One of the many tricky things about reading an MBS study is that they are literally (not figuratively) black and white. What this means for the SLP is that structures can look like barium (and vice versa) and distinguishing the two is critical. We have talked here before about obtaining a baseline, or “scout”, image prior to giving the patient anything with barium…and for patients with calcification of the laryngeal cartilages, this is even more important. Many of the places in which calcification shows up are also the places that aspiration and residues happen, so overinterpretation of MBS studies can be an easy mistake to make.
The video montage here highlights several examples of calcification that can easily be mistaken for aspiration or residues, including calcification of the hyoid, arytenoids, epiglottis (rare), carotids, tracheal rings, and finishes up with an interesting case of a calcified lymph node that looks like a piece of cocktail shrimp.
When beginning a study, take a quick image, then give yourself a few minutes to become familiar with that patient’s unique appearance before introducing barium. It might take you a little extra time in the Rad suite, but it can save you time during the study and/or review when you’re not sure if you’re seeing aspiration or something that was already there. And even more importantly, can save your patient from an unnecessarily restrictive recommendation if you mistake what you’re seeing.
Being confident in the anatomy of the entire head and neck region, including bones, cartilages, ligaments, arteries, etc. is important for every SLP completing MBS studies. Only by having this strong knowledge base can we accurately interpret the study.. and make valid recommendations for our patients.
See links below for more information on calcification!