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Radiology of the Esophagus

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sihirlifil's version from 2017-09-26 16:56

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Question Answer
Esophagus extends from where to where?From caudal skull (pharyngeal region) to entrance of stomach
Where does the esophagus lie in relation to the trachea in the neck? Cr thorax? Cd thorax?Neck: Inclines to left of trachea at thoracic inlet
Cr thorax: crosses dorsal at carina, superimposed to trachea on its left
Cd thorax: Between aorta and CVC
Can't ID a normal esophagus because...Same opacity as neck muscles & mediastinum. Need contrast study
You can see the esophagus on radiograph when...Contains some material (fluid/air)
To assess esophageal motility and look for masses, what can you do?Administer food coated with barium sulphate (positive contrast)
When should you use iodinated contrast?Aspiration is serious risk, so dogs that are regurgitating or have swallowing problems
Indications for esophageal radiographyPersistent regurg, difficulty swallowing
Megaesophagus: dilation can be? (2)Focal (stenosis, vascuar ring anomaly)
Generalized
What is the tracheal stripe sign?Interface of esophageal mucosa (ventral margin) and air visible, outlined by dorsal trachea
How may anesthesia affect esophagus on radiographs?Cause small quantity of gas (write in report)
What's going on here?
Herring bone pattern Normal in cats! Caudal 1/3 of esophagus is smooth muscle (dogs have striated longitudinal throughout)
2 types of megaesophagus:Congenital or aquired
Congenital megaesophagus =Usually generalized
Localized: vascular ring anomalies e.g. PRAA (usually segmental)
Acquired megaesophagus = Generalized or localized
Reasons for aquired megaesophagus: (5)Neuropathies (MG)
Addison's disease
Toxicities
Post-FB/strictures
Idiopathic
Megaesophagus (tracheal stripe sign, air dorsal to trachea, aspiration pneumonia bright on cardiac silhuoette)
Animals with megaesophagus are predisposed toAspiration pneumonia
Aspiration pneumonia typically occurs where?Right middle lobe
If you saw this radiograph of a Samoyed puppy, you'd be thinking...
Congenital megaesophagus (marked ventral tracheal displacement)
Radiographic signs of PRAAGranular food material in lumen, depressed trachea, esophagus drapes over trachea (b/c so big from side-side)
What's going on here? Arrow?PRAA
Arrow = where stricture located (radiolucent band at base of heart)
Esophageal neoplasia looks like?Soft tissue opacity, distended esophagus (fluid, air)
Ddx for esophageal neoplasiaSpirocerca lupi granulomas
OsteaSA/FibroSA can occur 2ry
Common locations for FB in dog:Thoracic inlet
Base of heart
Just cranial to diaphragm (hiatus)
Esophageal FB more common in?Dogs
FB locations in catsJust caudal to pharynx
Thoracic inlet
If you see a ST opacity along with a FB, suggests what?Perforation --> mediastinitis
Esophageal FB at thoracic inlet (short arrow = air in esophagus cranially)
Spirocerca lupi (soft tissue = granulomas) (+spondylitis of ventral aspect thoracic vertebrae)
CS of spirocerca lupiLike FB obstruction (regurgitation +/- blood, weight loss)
Any radiographic changes in the spind that can happen with spirocerca lupi?Spondylitis of thoracic vertebrae
Esophageal neoplasia, dorsal aspect of esophagus (soft tissue opacity in caudal thorax, Long arrows = air cranial to mass)
What is gastro-esophageal reflux?Functional disturbance- no true sphincter between esophagus and diaphragm, just muscle pressure difference
How do you confirm a dx of gastro-esophageal reflux?Needs fluoroscopy with barium food
See reflux of material from stomach into esophagus real-time
Radiographic signs of gastro-esophageal reflux+/- intermittent soft tissue opacity in caudal thorax
Mediastinal LN: normally visible?No
When can you see mediastinal LN?If enlarged (or mineralized); mass effect when enlargement displaces adjacent organs e.g. trachea
Cranial mediastinal LN: drain what?Mainly thoracic wall, more cranial structures
Sternal LN: drain what?Mainly peritoneum
Tracheobronchial LN: drain what?Mainly the lungs
Where do the tracheobronchial LN lie?One ventral to base of trachea, one caudodorsal
Normal position of LN in mediastinum
Hilar lymphadenopathy (enlarged cranial mediastinal & trachobronchial LNs)
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