Epiglottic motion: video recording of muscular dysfunction

Progression of epiglottic movement was demonstrated on video tape during a pharyngeal swallow in 618 patients. Dysfunction of extrinsic laryngeal musculature and restriction of normal epiglottic motion produced the most significant changes. Intrinsic muscular dysfunction creates minor abnormalities in epiglottic motion but may lead to laryngotracheal aspiration. Alterations in normal movement should be recognized as such and significant neuromuscular and malignant disease considered.     

Videofluoroscopic assessment of patients with dysphagia: pharyngeal retention is a predictive factor for aspiration.

OBJECTIVE: This study evaluated the clinical significance of pharyngeal retention to predict aspiration in patients with dysphagia. MATERIALS AND METHODS: At videofluoroscopy, pharyngeal retention was found in 108 (28%; 73 males, 35 females; mean age, 60 years) of 386 patients with a suspected deglutition disorder. Swallowing function was assessed videofluoroscopically. The amount of residual contrast material in the valleculae or piriform sinuses was graded as mild, moderate, or severe. The frequency, type, and grade of aspiration were assessed. RESULTS: Pharyngeal retention was caused by pharyngeal weakness or paresis in 103 (95%) of 108 patients. In 70 patients (65%) with pharyngeal retention, postdeglutitive overflow aspiration was found. Aspiration was more often found in patients who had additional functional abnormalities such as incomplete laryngeal closure or impaired epiglottic tilting (p < 0.05). Postdeglutitive aspiration was diagnosed in 25% patients with mild, in 29% with moderate, and in 89% with severe pharyngeal retention (p < 0.05). CONCLUSION: Postdeglutitive overflow aspiration is a frequent finding in patients with pharyngeal retention, and the risk of aspiration increases markedly with the amount of residue. Functional abnormalities other than pharyngeal weakness, such as impaired laryngeal closure, may contribute to aspiration.     

Prevalence of calcified epiglottis in postmortem computed tomography. Is there a correlation to failed endotracheal intubation?

Objectives:Calcification of the epiglottis is a normal physiological degenerative process, although it can also be a consequence of infection or trauma. There are three possible forensically relevant consequences from epiglottic calcification: misinterpretation as foreign bodies, dysphagia as a major contributing factor to aspiration, and association with difficult intubation or a misplaced ventilation tube. It is the aim of this study (I) to inquire about the prevalence of epiglottic calcification in postmortem CT in general and (II) to investigate whether calcification of the epiglottis is linked to a higher incidence of failed endotracheal intubation.Methods:We retrospectively analysed 2930 consecutive cases in postmortem CT at the Institute of Forensic Medicine.Results:The prevalence of epiglottic calcification was 4.1%. Higher age and male sex are associated with an increased risk of epiglottic calcification. There was no calcification of the epiglottis in the cases with misplacement of the ventilation tube in the esophagus.Conclusions:To verify the result of our study, that is, the calcification of the epiglottis is not linked to a higher incidence of failed endotracheal intubation, it might be reasonable to repeat this study with a more representative study population. The high interindividual variations of calcified epiglottis could be used for identification.     

电视荧光放射录相术对中风后吞咽障碍检查的临床价值

目的 探讨电视荧光放射录相术（VFG）对中风后蚕咽障碍检查的价值。材料与方法 中风后吞咽障碍组60例和健康中老年人组20例行VFG，分别记录两组受试者吞咽稀钡及半胶钡（含钡面糊）过程中的口通过时间和咽通过时间，并评价口、咽功能，记录有无舌肌运动减弱，钡剂残留梨状隐窝、会厌Xi，是否误吸入气管。结果 （1）吞咽障碍组各吞因时相通过时间均较健康中老年组延长。（2）会厌Xi钡剂残留在患者中发生率最高（45．0％；33．3％），梨状隐窝钡剂残留发生率较高（35．0％；25．0％）。脑干病变组各病理征象发生率均高于大脑半球病变组。经统计学处理，脑干病变组与大脑半球病变组误吸发生率有显著性差异（P＜0．05）。结论 VFG可以对吞咽全过程特别是咽时相的病理征象进行更详细的观察，是中风后吞咽障碍检查的有效方法。     

