J Korean Dysphagia Soc.  2019 Jan;9(1):46-49. 10.0000/jkdps.2019.9.1.46.

Subtle Dysphagia as an Initial Presentation of Hidden Malignancy: A Report of 2 Cases

Affiliations
  • 1Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. seonghoon@catholic.ac.kr
  • 2Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Abstract

Subtle dysfphagia, which is increased post-swallowing remnants, is a frequent finding in the elderly with various etiologies. These changes in swallowing are frequently overlooked by physicians. On the other hand, subtle changes evident on a videofluoroscopic swallowing study (VFSS) may suggest hidden disease. Therefore, clinicians should evaluate incidental dysphagia. Case 1: A 65-year-old man with no relevant medical history, presented with dysphagia and residual sensation during meals. VFSS showed moderate post-swallowing remnants in the vallecular fossa and pyriformis sinus. Further examination revealed prostate cancer with multiple bone metastases including the skull. Case 2: A 60-year-old man complained of residual sensation after swallowing, which started 2 months ago. He had a history of lung cancer. Pharyngeal residue was observed on VFSS. A brain metastasis was observed on MRI. Post-swallowing residue is often neglected or overlooked by clinicians who regard them as the features of aging. The present cases show that mild dysphagia with increased post-swallowing remnants may be an initial presentation of a hidden malignancy with metastasis. Physicians should consider unexplained dysphagia or tongue atrophy as possible initial presentations of hidden malignancies.

Keyword

Dysphagia; Post-swallowing remnant; Metastasis; Cancer; Initial presentation
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