This is GREAT share from our newest Detroit SLP, Claire, and our Director of Clinical Services and Operations, Elizabeth Musto.
This patient was post MVA with a capped trach, had a couple prior instrumentals, FEES and MBS, both of which recommended a diet, which was initiated. The patient developed aspiration pneumonia and then a choking episode, after which they refused to eat due to fear. Our MBS showed a pretty significant tracheoesophageal fistula, which the patient aspirates through. This is an important example of how ensuring a quality image and positioning can be. Had our team not made sure the shoulder was dropped a bit, they might have missed it. Fortunately, they were able to spot it quickly and make the ENT referral.
Below is a link to a case study on acquired tracheoesophageal fistulas, it has a really informative introduction on this rare finding.
PS The two dark lines under the mandible is the nose piece to the patient’s mask. I was very confused when Elizabeth first sent me this video. ;)