First AD

Second AD

A 74 year old woman with complaints of food “sticking” in her throat.

This is a dramatic example of a pseudotumor, so called because, if a flat film were made at the point of extreme extension, it would probably be mistaken for a tumor. The anterior bulging of the pharynx seen developing is common in long standing dysphagia, possibly as an attempt to protect the entrance to the airway which is normally accomplished by contact between the arytenoids and the base of the epiglottis. It is presumed to be achieved by extreme tension of the pharyngeal constrictor muscles. It is interesting that, although aspirating constantly for many years, this woman never developed any respiratory disease/infection although it is mistakenly assumed that any and all aspiration will lead to pneumonia. The facts are these: Aspiration pneumonia, as distinct from aspiration pneumonitis, occurs in the following circumstances:

4. Most importantly, the condition of the patient’s immune response. 

All four variables must be considered together.

The cause of this patient’s dysphagia was the adverse effect of 30 years of psychotropic medications including antipsychotics, well known to negatively affect swallowing. In this case, because of no history of respiratory involvement, there was no need to change or restrict her intake. Reassurance with respect to her fear of cancer was sufficient.

(Please note: This is not an example of the more common inflammatory pharyngeal pseudotumor.)

1. Rudolph JL, Gardner KF, Gramigna GD, McGlinchey RE. Antipsychotics and oropharyngeal dysphagia in hospitalized older patients

2. Sokoloff LG1, Pavlakovic R. Neuroleptic-induced dysphagia. 

3. Gonzalez F. Extrapyramidal syndrome presenting as dysphagia: a case report. 

 Edition.Mahmood F. Mafee , Galdino E. Valbasson, Minerva Becker, J S Lewin (Eds) 2004. Thieme Publishers 2004.

Image IQ

74-year-old woman complains of food “sticking” in her throat.

Image IQ: Food “Sticks” in Throat

Irene Campbell-Taylor, MB ChB, PhD