Clinical Query

Very happy to note your efforts have taken off and now our members are looking up this site for upcoming conferences and CMEs. And you have fantastic links too.

I would suggest you add a discussion board too; if there is one, I couldn't locate it.

If you start one, can you pls add my this query:

I would like to have your advice for the following patient.

60 yr old male, has been having dysphagia and chokes on fluids and solids
for about 2 yrs or more. The daughter who happens to be our nurse, says it
is a pain to watch him taking food.

His X-ray neck lateral shows big osteophytes between C2-3, C3-4, C4-5, C5-6,
and C5-7. The ones C4-5-6 looks like a single unit. They are big and roughly
measures the antero-posterior diameter of the corresponding vertebral body.

A CT done 2 yr back revealed nothing more than this. We couldn't do a
Barium swallow for flimsy reasons, but it could be done about a week back,
and since the software to record the same didn't work, we had to be
contented by just seeing what was seen during fluoroscopy. The barium went
down without any hitch, sliding in front and below the "C" projection of the
C4-5-6-7osteophytes at the root of neck.

We sent him to our Orthopaedician, who asked for an MRI; but it couldn't be
done, as he was unable to lie down for the same because of pain (Radiologist
told the nurse-daughter) Hence a repeat CT was done (Is the position for CT
different from MRI?), which showed no change from the previous CT.

What next?
I have posted the Xray Neck Lateral and a section of CT here:
Best rgds,

Dr.Thomas Antony
Aden,Rep of Yemen