会厌癌的CT诊断及评价

目的：探讨会厌癌的ＣＴ 表现、诊断价值及限度。材料和方法：回顾分析４３ 例经病理证实的会厌癌的ＣＴ 资料。结果：４３ 例会厌癌中源发于会厌喉面２３ 例;会厌舌面７ 例;混合型１３ 例。肿瘤呈结节状、团块样及不规则弥漫性浸润,增强后可呈不均匀强化。侵犯会厌前间隙１８ 例;喉旁间隙７ 例;舌根部３ 例。６ 例有甲状软骨破坏,３０ 例伴淋巴结转移。结论：ＣＴ 扫描在会厌癌的诊断中发挥了明显的作用,其直接征象可为手术方式、治疗及预后的评价提供正确可靠的信息。     

Needle aspiration biopsy in cystic papillary carcinoma of the thyroid

The records of 11 patients with cystic papillary carcinoma of the thyroid who had undergone preoperative sonography and fine-needle aspiration biopsy were retrospectively reviewed. The lesions varied from 1.5 to 5 cm in diameter. In only six (55%) of the 11 patients was the correct diagnosis made preoperatively. In the other 45%, the lesion was initially misdiagnosed as a benign or hemorrhagic cyst. These data indicate that needle aspiration often yields false-negative results in patients with cystic papillary carcinoma. All patients diagnosed on sonography and fine-needle aspiration as having benign cysts should have continued clinical follow-up. If lesions do not disappear either clinically or by sonography, a more aggressive approach should be taken.     

Brachytherapy boost: a novel approach for epiglottic carcinoma

PURPOSE: Epiglottic (epilaryngeal) carcinoma has been treated conventionally by radical external beam radiotherapy or partial laryngectomy. The aim of this study is to evaluate the role of brachytherapy boost as a novel approach for lingual epiglottic lesions. METHODS AND MATERIALS: Twenty-three patients with T(2-3)N(0-1) lingual epiglottic carcinoma (SCC) were treated with curative intent between January 1990 and December 2001 using low dose rate interstitial (192)Ir implant boost, moderate dose of 25Gy at 0.5cm (mean dose rate, 50.5 cGy/h) 3 weeks after moderate dose of external beam radiotherapy (mEBRT) of 46Gy/23#/28-31d. RESULTS: Complete response after mEBRT was observed in 18 of the 23 patients (78%) and partial response was seen in 5 of the 23 patients (22%). After implant, all patients had complete response. Locoregional control was seen in 19 of the 23 patients (82.6%). Two patients developed distant metastases. Disease-free survival and overall survival at 5 years were 68.3% and 66.7%, respectively. Disease-free survival at 5 years showed a trend toward better outcome for biologically equivalent doses >85Gy compared with biologically equivalent doses <85Gy (80% vs. 68%) (p=0.18). All patients had minimal to acceptable xerostomia. CONCLUSIONS: Interstitial boost with mEBRT is feasible, effective, and a novel approach for lingual epiglottic lesions.     

Small-cell carcinoma of the lung. Cytological, roentgenologic, and clinical findings in a consecutive series diagnosed by fine-needle aspiration biopsy.

Small-cell anaplastic carcinoma was diagnosed cytologically in 54 of 2,726 consecutive transthoracic fine-needle aspiration biopsies. Histological material was available in 31 cases (28 anaplastic small-cell carcinomas, 1 carcinoid tumor, 1 adenocarcinoma, and 1 reticulum-cell sarcoma). Fine-needle aspiration cytology is reliable enough to permit a definite diagnosis of small-cell carcinoma, especially when combined with the roentgenograms and clinical findings.     

Cervical osteophytes impinging on the pharynx: importance of size and concurrent disorders for development of aspiration

