Obtaining a CT scan with and without IV contrast offers little additional benefit compared to a CT with IV contrast alone. Esophageal Transit Nuclear Medicine Scan Scintigraphy is usually not indicated in this clinical scenario. Variant 6: Delayed (greater than 1 month) postoperative development of dysphagia. Oropharyngeal or retrosternal. Initial imaging. Dysphagia occurring weeks or months following surgery may be due to dysmotility, gastroesophageal reflux, or structural abnormalities, such as anastomotic strictures, diverticula, or recurrent disease [38]. The incidence of dysphagia after laryngectomy is reported to occur in up to 72% of patients [44], and aspiration occurs in 65% of patients [45]. In addition to patients who have undergone operations to the oropharynx, larynx, and esophagus, operative procedures on the cervical spine may also cause dysphagia and significant disability. In the latter group of patients, dysphagia may be caused by structural abnormalities (displaced surgical hardware or bone graft) or functional abnormalities resulting in aspiration or penetration [1]. Patients following esophageal and gastric surgery can also experience dysphagia related to many potential complications. Fluoroscopy Pharynx Dynamic and Static Imaging Pharynx dynamic and static imaging is usually not appropriate because it is a double-contrast barium evaluation of the pharynx alone. A single-contrast esophagram with water-soluble contrast possibly followed with barium is more appropriate to evaluate for postoperative leak or fistula in a patient who has had surgery in the neck and is complaining of oropharyngeal dysphagia [42]. Furthermore, this study does not evaluate the thoracic esophagus Dysphagia and gastric cardia. Alone, pharynx dynamic and static imaging is not appropriate for postoperative retrosternal dysphagia because it does not evaluate the retrosternal anatomy but may be useful combined with esophageal evaluation.
Dysphagia. Obtaining a CT scan with and without IV contrast offers little additional benefit compared to a CT with IV contrast alone. Esophageal Transit Nuclear Medicine Scan Scintigraphy is usually not indicated in this clinical scenario. Variant 6: Delayed (greater than 1 month) postoperative development of dysphagia. Oropharyngeal or retrosternal. Initial imaging. Dysphagia occurring weeks or months following surgery may be due to dysmotility, gastroesophageal reflux, or structural abnormalities, such as anastomotic strictures, diverticula, or recurrent disease [38]. The incidence of dysphagia after laryngectomy is reported to occur in up to 72% of patients [44], and aspiration occurs in 65% of patients [45]. In addition to patients who have undergone operations to the oropharynx, larynx, and esophagus, operative procedures on the cervical spine may also cause dysphagia and significant disability. In the latter group of patients, dysphagia may be caused by structural abnormalities (displaced surgical hardware or bone graft) or functional abnormalities resulting in aspiration or penetration [1]. Patients following esophageal and gastric surgery can also experience dysphagia related to many potential complications. Fluoroscopy Pharynx Dynamic and Static Imaging Pharynx dynamic and static imaging is usually not appropriate because it is a double-contrast barium evaluation of the pharynx alone. A single-contrast esophagram with water-soluble contrast possibly followed with barium is more appropriate to evaluate for postoperative leak or fistula in a patient who has had surgery in the neck and is complaining of oropharyngeal dysphagia [42]. Furthermore, this study does not evaluate the thoracic esophagus Dysphagia and gastric cardia. Alone, pharynx dynamic and static imaging is not appropriate for postoperative retrosternal dysphagia because it does not evaluate the retrosternal anatomy but may be useful combined with esophageal evaluation.