Ihe diagnosis of the underlying pathology of dysphagia is most often made outside of the emergency department (ED). Ihe workup is dependent on whether transfer or transport dysphagia is thought to be present, as noted above. Initial evaluation of dysphagia in the ED can include anteroposterior (AP) and lateral neck radiographs, which can be helpful in transfer dysphagia and cases where the transport dysfunction seems proximal. Chest radiography should be obtained in most patients thought to have transport dysphagia. Direct laryngoscopy can be used to identify structural lesions.

Ultimately, oropharyngeal dysphagia is best worked up with videoesophagography, a specialized form of a barium swallow study in which videotaped images are reviewed at low-speed playback to allow detailed analysis. Iraditional barium swallow is usually the first test for patients with transport dysphagia. Manometry and esophagoscopy are also employed, depending on the clinical picture. If a foreign body is suspected, the diagnostic workup takes yet another path (see Chap 72,

"Swallowed Foreign Bodies").

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