Siraj Q H, McClenahan R, Hilson AJW.
A novel Scintigraphic approach for the detection and evaluation of Bronchopulmonary aspiration.
J Pak Med Assoc Jan ;54(4):219-21.

A 55-year-old man with a history of alcohol abuse, was initially treated with radiotherapy and chemotherapy for carcinoma of the larynx involving the piriform fossa. Treatment was complicated by cavitating disease at the apices of the lungs, which was treated with six months of anti-tuberculous chemotherapy. He subsequently developed periodic mild dysphagia with the sensation of food sticking at the level of the xiphisternum, and lost 30 kg in weight over the following two years. The patient was readmitted after three years with a sudden onset of right sided hemiparesis. CT showed an area of haemorrhage centred on the left lentiform nucleus. The hemiparesis improved over the next few days. Bedside assessment of his dysphagia indicated that oral intake of any consistency was unsafe. A gastrostomy was performed and patient was fed and hydrated exclusively via the gastrostomy tube and was discharged home on this regime. However, the patient showed poor compliance, started supplementing his gastrostomy feeds with regular oral meals. He was considered clinically at a high risk for bronchopulmonary aspiration (BPA) and was advised to confine to gastrostomy feeding. The patient was referred to the nuclear medicine department for further investigation. Pulmonary ventilation scanning was performed using Kr-81m eluted from a 10 mCi Rb-81 generator. Baseline lung scan showed loss of ventilation in the lower lobe of the left lung with a subsegmental defect in its antero-apical segment.

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