However, patient cooperation and mobility are required and single-contrast technique may be better suited for those patients who are unable to fully cooperate with the biphasic examination, such as elderly, debilitated, and obese patients. Fluoroscopy Barium Swallow Modified A modified barium swallow examination may be of benefit in this setting, particularly if structural abnormalities have been excluded by direct endoscopic visualization. In a study by Madhavan et al [19], a videofluoroscopic Dysphagia modified barium swallow identified a cause for dysphagia in 76% of patients. Localization of the videofluoroscopic finding to the site of the patients symptoms was accurate in 75% of cases when the finding was structural versus 18% when the finding was physiologic [19]. CT Neck and Chest CT is usually not indicated in this clinical scenario as initial imaging because it does not assess oropharyngeal and esophageal mucosa and motility. CT may be helpful in the subsequent evaluation of patients if initial studies are not revealing. Esophageal Transit Nuclear Medicine Scan Nuclear scintigraphy could be used to assess for motility abnormalities or gastroesophageal reflux; however, it is not a substitute for examinations that evaluate the function and structure of the pharynx. Variant 3: Retrosternal dysphagia in immunocompetent patients. Initial imaging. Patients with retrosternal dysphagia experience a sensation of blockage or discomfort at any level between the thoracic inlet and the xiphoid process. Because retrosternal dysphagia can be caused by esophageal motility disorders or by structural abnormalities of the esophagus or cardia (ie, esophagitis, rings, strictures, or tumors), a biphasic esophagram is the preferable imaging procedure. Fluoroscopy Biphasic Esophagram The biphasic esophagram permits detection of both structural and functional abnormalities of the esophagus. Structural lesions include esophagitis, strictures, rings, and carcinoma.
Dysphagia. However, patient cooperation and mobility are required and single-contrast technique may be better suited for those patients who are unable to fully cooperate with the biphasic examination, such as elderly, debilitated, and obese patients. Fluoroscopy Barium Swallow Modified A modified barium swallow examination may be of benefit in this setting, particularly if structural abnormalities have been excluded by direct endoscopic visualization. In a study by Madhavan et al [19], a videofluoroscopic Dysphagia modified barium swallow identified a cause for dysphagia in 76% of patients. Localization of the videofluoroscopic finding to the site of the patients symptoms was accurate in 75% of cases when the finding was structural versus 18% when the finding was physiologic [19]. CT Neck and Chest CT is usually not indicated in this clinical scenario as initial imaging because it does not assess oropharyngeal and esophageal mucosa and motility. CT may be helpful in the subsequent evaluation of patients if initial studies are not revealing. Esophageal Transit Nuclear Medicine Scan Nuclear scintigraphy could be used to assess for motility abnormalities or gastroesophageal reflux; however, it is not a substitute for examinations that evaluate the function and structure of the pharynx. Variant 3: Retrosternal dysphagia in immunocompetent patients. Initial imaging. Patients with retrosternal dysphagia experience a sensation of blockage or discomfort at any level between the thoracic inlet and the xiphoid process. Because retrosternal dysphagia can be caused by esophageal motility disorders or by structural abnormalities of the esophagus or cardia (ie, esophagitis, rings, strictures, or tumors), a biphasic esophagram is the preferable imaging procedure. Fluoroscopy Biphasic Esophagram The biphasic esophagram permits detection of both structural and functional abnormalities of the esophagus. Structural lesions include esophagitis, strictures, rings, and carcinoma.