or (ir)regularly irregular pulse
• Bradycardia with regular pulse or (ir)regularly irregular pulse
• Tachypnea / bradypnea
• Kussmaul respirations
• Weak / bounding pulse
• High / low blood pressure with normal pulse pressure

• Tight, hardened skin in limited scleroderma
• Red spots or lines in skin of face and hand due to telangiectasia in scleroderma
• Bumps under the skin due to deposition of calcium in scleroderma.
• Ulcers of finger and toes may be present in scleroderma
• Insect bite wound may be seen in Chaga’s disease with excoriation at the bite site.

• Romana’s sign is seen in Chaga’s disease (swelling of eyelid at the site of parasite entry)
• Ophthalmoscopic exam may be abnormal with findings of diabetic retinopathy in diabetics as well as cataract changes.
• Lower extremities edema in Chaga’s disease.
• Dry mouth and dry eye in scleroderma.

• Lymphadenopathy (Chaga’s disease)
• Thyromegaly / thyroid nodules

• Asymmetric chest expansion / Decreased chest expansion
• Lungs are hyperresonant in scleroderma.
• Fine/coarse crackles upon auscultation of the lung bases/apices bilaterally seen in scleroderma.

Heart involvement in Chagas’s cardiomyopathy are:

• Displaced point of maximal impulse (PMI).
• S3, S4
• Disturbances of rhythm (arrhythmias) may be noted in scleroderma.

• Abdominal distention or bloating is noted in Scleroderma, Diabetes.
• Hepatosplenomegaly is feature of Chaga’s disease.

• Clubbing , Cyanosis are features of chronic involvement and fibrosis of lungs in Scleroderma.
• Pitting edema of the lower extremities may be noted in Chaga’s cardiomyopathy.