Sandbox: dysphagia: Difference between revisions

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<small>
{| class="wikitable"
{| class="wikitable"
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Disease
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| align="center" style="background:#4479BA; color: #FFFFFF;" |Type
| align="center" style="background:#4479BA; color: #FFFFFF;" |Type
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |Plummer-Vinson syndrome
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Plummer-Vinson syndrome]]
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* Gradual
* Gradual
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* Multiple upper [[Esophageal stricture|esophageal constrictions]]
* Multiple upper [[Esophageal stricture|esophageal constrictions]]
[[Image:Plummer-vinson-syndrome.jpg|center|200px|thumb|Barium esophagogram (Source: Case courtesy of Dr Hani Salam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/14029">rID: 14029</a>)]]
[[Image:Plummer-vinson-syndrome.jpg|center|200px|thumb|Barium esophagogram (Source: Case courtesy of Dr Hani Salam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/14029">rID: 14029</a>)]]
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|  
* Direct visualization of [[esophageal webs]]
* Direct visualization of [[esophageal webs]]
* Superior to [[esophagogram]]
* Superior to [[esophagogram]]
{{#ev:youtube|200px|HFfsTgsB6Pg}}
<div style="width:350px">{{#ev:youtube|HFfsTgsB6Pg}}</div>
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* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings
* Videofluoroscopy shows [[mucosal]] and [[submucosal]] foldings
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* Circumferential thickening in [[Gastroesophageal reflux disease|GERD]]
* Circumferential thickening in [[Gastroesophageal reflux disease|GERD]]
* Pale [[mucosa]] with white [[exudate]] in lymphocytic esophagitis
* Pale [[mucosa]] with white [[exudate]] in lymphocytic esophagitis
 
* [[Swelling]] and [[hemorrhagic]] [[congestion]] in [[caustic]]<nowiki/> ingestion
* [[Swelling]] and [[hemorrhagic]] [[congestion]] in [[caustic]]<nowiki/>ingestion
<div style="width:350px">{{#ev:youtube|vax5E-jMnQ}}</div>
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* [[Manometry]] may show dysmotility
* [[Manometry]] may show dysmotility
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* Inconclusive
* Inconclusive
<div style="width:350px">{{#ev:youtube|2ipA34iMA3c}}</div>
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*[[Manometry]] shows high-amplitude [[esophageal]] contractions
*[[Manometry]] shows high-amplitude [[esophageal]] contractions
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* [[Manometry]]
* [[Manometry]]
|-
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Achalasia]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Achalasia]]
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* Gradual
* Gradual
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* Residual food fragments  
* Residual food fragments  
* Normal [[mucosa]]  
* Normal [[mucosa]]  
<div style="width:350px">{{#ev:youtube|ydLcskQzEjM}}</div>
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* Residual pressure of [[Lower esophageal sphincter|LES]] > 10 mmHg
* Residual pressure of [[Lower esophageal sphincter|LES]] > 10 mmHg
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* Thin projections on [[esophageal]] wall over [[Killian's dehiscence|Killian's triangle]]
* Thin projections on [[esophageal]] wall over [[Killian's dehiscence|Killian's triangle]]
[[Image:Zenker-4.jpg|center|200px|thumb|Zenker's diverticulum-Frontal view <br> Source:Radiopaedia<ref name="urlZenker diverticulum, Case courtesy of Dr Bruno Di Muzio, | Radiology Case | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/cases/zenker-diverticulum |title=Zenker diverticulum &#124; Radiology Case &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref>]]
[[Image:Zenker-4.jpg|center|200px|thumb| Radiopaedia.org">{{cite web |url=https://radiopaedia.org/cases/zenker-diverticulum |title=Zenker diverticulum &#124; Radiology Case &#124; Radiopaedia.org |format= |work= |accessdate=}}<nowiki></ref></nowiki>]]
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* Outpouching of posterior [[pharyngeal]] wall
* Outpouching of posterior [[pharyngeal]] wall


