Clinically, this patient could seem like a “straight up” cause of dysphagia. They have a trach, patient underwent blue dye screening that showed blue dye being suctioned from the airway. Definitely aspirating? Probably because of the trach, right? Maybe not. (For information on trachs and swallowing, see our earlier #MM).
The facility SLP still ordered the MBS study, since she recognized that she didn’t know WHY the patient was aspirating… and our Cleveland market SLP noticed right away that the epiglottis didn’t look quite right. You can see that it is quite a bit thicker than usual. Our SLP was concerned about epiglottitis, and recommended an ENT consult quickly. It turned out to be a mass, so the facility and our MBS Envision team (and the patient) were very happy that everyone involved acted so speedily. (The patient also has carotid plaque, if you want to see great example-notice it pulsing during the clip.)
This patient is a good reminder that even if we know that a patient is aspirating, and it might seem clinically “obvious”, we still need an instrumental to ensure a proper plan of care. We also need to be very aware of what normal looks like, so that we can spot those structural abnormalities. (Need to see more normal? Check out our very first #MM clip!)