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[Dysphagia] interesting case
The first thing to consider re both the tongue atrophy and salivary gland atrophy would be the effect of pressure of the spinal cord compression on the cervical sympathetic nervous system, although bilateral effects woudl be unusual. There is also the possibility of an atypical form of scleroderma.
wendy jackson <wendycccslp@yahoo.com> wrote:Sorry for the long post but my colleague and I would appreciate some input on the following patient:
84 y/o male, snf resident, presented with several week hx of swallowing difficulty and 40 pound weight loss. Pmh includes reflux, sinusitis, CVA, afib, COPD, cardiomyopathy, PVD, HTN, glaucoma. Video swallow and CT of neck were completed.
Pharyngeal phase was described as:
abnormal structure with wide/dilated pharynx and distended pyriform sinus. UES appeared abnormal and relaxed. No pharyngeal peristalsis and material essentially fell into pyriform sinus and through UES, which appeared open. There was some anterior hyoid mvmt but as the UES seemed completely relaxed at all times regardless of hyoid or laryngeal mvmt. Pt could not really achieve a true swallow. There was suprisingly no aspiration as all material could fall into and fill the pyriforms
CT of neck revealed the following:
THE PAROTID AND SUBMANDIBULAR GLANDS APPEAR ATROPHIC. THE TONGUE ALSO
APPEARS ATROPHIC AND THERE IS GASEOUS DISTENTION OF NASOPHARYNX AND PHARYNX AND SUPRAGLOTTIC LARYNX. THAT COULD OCCUR WITH PREVIOUS NECK RADIATION THERAPY BUT ELECTRONIC MEDICAL RECORD REVIEW GIVES NO INDICATION OF THAT.IT MIGHT BE RELATED TO THE CHRONIC OBSTRUCTIVE PULMONARY DISEASE.NEUROMUSCULAR DYSFUNCTION IS ALSO POSSIBLE. SLICES THROUGH THE HEAD INCLUDE THE BRAIN STEM AND SHOW NO INDICATION OF BRAIN STEM LESION.
THERE IS NO INDICATION OF MASS OR ADENOPATHY, NO OTHER SIGNIFICANT FINDINGS
ARE DEMONSTRATED.
IMPRESSION:
1. DILATED AIRWAYS IN THE UPPER NECK, AND ATROPHIC APPEARANCE OF TONGUE
AND SALIVARY GLANDS.
2. LEFT INTERNAL CAROTID ARTERY SEVERE STENOSIS, PROBABLY AT LEAST 80%.
3. CERVICAL SPONDYLOSIS INCLUDING SPINAL CORD COMPRESSION BY SPURS.
We understand the nutritional issue, this patient will need a PEG to supplement pleasure oral feeding. Our frustration lies with the physicians focusing on PEG placement and not really trying to diagnose WHY this patient has this problem.
Any insight into possible etiology or interventions would be appreciated.
Thank-you,
Wendy Jackson
Wendy K. Jackson
Speech Language Pathologist
Bronson Methodist Rehab Services
Phone: (269) 341-6390 jacksonw@bronsonhg.org
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