Today’s case is a 5 month old domestic long haired cat with regurgitation. Take a look and post your interpretation in the comments!
5 month old DLH cat
Teaching and learning about veterinary diagnostic imaging.
Teaching and learning about veterinary diagnostic imaging.
Today’s case is a 5 month old domestic long haired cat with regurgitation. Take a look and post your interpretation in the comments!
In the LL and RL the trachea is displaced ventrally. the esophagus is distended with a lot of gas. the cranial and medium lung lobes have an alveolar pattern. the heart shape is not clearly visible. in the DV there is an increase soft tissue opacity in the cranial mediastinum.
pulmonitis secondary to a megaesophagus, is it rare in cats ?
In all three projection distended oesophagus is well seen, it displaces trachea ventrally. At the base of the heart the size of trachea is decreased. Maybe because of left atrium enlargement, that is seen on vd projection. There is a soft tissue shadow that changes the shape of oesophgus located over carina. I would say that there is a peribronchial lung pattern and alveolar pattern in midlle lung lobes. I am not sure but I see widened pulmonary vessels of main bronchi on vd projection. Chest Lymphnodes are not visible. In diagnosis would consider ductus Botalli persistens? Is it posibble to see it so clearlly?
The esophagus is distended with gas and some fluid on all views. There is a focal narrowing of this distension at the area of the carina.
There is a diffuse interstitial to alveolar pattern throughout the lungs. Due to the young age I would suspect a congenital anomaly, possible developmental problem of the esophageal innervation are there any other neurological signs? Due to the focal narrowing over the carina, a vascular ring anomaly is possible as well, but in this case i would expect the clinical signs to have started earlier. The pulmonary infiltrates might be a result of a aspiration pneumonia
Great, everyone identified the megaesophagus and pulmonary pattern. Given the age of the cat, I’d also consider a congentital cause. This cat was referred on suspicion of a persistent right aortic arch. So to help distinguish a megaesophagus from a PRAA, my questions for you are:
1. At what level would you see the constriction of the esophagus?
2. What would the distal esophagus look like in PRAA?
3. What is causing that indentation of the esophagus in the 5th intercostal space?
1. at the level of the fourth rib
2. looks normal
3. the ligamentum arteriosum or patent ductus arteriosus
it doesn’t look like a megaesophagus secondary to a PRAA. Maybe d/d are megaesophagous secondary to a cardias stenosis, because all the esophagus is distended, or megaesophagus secondary to a neurologic causes like feline dysautonomia, or megaesophagus secondary to an esophageal stenosis, or at least idiopathic megaesophagus.
sorry I did a mistake in this case : )
the right answer n. 3 is the azygous vein. The esophagous indentation with the ligamentum arteriosum is anatomically possible only when you have a PRRA