Subtle Dysphagia as an Initial Presentation of Hidden Malignancy: A Report of 2 Cases
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Subtle dysfphagia, which is increased post-swallowing remnants, is a frequent finding in the elderly with variousetiologies. These changes in swallowing are frequently overlooked by physicians. On the other hand, subtlechanges evident on a videofluoroscopic swallowing study (VFSS) may suggest hidden disease. Therefore, cliniciansshould evaluate incidental dysphagia. Case 1: A 65-year-old man with no relevant medical history, presented withdysphagia and residual sensation during meals. VFSS showed moderate post-swallowing remnants in the vallecularfossa and pyriformis sinus. Further examination revealed prostate cancer with multiple bone metastases including theskull. Case 2: A 60-year-old man complained of residual sensation after swallowing, which started 2 months ago. He had a history of lung cancer. Pharyngeal residue was observed on VFSS. A brain metastasis was observed onMRI. Post-swallowing residue is often neglected or overlooked by clinicians who regard them as the features ofaging. The present cases show that mild dysphagia with increased post-swallowing remnants may be an initial presentationof a hidden malignancy with metastasis. Physicians should consider unexplained dysphagia or tongue atrophyas possible initial presentations of hidden malignancies.
Abstract
Subtle dysfphagia, which is increased post-swallowing remnants, is a frequent finding in the elderly with variousetiologies. These changes in swallowing are frequently overlooked by physicians. On the other hand, subtlechanges evident on a videofluoroscopic swallowing study (VFSS) may suggest hidden disease. Therefore, cliniciansshould evaluate incidental dysphagia. Case 1: A 65-year-old man with no relevant medical history, presented withdysphagia and residual sensation during meals. VFSS showed moderate post-swallowing remnants in the vallecularfossa and pyriformis sinus. Further examination revealed prostate cancer with multiple bone metastases including theskull. Case 2: A 60-year-old man complained of residual sensation after swallowing, which started 2 months ago. He had a history of lung cancer. Pharyngeal residue was observed on VFSS. A brain metastasis was observed onMRI. Post-swallowing residue is often neglected or overlooked by clinicians who regard them as the features ofaging. The present cases show that mild dysphagia with increased post-swallowing remnants may be an initial presentationof a hidden malignancy with metastasis. Physicians should consider unexplained dysphagia or tongue atrophyas possible initial presentations of hidden malignancies.
참고문헌 (13)
- Dejaeger E, "Mechanisms involved in postdeglutition retention in the elderly", Dysphagia, 12, pp.63~67 (1997)
- Cook IJ, "Influence of aging on oral-pharyngeal bolus transit and clearance during swallowing: scintigraphic study", Am J Physiol, 266, pp.G972~G977 (1994)
- Ekberg O, "Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases", AJR Am J Roentgenol, 156, pp.1181~1184 (1991)
- Robbins J, "Oropharyngeal swallowing in normal adults of different ages", Gastroenterology, 103, pp.823~829 (1992)
- Tracy JF, "Preliminary observations on the effects of age on oropharyngeal deglutition", Dysphagia, 4, pp.90~94 (1989)
- Mulheren RW, "Swallowing Changes in Community-Dwelling Older Adults", Dysphagia, 33, pp.848~856 (2018)
- Hong J, "Dysphagia after Occipitocervical Fusion", N Engl J Med, 376, pp.e46~ (2017)
- Sonja M. Molfenter, "Volumetric Changes to the Pharynx in Healthy Aging: Consequence for Pharyngeal Swallow Mechanics and Function", Dysphagia, 34(1), pp.129~137 (2019), Springer Science and Business Media LLC[DOI]
- Raber-Durlacher JE, "Swallowing dysfunction in cancer patients", Support Care Cancer, 20, pp.433~443 (2012)
- Camidge DR., "The causes of dysphagia in carcinoma of the lung", JRSM, 94, pp.567~572 (2001)
- Rangarathnam B, "Role of cerebellum in deglutition and deglutition disorders", Cerebellum, 13, pp.767~776 (2014)
- Raizer JJ, "Brain Metastases" (2007), Springer US
- Stokely SL, "The Relationship Between Pharyngeal Constriction and Post-swallow Residue", Dysphagia, 30, pp.349~356 (2015)