Simons et al identified several findings predictive of a positive salivagram in a pediatric patient. These can help identify patients who are more likely to have chronic aspiration. The authors are from Children's Hospital of Pittsburgh and the University of Pittsburgh.
The radionuclide salivagram consists of sublingual placement of a small amount of a technetium 99 m sulfur colloid solution. A gamma camera is used over 1-4 hours to follow the radionuclide as the saliva is swallowed. A positive salivagram is when the radionuclide is seen in the tracheobronchial tree. A negative salivagram is when all of the radionuclide enters the stomach.
Predictors of a positive salivagram:
(1) history of chronic pneumonia or other respiratory infections
(2) history of therapy with an anti-reflux medication (H2 blocker, proton pump inhibitor)
(3) presence of developmental delay
(4) multiple exacerbations of reactive airway disease
A patient with one or more of these predictors should be evaluated with a high level of suspicion for aspiration.
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