* Exclude the presence of [[Squamous cell carcinoma|SCC]] 
* Exclude the presence of [[Squamous cell carcinoma|SCC]]
<div style="width:350px">{{#ev:youtube|FdEruFsNdVA}}</div> 
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* [[CT]] & [[MRI]] shows out-pouching over the posterior esophagus in the Killian's triangle
* [[CT]] & [[MRI]] shows out-pouching over the posterior esophagus in the Killian's triangle
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* [[Esophageal]] obstruction
* [[Esophageal]] obstruction
* Staging of disease
* Staging of disease
<div style="width:350px">{{#ev:youtube|5ucSlgqGAno}}</div>
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* [[CT]] and [[PET scan]] is an optional test for staging of the disease
* [[CT]] and [[PET scan]] is an optional test for staging of the disease
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* [[Biopsy]]
* [[Biopsy]]
|-
|-
|style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Stroke]]
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |[[Stroke]]
([[Cerebral hemorrhage]])
([[Cerebral hemorrhage]])
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|
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* Barium [[esophagogram]]
* Barium [[esophagogram]]
|}
|}
<small>

Latest revision as of 01:03, 27 November 2017

Disease Signs and Symptoms Barium esophagogram Endoscopy Other imaging and laboratory findings Gold Standard
Onset Dysphagia Weight loss Heartburn Other findings Mental status
Solids Liquids Type
Plummer-Vinson syndrome
  • Gradual
+ - Non progressive +/- - Normal
Barium esophagogram (Source: Case courtesy of Dr Hani Salam, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/14029">rID: 14029</a>)
{{#ev:youtube|HFfsTgsB6Pg}}

Triad of

Esophageal stricture
  • Gradual
  • Sudden onset
+ - Progressive +/- +/- Normal
  • Sacculations
  • Fixed transverse folds
  • Esophageal intramural pseudodiverticula   
Case courtesy of Dr Ahmed Abd Rabou, Radiopaedia.org, rID: 23008
{{#ev:youtube|vax5E-jMnQ}}
Diffuse esophageal spasm
  • Sudden
+ + Non progressive + + Normal
  • Nonperistaltic and nonpropulsive contractions
  • Corkscrew or rosary bead esophagus
Barium swallow appearance of DES
Source:By Nevit Dilmen [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)
  • Inconclusive
{{#ev:youtube|2ipA34iMA3c}}
Achalasia
  • Gradual
+ + Non progressive +/- - Normal
  • "Bird's beak" or "rat tail" appearance
  • Dilated esophageal body
  • Air fluid level (absent peristalsis)
  • Absence of an intragastric air bubble
Case courtesy of Dr Mario Umana, Radiopaedia.org, rID: 38071
{{#ev:youtube|ydLcskQzEjM}}
  • Residual pressure of LES > 10 mmHg
  • Incomplete relaxation of the LES
  • Increased resting tone of LES
  • Aperistalsis
Systemic sclerosis
  • Gradual
+ + Progressive +/- + Normal
  • Dysmotility
  • Peptic stricture (advanced cases)
Positive serology for
Zenker's diverticulum
  • Gradual
+ - +/- - Normal
Radiopaedia.org">"Zenker diverticulum | Radiology Case | Radiopaedia.org".</ref>
  • Exclude the presence of SCC
{{#ev:youtube|FdEruFsNdVA}}
 
  • CT & MRI shows out-pouching over the posterior esophagus in the Killian's triangle
Esophageal carcinoma
  • Gradual
+ + Progressive + +/- Normal
Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 4232f
{{#ev:youtube|5ucSlgqGAno}}
  • CT and PET scan is an optional test for staging of the disease
Stroke

(Cerebral hemorrhage)

  • Sudden
+ + Progressive + +/- Impaired
Motor disorders

(Myasthenia gravis)

  • Gradual
+ + Progressive +/- Normal
  • Stasis in pharynx and pooling in pharyngeal recesses
  • Anti–acetylcholine receptor antibody test
GERD
  • Gradual
  • Sudden onset
+ - Progressive +/- + Normal
Esophageal web
  • Gradual
+ +/- Progressive - +/- Normal
  • Smooth membrane not encircling the whole lumen