This pathophysiology diagram illustrates a hypothesized neurological mechanism for post-stroke dysphagia (PSD) and aspiration following a lesion in the insular cortex. The visual is divided into three sections: a cortical view, a sagittal brain section, and a peripheral anatomical view. The process begins with sensory inputs from peripheral organs (tongue, bronchial, and esophagus) directed via green arrows (promotion) to the brainstem. In the brainstem, the swallowing center pattern generator (swCPG) and respiratory center pattern generator (rCPG) are depicted as adjacent ovals with a red horizontal line indicating reciprocal inhibition. Information flows from the brainstem to the thalamus, which serves as a central relay station, and subsequently to the insular cortex. A red starburst in the insular cortex represents a stroke or disturbance. Red arrows indicate that this cortical damage disrupts the thalamic and brainstem pathways, specifically interfering with the swCPG/rCPG reciprocal inhibition. The final outcome is shown in a cross-sectional view of the throat and lungs, where a red bolus is seen entering the trachea, labeled 'Aspiration,' signifying a failure of airway protection mechanisms.

This composite educational image illustrates the use of ultrasonography for evaluating pharyngeal residue in patients with dysphagia. It is divided into two sections, (a) and (b), each featuring a probe placement diagram, a transverse ultrasound scan, and a corresponding labeled schematic. Row (a) demonstrates the visualization of the epiglottic vallecula. The probe is positioned submentally at the level of the hyoid bone. The ultrasound reveals a distinct hyperechoic area within the vallecular space, indicating food or liquid residue. Row (b) illustrates the assessment of the pyriform sinus. The probe is placed lower on the lateral neck at the level of the laryngeal prominence. Key anatomical landmarks include the thyroid cartilage and the common carotid artery, which serve as orientation points for the pyriform sinus. In this view, a smaller hyperechoic residue is visible within the sinus. This diagnostic imaging modality provides a non-invasive method for detecting post-swallow residue, aiding in the clinical management of swallowing disorders.

This diagnostic image is a 3D CT angiography reconstruction of the aortic arch and supra-aortic vessels, illustrating a treatment plan for Dysphagia Lusoria. The primary pathology shown is an Aberrant Right Subclavian Artery (ARSA), which originates as the last branch of the aortic arch and takes a retroesophageal course. The diagram annotates a surgical strategy for bilateral carotid-to-subclavian transposition. Key anatomical labels include the Right Common Carotid Artery and Left Common Carotid Artery, with yellow arrows indicating the proposed transposition of both the ARSA and the Left Subclavian Artery to their respective ipsilateral common carotid arteries. This vascular reconstruction highlights the relationship between the aberrant vessel and the esophageal compression site. The image serves as a clinical algorithm for hybrid surgical management, focusing on the debranching and revascularization of the upper extremities to relieve symptomatic compression while maintaining distal perfusion. Target audience includes vascular surgeons and radiologists studying congenital aortic arch anomalies.

Summary : This figure presents a categorized list of other causes of chronic cough, divided into intrathoracic and extrathoracic origins, as shown in Figure 2.2. list diagram: # Categories : ## Intrathoracic : • Asthma • Lung Cancer • Tuberculosis • Bronchiectasis • Left Heart Failure • Interstitial Lung Disease • Cystic Fibrosis • Idiopathic Cough ## Extrathoracic : • Chronic Allergic Rhinitis • Post Nasal Drip Syndrome (PNDS) • Upper Airway Cough Syndrome (UACS) • Gastroesophageal Reflux • Medication (e.g., ACE Inhibitors) # Layout : • Two adjacent boxes, each with a heading and bulleted list. • Left box: "INTRATHORACIC" causes. • Right box: "EXTRATHORACIC" causes. # Figure Label : • Figure 2.2 in upper right corner. # Analysis : • The figure clearly distinguishes between causes of chronic cough originating within the thorax (primarily pulmonary and cardiac conditions) and those outside the thorax (mainly upper airway, gastrointestinal, and medication-related causes). • Intrathoracic causes are more disease-specific, while extrathoracic causes include syndromes and external factors. • This classification aids in systematic differential diagnosis for chronic cough.

A lateral view videofluoroscopic swallowing study (VFSS) image demonstrating oropharyngeal dysphagia. The image captures the cervical spine and the pharyngeal/esophageal soft tissue structures during the transit of a radiopaque contrast bolus. A prominent anterior osteophyte at the C5 vertebral body level (indicated by a black arrow) causes focal extrinsic compression and narrowing of the proximal cervical esophagus. This mechanical obstruction leads to the stasis and pooling of the contrast material above the upper esophageal sphincter. Significantly, contrast is seen misdirected into the laryngeal vestibule and trachea (indicated by a red arrow), confirming laryngeal penetration and tracheal aspiration. This diagnostic image illustrates the clinical relationship between cervical spondylosis (DISH or severe osteophytosis) and mechanical dysphagia, highlighting the risk of respiratory complications due to impaired bolus clearance and subsequent airway entry.