OBJECTIVE: This study evaluated the clinical significance of cervical osteophytes impinging on the pharynx in patients with dysphagia and the importance of concurrent disorders that may affect swallowing function. MATERIALS AND METHODS: On videofluoroscopy, anterior cervical osteophytes were found in 55 (32 men, 23 women; mean age, 69 years) of 3318 patients with dysphagia (1.7%). Coexisting diseases that affected swallowing function were found in 28 patients (stroke, n = 7; thyroidectomy, n = 7; tongue base or laryngeal cancer surgery, n = 5; other diseases, n = 9). Swallowing function was assessed with videofluoroscopy evaluating epiglottic tilting, laryngeal closure, impression of the hypopharynx, pharyngeal residue, and aspiration. RESULTS: With advancing age, the probability of aspiration (odds ratio, 1.07; p < 0.05) and of enlarging osteophytes (odds ratio, 1.26; p < 0.01) increased; the probability was higher for osteophytes at more than one vertebrae (odds ratio, 8.00; p < 0.01) and for concurrent diseases (odds ratio, 8.02; p < 0.01). Aspiration was found in 75% of patients with osteophytes larger than 10 mm and in 34% with osteophytes smaller than or equal to 10 mm. In 88% of patients with small osteophytes who aspirated, other diseases affected swallowing function. CONCLUSION: Aspiration is common in patients with dysphagia and cervical osteophytes larger than 10 mm. Aspiration is rare in patients with osteophytes smaller than or equal to 10 mm unless these patients suffer from other disorders that may affect swallowing.     

甲状腺乳头状癌临床检查方法的价值分析

目的探讨甲状腺乳头状癌常用临床检查手段的有效组合策略。方法总结我院自2002年1月—2010年7月收治的74例甲状腺乳头状癌患者的临床检查资料,对比超声、CT及细针穿刺细胞学检查3种检查中,每一单项、任意两项检查组合、三项检查组合对本病的阳性诊断率。结果超声、CT及细针穿刺细胞学检查对本病的诊断阳性率分别为55.4%、70.3%、73.0%,后两者比较差异无统计学意义(P>0.05);任意两项检查组合中,各组合之间比较,差异无统计学意义(P>0.05),且超声+CT组合对本病的诊断阳性结果与单项细针穿刺细胞学或CT检查结果无统计学差异(P>0.05);三项检查组合的诊断阳性率达98.6%。其余各组对比结果均有统计学差异(P<0.05)。结论单项CT或细针穿刺细胞学检查对本病的诊断阳性率高,同时行三项检查,对本病的诊断效能最高。     

Cervical osteophyte induced dysphagia

Although cervical spondylosis is a common disorder, dysphagia induced by osteophyte formation is uncommon. Fewer than one hundred cases of cervical osteophyte induced dysphagia have been reported, with little attention to the diagnosis by barium swallow. The radiological features of two cases treated surgically with good results are described. Both cases complained of dysphagia while one had associated respiratory obstruction on forward flexion of his neck. The features on barium study of cervical osteophytes causing dysphagia include deformity at the level of osteophyte formation, in both AP and lateral projections. Tracheal aspiration due to deformity at the laryngeal inlet and interference with epiglottic retroversion may be present.     

Esophagorespiratory fistula: long-term results of palliative treatment with covered expandable metallic stents in 61 patients

PURPOSE: To evaluate long-term clinical results of palliative treatment of esophagorespiratory fistulas (ERFs) with covered expandable metallic stents. MATERIALS AND METHODS: Sixty patients with ERFs due to esophageal or bronchogenic carcinoma and one patient with ERF due to pressure necrosis caused by initial esophageal stent placement for esophageal carcinoma were treated with covered expandable esophageal or tracheobronchial metallic stents. Information about technical success of stent placement, initial clinical success and failure, fistula reopening, and complications was obtained. Survival curves for both patient groups with initial clinical success and failure were obtained and compared with Kaplan-Meier methods and log-rank test. RESULTS: Stent placement was technically successful in all patients, with no immediate procedural complications. The stent completely sealed off the fistula in 49 (80%) of 61 patients so that they had no further aspiration symptoms (initial clinical success). Twelve (20%) of 61 patients had persistent aspiration symptoms due to incomplete ERF closure (initial clinical failure). During follow-up, the fistula reopened in 17 (35%) of 49 patients with initial clinical success: In eight patients, the reopened ERF was sealed off successfully with stent placement or balloon dilation. In two patients with reopened ERF caused by food impaction, the reopened fistula resolved spontaneously. Seven patients did not undergo further treatment. All patients died during follow-up, and mean survival was 13.4 weeks (range, 1-56 weeks) after stent placement. Mean survival in patients with initial clinical success was significantly longer than that in patients with initial clinical failure (15.1 vs 6.2 weeks, P <.05). CONCLUSION: Covered expandable metallic stents were placed in 61 patients with ERFs, but the initial clinical success rate was poor and the rate of reopening was high; however, interventional treatment was effective for sealing off reopened ERFs. Copyright RSNA, 2004     

