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Background
Modified barium swallow (MBS) examinations (video fluoroscopic swallowing exams) represent an increasing proportion of fluoroscopy studies being performed with a primary focus on aspiration and the swallowing mechanism. Important structural findings contributing to a patient’s swallowing dysfunction can be found in the MBS study, and radiologists must be able to recognize these findings despite often suboptimal image quality. We will review a spectrum of imaging findings that can be seen on MBS and their potential impact on patient management.

Educational Goals / Teaching Points
MBS is an increasingly common fluoroscopic procedure performed in conjunction with speech language pathology (SLP), with a primary goal of assessing a patient’s ability to swallow various consistencies safely and effectively. Although the primary focus of the examination is to assess the swallowing mechanism and detect laryngeal penetration and aspiration, a variety of often unexpected findings may be seen during the examination and must be appropriately recognized. Many of these findings may significantly impact patient management beyond the scope of SLP and some may contribute to swallowing dysfunction or aspiration.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We will review a spectrum of potential unexpected findings on MBS including tracheoesophageal fistula, pharyngeal mass, esophageal pill impaction, upper esophageal diverticula, leak, post radiation change, strictures, webs and cricopharyngeal dysfunction. These findings are often much more difficult to identify on MBS as compared with esophagography, due to video/cine capture rather than diagnostic quality spot imaging.

Conclusion
MBS examinations are primarily intended to provide functional information about the swallowing mechanism; however, a variety of unexpected structural findings may be seen that may significantly impact patient management and are important to recognize.