Атлас по рентгенологии травмированных собак и кошек / an-atlas-of-radiology-of-the-traumatized-dog-and-cat

182 Radiology of Thoracic Trauma

Case 2.93

2

Day 1

Signalment/History: “Abby” was a 3-year-old, female mixed breed who had been intermittently retching after having eaten a “rawhide bone” eight days earlier. Referral radiographs were available for examination.

Radiographic diagnosis (day 1, referral lateral view only): An increase in fluid density in the dorsocranial mediastinum suggested the presence of a radiolucent esophageal lesion, possible a foreign body. A localized mediastinitis associated with the lesion could explain the presence of some of the fluid. No evidence of a pulmonary lesion was noted.

Radiographic diagnosis (day 3, referral lateral view only): The mediastinal mass had a similar appearance as on day 1.

Radiographic diagnosis (day 3, referral lateral view only with barium sulfate swallow): The contrast swallow identified a linear intraluminal object within the distended esophagus over the heart base. A part of the swallow had passed into the stomach.

Esophageal foreign bodies 183

2

Day 3

Day 3, barium swallow

184 Radiology of Thoracic Trauma

2

Day 4

Radiographic diagnosis (day 4, referral DV and lateral view): The liquid density mass over the heart base was unchanged. However, collapse of the right cranial lobe with an air-bronchogram pattern was indicative of collapse due to aspiration pneumonia or an obstructive atelectasis associated with an extrabronchial mass.

Treatment/Management: The pulmonary lesion compromised what might have been a simple esophageal foreign body and suggests penetration or a periesophageal inflammatory lesion. “Abby” died shortly after surgical removal of the esophageal foreign body due to a ruptured esophagus. It was not clear from the clinical record why surgical removal of the foreign body had been delayed.

Esophageal foreign bodies 185

Case 2.94

2

Signalment/History: “Boscoe” was a mature female Beagle with a history of repeated attempts to regurgitate food.

Radiographic procedure: Whole-body radiographs were made to look for a foreign body.

Radiographic diagnosis: A radiopaque esophageal foreign body lay within the caudal aspect of the esophagus. The lung fields were within normal limits.

Treatment/Management: A bottle cap was withdrawn from the esophagus using a retractor.

186 Radiology of Thoracic Trauma

Case 2.95

2

Without esophageal tube

Esophageal foreign bodies 187

2

With esophageal tube

Signalment/History: “Muggy” was a 5-month-old, male Lhasa Apso who had swallowed a fishhook.

Radiographic procedure: Radiographs included the cervical esophagus.

Radiographic diagnosis: The first radiographs showed the hook at the thoracic inlet with the point more distal. The VD view showed the cranial mediastinum was widened, but a puppy this age has a persistent thymus gland that can prove difficult to differentiate from mediastinal thickening secondary to injury.

A second study was made with an esophageal tube in position. The hook had turned but not moved, suggesting that it was fixed in position.

Treatment/Management: An unsuccessful attempt was made to retract the hook with the result that it was driven firmly into the esophageal wall. It was then removed on a subsequent attempt using an endoscope.

188 Radiology of Thoracic Trauma

2.2.16 Esophageal injury

Case 2.96

2

Noncontrast

Signalment/History: “Pia”, a 1-year-old, female Queensland Heeler, was presented with acute signs of vomiting and discomfort.

Physical examination: Following examination, the tentative diagnosis was that of a diaphragmatic hernia. However, the presence of subcutaneous emphysema did not exactly fit that diagnosis.

Radiographic procedure: Studies were made of the thorax and cervical region. These were followed by a barium swallow.

Radiographic diagnosis (noncontrast): Subcutaneous emphysema and pneumomediastinum made evaluation of the infiltrative pattern throughout the lung fields difficult to evaluate. The mediastinum was increased both in depth and width, suggesting an accumulation of mediastinal fluid associated with a mediastinitis. The cause of the mediastinal air and fluid could not be determined. The cardiac silhouette was shifted to the right perhaps influenced by the VD positioning. The diaphragm was intact on both views.

Esophageal injury 189

2

Barium swallow

Radiographic diagnosis (barium swallow): The liquid contrast agent was injected through a tube with its tip lying in the proximal portion of the esophagus. The liquid immediately leaked into the periesophageal tissues on the left side and into the mediastinum. Leakage of this magnitude indicated an extensive tear in the wall of the esophagus (arrows).

Treatment/Management: “Pia” died shortly after the examination and the owners prevented a necropsy examination. It was thought that the dog had received a severe bite wound; however, the owner refused to support this possibility.

190 Radiology of Thoracic Trauma

Case 2.97

2

Liquid barium swallow

Signalment/History: “Hastey Hattie” was a 1-year-old, male mixed breed cat that had been experiencing vomiting immediately after eating solid food for the previous four weeks.

Radiographic procedure: Studies of the thorax were followed by contrast studies including both liquid and solid swallows.

Radiographic diagnosis: An esophageal stricture was indicated by identification of a narrowing of the lumen that permitted passage of the liquid swallow. The esophageal meal identified the lesion more clearly with the failure of the solid food to pass through it.

Treatment/Management: The studies made with the liquid meal showed passage through the site of stricture with only a suggestion of a hold-up at the level of C6–7. The studies made with the liquid agent mixed with normal cat food created a bolus that was unable to pass through the site of esophageal stricture at C6–7 (arrows). It caused a dilation of the proximal esophagus until such a time when the cat regurgitated the bolus. The owners refused treatment and promised to control the nature of the food given to the cat.

Esophageal injury 191

2

Solid barium swallow