Modified Mondays: Incidental findings

We all know that instrumental assessments should include a good look at the anatomy and physiology of the swallow mechanism. However, it can be really easy to miss some questionable anatomy when the physiology is A-OK. This case from our Wisconsin team highlights just such a situation.

The patient had some complaints of feeling like food was “still in his throat after swallowing” as well as decreased PO intake and weight loss. Medical history of dementia, COVID-19 and remote CVA. Clinically, the facility SLP noted multiple swallows per bolus, and suspected weakness leaving residues in the pharynx.

Our team found a pretty decent swallow, and very little residue. It would have been easy at this point to say “No problems! Eat what ya want! No aspiration here!”, but our SLP, upon review, noted some bulging at the base of tongue… and a somewhat “thick” appearance at the anterior UES. Our Radiologist confirmed both as areas of concern, and we made the recommendation for direct visualization with an ENT referral.

Reviews of the studies are critical. Swallowing – especially in a lovely swallow like this one – happens fast. During the review, remembering to look at all aspects of the swallow mechanism (the good, the bad, and the wonky looking) is an important part of making ALL the recommendations needed for the patient, whether it’s therapy…or further work up.