Fluoroscopy Pharynx Dynamic and Static Imaging Dynamic and static imaging of the pharynx may not be appropriate as the only examination performed in a patient with retrosternal dysphagia because the entire esophagus and gastric cardia should be assessed. This study does not evaluate the thoracic esophagus or gastric cardia. CT Neck and Chest CT is not usually indicated as an initial imaging modality in this clinical scenario because it does not assess 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 Specific protocols to assess esophageal emptying may be useful in patients with known or suspected achalasia but does not provide anatomic detail [29,30]. Radionuclide esophageal transit scintigraphy is a simple, noninvasive, and quantitative test of esophageal emptying that can be useful in these patients [3,31,32]. Variant 4: Retrosternal dysphagia in immunocompromised patients. Initial imaging. The major consideration in immunocompromised patients with dysphagia or odynophagia (painful swallowing) is infectious esophagitis, most commonly due to Candida albicans or herpes simplex virus. In HIV-positive patients, Candida is most often the cause of esophageal symptoms; cytomegalovirus, herpes simplex, and idiopathic ulcers (also known as HIV ulcers) are the other most common etiologies [33]. HIV-positive patients with esophageal symptoms may be treated empirically with antifungal therapy without first undergoing a diagnostic examination. However, most gastroenterologists prefer that those who have severe symptoms at presentation or persistent symptoms be evaluated by endoscopy. Endoscopy is preferred because of the ability to obtain specimens (eg, histology, cytology, immunostaining, or culture) [3,33].
Dysphagia. Fluoroscopy Pharynx Dynamic and Static Imaging Dynamic and static imaging of the pharynx may not be appropriate as the only examination performed in a patient with retrosternal dysphagia because the entire esophagus and gastric cardia should be assessed. This study does not evaluate the thoracic esophagus or gastric cardia. CT Neck and Chest CT is not usually indicated as an initial imaging modality in this clinical scenario because it does not assess 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 Specific protocols to assess esophageal emptying may be useful in patients with known or suspected achalasia but does not provide anatomic detail [29,30]. Radionuclide esophageal transit scintigraphy is a simple, noninvasive, and quantitative test of esophageal emptying that can be useful in these patients [3,31,32]. Variant 4: Retrosternal dysphagia in immunocompromised patients. Initial imaging. The major consideration in immunocompromised patients with dysphagia or odynophagia (painful swallowing) is infectious esophagitis, most commonly due to Candida albicans or herpes simplex virus. In HIV-positive patients, Candida is most often the cause of esophageal symptoms; cytomegalovirus, herpes simplex, and idiopathic ulcers (also known as HIV ulcers) are the other most common etiologies [33]. HIV-positive patients with esophageal symptoms may be treated empirically with antifungal therapy without first undergoing a diagnostic examination. However, most gastroenterologists prefer that those who have severe symptoms at presentation or persistent symptoms be evaluated by endoscopy. Endoscopy is preferred because of the ability to obtain specimens (eg, histology, cytology, immunostaining, or culture) [3,33].