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Videofluoroscopic Assessment of Patients with Dysphagia

Pharyngeal Retention Is a Predictive Factor for Aspiration

Edith Eisenhuber1, Wolfgang Schima, Ewald Schober, Peter Pokieser, Alfred Stadler, Martina Scharitzer and Elisabeth Oschatz

1 All authors: Department of Radiology and Ludwig Boltzmann-Institute for Clinical and Experimental Radiologic Research, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.



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  		Fig. 1A. —70-year-old woman with postpolio syndrome. Videofluoroscopy in lateral view shows severe pharyngeal retention of contrast material in piriform sinus (arrow) but no aspiration of contrast material into trachea.

 


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  		Fig. 1B. —70-year-old woman with postpolio syndrome. Videofluoroscopy in anteroposterior direction shows dilatation of left piriform sinus with severe retention (arrow) caused by left-sided pharyngeal paresis. Note minimal penetration of contrast material into laryngeal vestibule (arrowhead).

 


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  		Fig. 2A. —36-year-old man with long-standing dysphagia for solids and liquids and history of radiation therapy of neck for Hodgkin's lymphoma. Lateral double-contrast pharyngogram shows severe pharyngeal retention of contrast material in piriform sinuses (arrow) caused by radiation stricture at pharyngoesophageal segment (arrowhead).

 


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  		Fig. 2B. —36-year-old man with long-standing dysphagia for solids and liquids and history of radiation therapy of neck for Hodgkin's lymphoma. Videofluoroscopy shows absence of anterior movement of posterior pharyngeal wall, indicative of pharyngeal paresis. Note severe postdeglutitive overflow aspiration of retained contrast material into trachea (arrow).

 


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  		Fig. 2C. —36-year-old man with long-standing dysphagia for solids and liquids and history of radiation therapy of neck for Hodgkin's lymphoma. Double-contrast pharyngogram in anteroposterior view shows stricture (arrowhead) and severe retention in piriform sinuses (white arrow), resulting in aspiration. Aspirated contrast material in larynx and trachea is seen in midline (black arrow).

 


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  		Fig. 3A. —62-year-old man with dysphagia for solid food and occasional aspiration. During swallowing, videofluoroscopy reveals only minimal pharyngeal contraction (white arrow) and incomplete laryngeal closure, with intradeglutitive penetration of contrast material (black arrow).

 


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  		Fig. 3B. —62-year-old man with dysphagia for solid food and occasional aspiration. After swallowing, residue of contrast material is seen in larynx (black arrow). Note also severe retention of contrast material in piriform sinuses (white arrow), with aspiration into trachea (arrowhead).

 


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  		Fig. 3C. —62-year-old man with dysphagia for solid food and occasional aspiration. At a later stage, contrast material that penetrated into larynx has also been aspirated (arrowheads).

 


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  		Fig. 3D. —62-year-old man with dysphagia for solid food and occasional aspiration. In anteroposterior view, videofluoroscopy reveals bilateral dilatation of piriform sinuses with retention (arrow). Contrast material outlines vocal cords (arrowheads) and trachea.

 

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