This diagnostic image consists of three lateral-view cervical esophagrams (fluoroscopic barium swallow study) demonstrating oropharyngeal dysphagia and mechanical obstruction. The first panel highlights prevertebral soft tissue swelling at the C3–C4 level (white circle), which causes extrinsic compression and anterior displacement of the esophagus. The subsequent panels illustrate functional swallowing impairment: radiopaque contrast material is seen abnormally pooling within the laryngeal vestibule and epiglottic space. White arrows indicate laryngeal penetration and aspiration, where contrast moves anteriorly into the airway rather than proceeding through the upper esophageal sphincter. These findings are clinically significant for diagnosing mechanical dysphagia, in this case secondary to an anteriorly extruded cervical disc. Key educational concepts include the radiographic identification of aspiration, the assessment of prevertebral soft tissue thickness, and the recognition of extrinsic esophageal compression in the context of cervical spine pathology.

This composite educational clinical figure illustrates oropharyngeal and esophageal pathologies contributing to dysphagia. Image (a) is a transoral endoscopic view of an 87-year-old patient showcasing post-surgical changes following an extended partial resection of the right oropharynx and neck dissection. Visible features include a disrupted pharyngeal wall structure on the right and distorted mucosa consistent with radiotherapy and chemotherapy effects. Image (b) presents a transnasal endoscopic view of the velum and posterior oropharyngeal wall. It demonstrates significant scarring and asymmetrical contraction of the right-sided velum, with visible scar tissue extending across the posterior pharyngeal wall. Prominent white, viscous saliva is seen spanning the lumen, indicating impaired clearance and a transportation disorder. Image (c) is a contrast radiography (barium swallow) from a different patient, identifying tissue formations (indicated by an arrow) in the pharynx or esophagus that create mechanical obstacles. Together, these images teach how oncological treatments, scarring, and structural abnormalities disrupt the swallowing mechanism.

This composite medical image displays a case of esophageal leiomyoma through two modalities: diagnostic radiology and endoscopy. Panel A is a contrast esophagogram (barium swallow) showing an intramural tumor (T) in the distal esophagus (E) near the gastroesophageal junction. The lesion presents as a smooth, well-defined filling defect with sharp angles at its superior and inferior borders, characteristic of a benign intramural mass. Panel B is an intraluminal endoscopic photograph of the same tumor (T). It reveals a submucosal, rounded, protruding mass with an intact, smooth overlying mucosal surface, which is typical for a leiomyoma. The image illustrates key diagnostic features used to differentiate benign mesenchymal esophageal tumors from malignant mucosal lesions. These findings are clinically significant for planning surgical enucleation, often performed via video-assisted thoracoscopic surgery (VATS).

Educational composite image documenting an esophageal leiomyoma through multiple modalities. The top row features an Endoscopic Ultrasonography (EUS) scan showing a hypoechoic, well-circumscribed mass originating from the muscularis propria, alongside an initial endoscopic view of a subepithelial bulge. The middle row presents white-light endoscopy images of a raised, smooth-surfaced, hemispherical subepithelial tumor (SET) protruding into the esophageal lumen, showing intact overlying mucosa and normal vascularity. The bottom row displays a gross specimen measured against a centimeter scale, followed by histopathological analysis. The Hematoxylin and Eosin (H&E) stain shows fascicles of spindle cells with eosinophilic cytoplasm and minimal atypia. A corresponding immunohistochemistry (IHC) slide labeled 'SAM(+)' shows strong diffuse positive staining for smooth muscle actin (SMA), while the accompanying text notes negative results for CD117, DOG-1, and S100, and a low Ki-67 proliferation index (<1%), confirming the diagnosis of a benign mesenchymal tumor of myogenic origin.

This composite figure illustrates the multi-modal diagnostic and surgical management of an esophageal leiomyoma at the esophagogastric junction. (a) Coronal CT scan shows a low-density mass (red arrow) near the mediastinal-abdominal transition. (b) White-light endoscopy reveals a large submucosal bulge with smooth, intact overlying mucosa. (c) A 3D anatomical reconstruction maps the 4.3 cm x 6.2 cm tumor's relationship to the aorta and stomach. (d) Endoscopic ultrasound (EUS) characterizes the lesion as a hypoechoic mass originating from the muscularis propria. (e-f) Intraoperative endoscopic images demonstrate the resection process: the tumor is detached from the muscular layers using a HookKnife and snare-assisted traction. (g) The excised specimen is shown segmented within the gastric lumen prior to extraction. (h) The final panel shows the closure of the mucosal defect using the kissing suture technique with endoscopic clips and sutures. This series highlights the progression from diagnostic imaging and EUS localization to complete endoscopic resection of a gastrointestinal stromal-type tumor.