Diagnosis and Treatment of Pediatric Dysphagia: Radiography

Multiple radiographic studies are used to diagnose aspiration and dysphagia in children. Imaging studies, such as chest radiographs and computed tomography of the chest, are not specifically used for diagnosis of aspiration, but can show evidence of damage suggestive of aspiration, and can also be useful in determining the extent of lung injury from chronic aspiration. Chest radiographic findings of aspiration include hyperinflation, peribronchial thickening, and localized infiltrates. Chest CT is more sensitive than chest x-ray for early changes from aspiration, and characteristic findings include bronchial wall thickening, air trapping, and eventually bronchiectasis, honeycombing, and diffuse ground-glass opacities. While videofluoroscopic swallowing study is the most commonly used radiographic modality for diagnosis of aspiration, other studies including gastroesophageal scintigraphy and the radionuclide salivagram may also be used for detecting aspiration. Poor sensitivity of these studies and poor agreement between tests have limited their clinical utility and point to the difficulty of establishing a gold standard radiographic study for diagnosis of aspiration.