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. CT Neck and Chest For oropharyngeal and retropharyngeal dysphagia, CT of the neck and chest with intravenous (IV) contrast is Dysphagia indicated when there is concern of early postoperative complications, such as leak, fluid collection, abscess, or hematoma [40,43]. CT has a slightly higher sensitivity and substantially lower specificity than esophagography for detecting clinically relevant leaks after esophagectomy [40,43]. The use of CT as the initial imaging test in these patients can lead to earlier diagnosis and treatment of leaks missed on esophagography. In many patients, both CT and esophagrams are performed especially when the clinical concern is high. 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, whereas CT had a sensitivity of 86%, specificity of 33%, positive predictive value of 55%, and negative predictive value of 71%; esophagography and CT combined had a sensitivity of 100%, specificity of 27%, positive predictive value of 56%, and negative predictive value of 100%. CT may be useful to assess the position of surgical hardware or complication related to surgical hardware with respect to the oropharynx and airway. Oral contrast administered immediately before the examination may be a helpful adjunct to facilitate interpretation of esophageal integrity and anatomy, though one study showed the use of oral contrast did not change the sensitivity of CT for detection of leaks [40]. CT scan with IV contrast better defines the anatomic structures of the neck and chest compared to CT without IV contrast because normal soft-tissue and blood vessel enhancement are better delineated from postoperative fluid collections, such as hematomas and abscesses.
Dysphagia. 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. CT Neck and Chest For oropharyngeal and retropharyngeal dysphagia, CT of the neck and chest with intravenous (IV) contrast is Dysphagia indicated when there is concern of early postoperative complications, such as leak, fluid collection, abscess, or hematoma [40,43]. CT has a slightly higher sensitivity and substantially lower specificity than esophagography for detecting clinically relevant leaks after esophagectomy [40,43]. The use of CT as the initial imaging test in these patients can lead to earlier diagnosis and treatment of leaks missed on esophagography. In many patients, both CT and esophagrams are performed especially when the clinical concern is high. 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, whereas CT had a sensitivity of 86%, specificity of 33%, positive predictive value of 55%, and negative predictive value of 71%; esophagography and CT combined had a sensitivity of 100%, specificity of 27%, positive predictive value of 56%, and negative predictive value of 100%. CT may be useful to assess the position of surgical hardware or complication related to surgical hardware with respect to the oropharynx and airway. Oral contrast administered immediately before the examination may be a helpful adjunct to facilitate interpretation of esophageal integrity and anatomy, though one study showed the use of oral contrast did not change the sensitivity of CT for detection of leaks [40]. CT scan with IV contrast better defines the anatomic structures of the neck and chest compared to CT without IV contrast because normal soft-tissue and blood vessel enhancement are better delineated from postoperative fluid collections, such as hematomas and abscesses.