Follicular thyroid carcinoma masquerading as subacute thyroiditis. Diagnosis using ultrasonography and radionuclide thyroid angiography

The rare presentation of a follicular thyroid carcinoma mimicking the clinical and radionuclide features of subacute thyroiditis is described. Granulomatous thyroiditis was initially suspected on the clinical basis of acute onset of a hard, tender right lobe thyroid enlargement with associated systemic symptoms, modest elevation of thyroid hormone levels and suppressed thyroid RAIU. Fine needle aspiration cytology specimens were unsatisfactory for characterization. Three weeks later the thyroid RAIU was normal. The thyroid enlargement persisted, now being clearly visualized as a hypofunctional nodule on scintiscan. Repeat fine needle aspiration cytology was suggestive of acinar proliferation with hyperfunction. Ultrasonography revealed a solid nodule with a peripheral sonolucent halo. Radionuclide angiography showed intense arterial flow of Tc-99m pertechnetate through the right lobe thyroid enlargement suggestive of malignant thyroid pathology. Surgical excision and histopathological examination revealed a follicular carcinoma involving the right lobe. The possibility of carcinomatous involvement should be considered in those patients where initially tender thyroid nodularity persists longer than expected for a benign inflammatory disease, careful follow-up and relevant investigations being necessary to confirm the diagnosis.     

Wegener granulomatosis of the breast

Two cases of Wegener granulomatosis of the breast are reported. In both cases, this rare disease was detected on mammographic examination and was diagnosed for the first time by a fine-needle aspiration biopsy of the breast. The mammographic findings can lead to misinterpretations and can be confused with advanced mammary carcinoma or the alterations caused by lymphoblastoma, leukemia, or Hodgkin disease. The total regression of the tumorlike lesions in the breast, evidence of involvement of the lung with only slight clinical symptoms, and a very protracted course of the disease were remarkable in both cases.     

Periureteral thin-needle aspiration biopsy

The relatively common occurrence of ureteral obstruction in patients with known malignancy elsewhere presents an interesting clinical problem. In those who have undergone abdominal surgery or radiation therapy for malignancy, it is difficult to determine whether ureteral obstruction is the complication of therapy or of recurrent metastatic carcinoma. Transperitoneal thin-needle aspiration biopsy provides an acceptable alternative in determining the true cause of the obstruction. This procedure is competitive with explorative surgery and laparoscopy and is much more specific than CT, excretory urography, and other imaging modalities. In our series of 32 patients, biopsy revealed metastatic tumor in 18 patients, thus altering their clinical management.     

Swallowing dysfunction in the postpolio syndrome: a cinefluorographic study.

Twenty patients with a remote history of poliomyelitis and recent or progressive dysphagia were evaluated with cinefluorography. Radiographic abnormalities were present in the pharynx in varying degrees in all but one of the patients. Findings included atrophy of the prevertebral soft tissues, unilateral or bilateral weakness of the tongue or soft palate, paresis or paralysis of the pharyngeal constrictor muscle, incomplete or absent epiglottic tilt, poor laryngeal elevation, poor laryngeal closure with laryngeal penetration, aspiration (often without a cough), and luminal narrowing at the cricopharyngeal level. Other structural lesions included a Zenker diverticulum in one patient, bilateral pharyngeal pouches in five, and a unilateral pouch in one. Additional structural lesions contributing to dysphagia were found in two other patients, including a focal stricture in the cervical esophagus in one patient and two stenotic rings in the distal esophagus in another. In four patients (one of whom had the Zenker diverticulum), the inferior constrictor muscle contracted forcibly above a prominent cricopharyngeus muscle, perhaps contributing to the formation of the diverticulum. It is important to examine postpolio patients with dysphagia carefully with dynamic imaging to assess the severity of decompensation and to detect other lesions that may be treatable. The information derived can be used to guide management.     

