Ann Rehabil Med.  2020 Feb;44(1):38-47. 10.5535/arm.2020.44.1.38.

Characteristics of Patients With Esophageal Dysphagia Assessed by Chest X-Ray Imaging After Videofluoroscopic Swallowing Study

• Min YK
• Baek S
• Kang EK
• Nam SJ

• KMID: 2501044
• DOI: http://doi.org/10.5535/arm.2020.44.1.38

Abstract

Objective
To evaluate the prevalence rate, types, characteristics, and associated factors of esophageal dysphagia detected on chest X-ray images after videofluoroscopic swallowing study (VFSS).
Methods
The medical records of 535 adults were reviewed retrospectively. Chest X-ray images taken after barium swallow study were analyzed and presence of any residual barium in the esophagus was considered as esophageal dysphagia. Esophageal dysphagia was classified based on the largest width of barium deposit (mild, <2 cm; severe ≥2 cm) and the anatomic level at which it was located (upper and lower esophagus).
Results
Esophageal residual barium on chest X-ray images was identified in 40 patients (7.5%, 40/535). Esophageal dysphagia was more frequent in individuals aged 65–79 years (odds ratio=4.78, p<0.05) than in those aged <65 years. Mild esophageal dysphagia was more frequent (n=32) than its severe form (n=8). Lower esophageal dysphagia was more frequent (n=31) than upper esophageal dysphagia (n=9). Esophageal residual barium in patients diagnosed with esophageal cancer or lung cancer was significantly associated with severe esophageal dysphagia (p<0.05) and at the upper esophagus level (p<0.01).
Conclusion
Esophageal residual barium was observed on chest X-ray imaging after VFSS. Esophageal barium in the upper esophagus with a diameter of ≥2 cm is an important indicator of malignancy, and chest X-ray image taken after VFSS is an important step to evaluate the presence of esophageal disorder.

Keyword

Deglutition disorders; Esophageal diseases; Thoracic radiography; Esophageal dysphagia

Figure

• 

  Fig. 1. Flow diagram of esophageal residual barium in chest X-ray taken immediately after videofluoroscopic swallowing study (VFSS).

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  Fig. 2. Severity and level of esophageal dysphagia. Largest diameter (arrow) of 15.85 mm was classified as mild esophageal dysphagia. The distal end of the barium residue (asterisk) proximal to the tracheal bifurcation was classified as upper esophageal dysphagia. The distal trachea and bifurcation are delineated as black solid line.

• 

  Fig. 3. Imaging studies of the case who newly diagnosed as a cancer-related esophageal dysphagia after videofluoroscopic swallowing study (VFSS). The patient presented for unexplained swallowing difficulty with suffering from poor oral intake. (A) After VFSS, severe esophageal dilatation is observed at upper esophagus level (arrowhead) in the chest X-ray. (B) The esophagus, with a nasogastric tube, is compressed by the subcarinal mass (asterisk), and (C) hypermetabolism is seen on the positron emission tomography-computed tomography scan.

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