Modified Mondays: Hold on, just “web” a second…
Today’s Modified Monday features a large web which spans half the diameter of the esophagus. Thin liquids vividly outline the web, but as you’ll see in the video, when given puree the web is not apparent. This is typical with esophageal webs, they tend to be seen better with liquids versus puree or solids. Because of this, along with the clinician not focusing on the anterior cervical esophagus during the test, a web can easily be missed. A study review, which should always be completed, will give a therapist a second chance to see this esophageal protrusion.
Some might stop the study after the lateral view since the cause of this patient having food stuck in her throat was revealed. But was it? What if the patient was also having a referred sensation from esophageal dysmotility? In addition, the patient had aspiration pneumonia which might not be explained by the presence of the web. This patient was turned to AP view and the remainder of the esophagus was imaged. The patient had apparent dysmotility with a large column of barium remaining in the esophagus.
Note: Webs and dysmotility cannot be diagnosed by an SLP. A description can be written in the SLP report (shelf-like protrusion from the anterior cervical esophagus) and the radiologist can diagnose. SLP requested a GI consult for this patient.
LearningRadiology - esophageal, web, esophagus, plummer, vinson, syndrome, patterson, kelly, dysphagia, radiology, barium
Esophageal Webs and Rings: Pictures, Treatment, Causes, and More (healthline.com)