Detection of thyroid carcinoma in wall of a cystic lesion by FDG PET

PURPOSE: Three cases are described, in which positron emission tomography (PET) led to the diagnosis of carcinoma in solitary thyroid nodules (STN), which were considered benign by clinical assessment, ultrasonography, and fine needle aspiration cytology (FNAC). MATERIALS AND METHODS: These 3 cases were from a group of 51 patients with solitary thyroid nodules that were nonfunctioning or "cold" on pertechnetate scans that were later studied with FDG PET scanning. RESULTS: Of the entire group, 28 patients showed the nodule to be nonfunctioning on FDG scans. Of these, 3 showed one or more small foci of intense FDG uptake in the periphery. On histopathology, these sites were found to harbor carcinoma, papillary carcinoma in 2 patients and a follicular variant of papillary carcinoma in one. CONCLUSIONS: These cases demonstrate the usefulness of FDG PET in detection of cancer that may lurk in the wall of a cystic thyroid nodule, often misinterpreted as benign by conventional methods.     

CT or US-guided fine needle aspiration biopsy in gastric neoplasms

Gastric carcinoma of the linitis plastica type is occasionally difficult to diagnose endoscopically because of the large inflammatory response and the sparsity of tumor cells. Five patients who presented with signs and symptoms of gastric carcinoma underwent upper gastrointestinal endoscopy to confirm the diagnosis of carcinoma. In each case the gross appearance of the stomach was felt to represent gastric carcinoma but the biopsy and/or brushing specimens were unable to make the diagnosis. Ultrasound or CT in each of these five patients demonstrated thickening of the gastric wall and, in one instance, evidence of extensive metastatic disease. Fine needle aspiration biopsy was performed and a diagnosis of adenocarcinoma was made cytologically. Four were primary gastric adenocarcinoma of the linitis plastica type and one was metastatic adenocarcinoma from the breast. It is suggested that guided aspiration biopsy be performed when the diagnosis of gastric carcinoma cannot be confirmed endoscopically.     

Percutaneous needle evaluation of intradural extramedullary lesions of the lumbar spine

Summary A total of eight patients in whom five intradural extramedullary lesions and three epidural lesions were present were evaluated by percutaneous needle biopsy. In four patients the level of aspiration biopsy was determined using the initial myelogram and in those patients fluoroscopic guided percutaneous needle biopsies were performed. Three of these patients had large intradural extramedullary masses (above 1 cm); one patient had an epidural lesion. Diagnostic material was obtained in all cases (medulloblastoma, astrocytoma, small cell carcinoma, adenocarcinoma). Immediate post procedure CT and clinical followup showed no complications. In three patients with small lesions (below 1 cm), post myelographic CT was used to determine the level of aspiration. Post myelographic CT showed an intradural extramedullary mass in one patient and epidural lesions in two cases. Plain CT showed a high attenuation lesion in one patient. CT guided percutaneous needle biopsies in these four patients yielded diagnostic specimens (neurofibroma, uroepithelial carcinoma, hematoma, Thorotrast deposit). Clinical follow up showed no complications. Our experience indicates that percutaneous needle biopsy of intradural extramedullary and epidural lesions of the lumbar spine is safe and efficacious. Depending upon the size of the lesions, myelography or CT can be utilized to determine the level of aspiration.     

Surveillance CT and the prompt use of CT-guided fine-needle aspiration in patients with head and neck cancer who have undergone surgery

OBJECTIVE: The purpose of this study was to assess the usefulness of prompt CT-guided fine-needle aspiration in the evaluation of suspected tumor recurrence seen on surveillance images of patients who had undergone surgery for head and neck cancer. SUBJECTS AND METHODS: We reviewed 32 patients who had undergone CT-guided fine-needle aspiration after surgery for head and neck cancer. CT-guided fine-needle aspiration was performed with a 22-gauge spinal needle and a cytopathologist was present to assess the adequacy of the biopsy sample. As many as five needle passes were made. RESULTS: Of the 32 cases, pathologic findings revealed squamous cell carcinoma (n = 27), mucoepidermoid carcinoma (n = 2), neuroendocrine carcinoma (n = 1), papillary thyroid carcinoma (n = 1), and adenocarcinoma (n = 1). In 20 cases (62.5%) the results of CT-guided fine-needle aspiration were positive for tumor recurrence, whereas in 11 cases (34.4%) the results were negative. In one case (3.1%) the results were nondiagnostic. Of the 11 patients with negative findings on CT-guided fine-needle aspiration, two patients had a subsequent recurrence that was not at the biopsy site. There were no complications from the procedure. CONCLUSION: When a radiologist who is trained in head and neck imaging identifies with CT a possible early recurrence of tumor, the prompt use of CT-guided fine-needle aspiration is an effective way to diagnose these tumors so that appropriate treatment can be initiated.