The endoscopic or radiographic appearance alone usually does not accurately predict diseases other than Candida esophagitis; diagnosis requires specimen acquisition for laboratory study [33,34]. Fluoroscopy Biphasic Esophagram Esophagrams are preferred by some as an initial diagnostic study and can be useful in guiding management. A biphasic esophagram is more accurate than single-contrast esophagram for detecting ulcers or plaques associated with infectious esophagitis [35-37]. However, a single-contrast esophagram may be performed if the patient is too sick or debilitated to tolerate a double-contrast examination. Patients with radiographically diagnosed Candida or herpes esophagitis may be treated with antifungal or antiviral agents, respectively, without endoscopic evaluation. Endoscopy is warranted for patients with giant esophageal ulcers to differentiate cytomegalovirus and HIV and begin appropriate therapy [34]. Fluoroscopy Single-Contrast Esophagram Although the biphasic esophagram provides superior mucosal detail, allowing for earlier detection of subtle lesions, patient cooperation and mobility are required. For debilitated, immobile patients or patients who are limited in their ability to cooperate, a single-contrast esophagram may be necessary. Fluoroscopy Barium Swallow Modified A modified barium swallow does not evaluate esophageal anatomy and structure. It may not be appropriate because it may fail to reveal the etiology of retrosternal dysphagia. However, it may be useful to evaluate swallowing function in the setting of pharyngeal infection. Fluoroscopy Pharynx Dynamic and Static Imaging Dynamic and static imaging evaluates swallowing and oropharyngeal motility and structure. Performed alone, it may not be appropriate because it may fail to reveal the etiology of retrosternal dysphagia. Dysphagia CT Neck and Chest CT is usually not indicated as an initial imaging modality in this clinical scenario because it does not assess esophageal mucosa and motility.
Dysphagia. The endoscopic or radiographic appearance alone usually does not accurately predict diseases other than Candida esophagitis; diagnosis requires specimen acquisition for laboratory study [33,34]. Fluoroscopy Biphasic Esophagram Esophagrams are preferred by some as an initial diagnostic study and can be useful in guiding management. A biphasic esophagram is more accurate than single-contrast esophagram for detecting ulcers or plaques associated with infectious esophagitis [35-37]. However, a single-contrast esophagram may be performed if the patient is too sick or debilitated to tolerate a double-contrast examination. Patients with radiographically diagnosed Candida or herpes esophagitis may be treated with antifungal or antiviral agents, respectively, without endoscopic evaluation. Endoscopy is warranted for patients with giant esophageal ulcers to differentiate cytomegalovirus and HIV and begin appropriate therapy [34]. Fluoroscopy Single-Contrast Esophagram Although the biphasic esophagram provides superior mucosal detail, allowing for earlier detection of subtle lesions, patient cooperation and mobility are required. For debilitated, immobile patients or patients who are limited in their ability to cooperate, a single-contrast esophagram may be necessary. Fluoroscopy Barium Swallow Modified A modified barium swallow does not evaluate esophageal anatomy and structure. It may not be appropriate because it may fail to reveal the etiology of retrosternal dysphagia. However, it may be useful to evaluate swallowing function in the setting of pharyngeal infection. Fluoroscopy Pharynx Dynamic and Static Imaging Dynamic and static imaging evaluates swallowing and oropharyngeal motility and structure. Performed alone, it may not be appropriate because it may fail to reveal the etiology of retrosternal dysphagia. Dysphagia CT Neck and Chest CT is usually not indicated as an initial imaging modality in this clinical scenario because it does not assess esophageal mucosa and motility.