CT may be helpful in the subsequent evaluation of patients if initial studies are not revealing. Esophageal Transit Nuclear Medicine Scan Scintigraphy is usually not indicated in this clinical scenario. Variant 5: Early postoperative dysphagia. Oropharyngeal or retrosternal. Initial imaging. Dysphagia is a common complaint following surgery on the oropharynx, soft tissues of the neck, cervical spine, esophagus, or stomach. Imaging should be tailored to the type and location of surgery (oropharyngeal versus retrosternal) and the time of onset of symptoms following surgery. In the immediate or early postoperative period, fluid collections, anastomotic leaks, perforation, and abscess may be of clinical concern [38]. Fluoroscopy Single-Contrast Esophagram A single-contrast esophagram is the study of choice for patients presenting with dysphagia following surgery to the neck, c-spine, esophagus, or stomach [1,39]. When there is a question of leak or fistula, the study is ideally performed by utilizing water-soluble contrast followed by barium if necessary. Esophagrams are highly specific for the detection of leaks but not sensitive. Roh et al [39] showed that the sensitivity of the esophagram in diagnosing a leak was 36% and specificity was 97%. For this reason, a CT examination may be ordered if there is a high clinical suspicion following a negative esophagram. Lantos et al [40] showed that esophagography had a sensitivity of 79%, specificity of 73%, positive predictive value of 73%, and negative predictive value of 79% for detecting leaks, and esophagography and CT combined had a sensitivity of 100%, specificity of 27%, positive predictive value of 56%, and negative predictive value of 100%. The sensitivity of esophagography increased when high-density barium was administered after water-soluble contrast, whereas the sensitivity of CT was the same with and without oral contrast agent.
Dysphagia. CT may be helpful in the subsequent evaluation of patients if initial studies are not revealing. Esophageal Transit Nuclear Medicine Scan Scintigraphy is usually not indicated in this clinical scenario. Variant 5: Early postoperative dysphagia. Oropharyngeal or retrosternal. Initial imaging. Dysphagia is a common complaint following surgery on the oropharynx, soft tissues of the neck, cervical spine, esophagus, or stomach. Imaging should be tailored to the type and location of surgery (oropharyngeal versus retrosternal) and the time of onset of symptoms following surgery. In the immediate or early postoperative period, fluid collections, anastomotic leaks, perforation, and abscess may be of clinical concern [38]. Fluoroscopy Single-Contrast Esophagram A single-contrast esophagram is the study of choice for patients presenting with dysphagia following surgery to the neck, c-spine, esophagus, or stomach [1,39]. When there is a question of leak or fistula, the study is ideally performed by utilizing water-soluble contrast followed by barium if necessary. Esophagrams are highly specific for the detection of leaks but not sensitive. Roh et al [39] showed that the sensitivity of the esophagram in diagnosing a leak was 36% and specificity was 97%. For this reason, a CT examination may be ordered if there is a high clinical suspicion following a negative esophagram. Lantos et al [40] showed that esophagography had a sensitivity of 79%, specificity of 73%, positive predictive value of 73%, and negative predictive value of 79% for detecting leaks, and esophagography and CT combined had a sensitivity of 100%, specificity of 27%, positive predictive value of 56%, and negative predictive value of 100%. The sensitivity of esophagography increased when high-density barium was administered after water-soluble contrast, whereas the sensitivity of CT was the same with and without oral contrast agent.