Salivagram revisited: justifying its routine use for the evaluation of persistent/recurrent lower respiratory tract infe
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ORIGINAL ARTICLE
Salivagram revisited: justifying its routine use for the evaluation of persistent/recurrent lower respiratory tract infections in developmentally normal children Vijay Harish Somasundaram • Padma Subramanyam Shanmugasundaram Palaniswamy
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Received: 3 February 2012 / Accepted: 28 May 2012 / Published online: 20 June 2012 The Japanese Society of Nuclear Medicine 2012
Abstract Purpose To assess and establish the utility of radionuclide salivagram in the routine evaluation of developmentally normal children with persistent/recurrent lower respiratory tract infection. Methods 113 neurodevelopmentally normal children diagnosed with persistent/recurrent lower respiratory tract infection underwent a salivagram and a milk scan on two consecutive days. Frequency of detection of pulmonary aspiration by either procedure individually and increment in detection rates on combining the two were assessed. The agreement between the tests was also studied. Results Antegrade pulmonary aspiration was demonstrated using the salivagram in 39.2 % of infants and 16.1 % of children between the ages of 1 and 2 years. No antegrade aspiration was seen in children above the age of 2 years. 44 % of all antegrade aspirations identified were bilateral, while remaining 66 % were into the right lung. Milk scan revealed gastroesophageal reflux in 38 % of children and most commonly in those above the age of 2 years. Diagnosis of pulmonary aspiration as an underlying cause of the lung pathology increased from 38 % with the use of milk scan alone to 53.9 % on combining the procedures. There was a poor agreement between the two procedures (kappa -0.103). Conclusion Antegrade pulmonary aspiration can be demonstrated as an underlying cause for persistent/recurrent lower respiratory tract infection in developmentally
V. H. Somasundaram (&) P. Subramanyam S. Palaniswamy Department of Nuclear Medicine and PET-CT, Amrita School of Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Lane, Ponekkara P.O., Kochi 682041, India e-mail: [email protected]
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normal children, with age being an important clinical predictor. Combined use of salivagram and milk scan is warranted to objectively evaluate pulmonary aspiration in children. Keywords Salivagram Milk scan Pulmonary aspiration Persistent/recurrent pneumonia Gastroesophageal reflux
Introduction Direct antegrade pulmonary aspiration with dysfunctional swallowing is known to be a more common cause of recurrent respiratory tract infections than retrograde aspiration resulting from gastroesophageal reflux (GER) [1]; nevertheless, lung disease is usually associated with the latter. The reason for this is the combination of easier detection of GER and underutilisation of appropriate techniques to assess antegrade aspiration. Though the ‘milk scan’/GER scintigraphy is recognised as a diagnostic test in the routine evaluation of aspiration, the same is not for the salivagram. The milk scan often only demonstrates the presence of GER and not the actual en
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