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Clinical Problem Solving
July 2014

Progressive Dysphagia in a Patient With a History of Cervical Spine Fusion

Author Affiliations
  • 1Temple University School of Medicine, Philadelphia, Pennsylvania
JAMA Otolaryngol Head Neck Surg. 2014;140(7):675-676. doi:10.1001/jamaoto.2014.787

A man in his 30s presented with a chief complaint of having coughed up a metallic screw. He reported progressive dysphagia and choking spells with liquids over the previous 6 months and had a recent admission for pneumonia. His medical history was notable for anterior cervical spine plating and fusion after a diving accident 11 years earlier with resultant paraplegia.

Examination revealed a wheelchair-bound young man in no acute distress. The right aspect of the neck had a well-healed scar along the anterior border of the sternocleidomastoid muscle. Flexible laryngoscopy revealed an immobile right true vocal fold with anterior location of the arytenoid. Findings from the remainder of his head and neck examination was normal. His workup included computed tomography of the neck (Figure 1A) and a barium esophagram (Figure 1B).

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