Radiology2- Larynx Trachea Esophagus
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What are differentials for laryngeal masses? (5)
- granulation tissue
- foreign body
How do laryngeal masses appear radiographically? (2)
- gas outlines masses
- distort normal structures
What is the typical signalment of nasopharyngeal polyps?
Describe the clinical aspects of nasopharyngeal polyps. (3)
- inflammatory polyp in middle ear, extending into pharynx via auditory tube
- leads to secondary otitis media
- often Px with otitis and upper respiratory problems
What is the most useful secondary diagnostic if you suspect a laryngeal foreign body?
oral exam, laryngoscope
Thickened soft palate is common in...
brachycephalic dogs, especially bulldogs
Thickened soft palate may appear...
to cause ventral displacement of the epiglottis.
The soft palate should normally end...
at the hyoid apparatus
How does gutteral pouch tympany appear radiographically? (2)
- narrowed nasopharynx
- hugely dilated gutteral pouch with air opacity
What is the cause of gutteral pouch tympany?
flap of soft tissue covers the auditory tube opening, allowing gas to enter the gutteral pouch, but not exit
How will gutteral pouch fluid appear on radiographs? (3) What usually causes this? (2)
- gas fluid interface, with gas in dorsal GP and fluid in ventral GP
- soft tissue opacity within the GP
- compression of the nasopharynx (wine goblet shaped gas opacity below GP)
- blood or pus (empyema) within the GP
What are chondroids?
- soft tissue roundish opacities in the gutteral pouch
- dried out empyema
What are DDx for soft tissue-filled gutteral pouch on radiographs? (5)
- retropharyngeal lymphadenopathy
How is tracheal hypoplasia radiographically diagnosed?
- Diameter of trachea/ diameter of thoracic inlet
- diameter of thoracic inlet= length from first sternebra to cervical vertebra
- Most dogs: 0.2
- Brachycephalics: 0.16
- Bulldogs: 0.13
Describe the clinical picture of tracheal collapse.
- older small breed dogs d/t chondromalacia
- goose honking cough
How does tracheal collapse appear on radiographs?
- normal diameter trachea on inspiration
- forced expiration (elicit a cough)- tracheal diameter narrows by greater than 50%
Describe the discrepancy b/w tracheal narrowing extra- and intra-thoracic trachea.
- Inspiration- extra-thoracic tracheal collapse
- Expiration- intra-thoracic tracheal collapse
Describe esophageal anatomy.
- all striated muscle in the dog
- caudal 1/3 smooth muscle in cats
- usually not seen radiographically; a small amount of transient gas or fluid may be normal (dorsal to trachea)
There is trachea deviation within the thorax. How can you differentiate b/w positional deviation and a mediastinal mass?
- look at the VD
- straighten the dogs neck and try again
To detect tracheal collapse in a yorkie, you make thoracic radiographs after...
forced expiration (elicit a cough)
What are indications of esophogram (barium in esophagus)? (4)
What are contraindications for doing an esophogram (barium into esophagus)? (3)
- diffuse megaesophagus (high risk for aspiration of barium)
- known esophageal rupture
- concern for aspiration pneumonia
- [always do survey radiographs first before a contrast study]
What are the different types of positive contrast media? What is each used to detect? (4)
- 1. liquid barium suspension- detect motility and/or obstructions
- 2. barium sulfate paste- detect mucosal elevation
- 3. food coated in barium
- use iodinated contrast if perforation is suspected
What is the technique for an esophogram? (5)
- survey radiographs- rule out contraindications, DDx
- avoid sedation is evaluating for motility
- give positive contrast per os
- image at intervals
Describe a normal esophogram.
- no contrast retention
- some coating of esophageal mucosa is normal- longitudinal folds in dogs, herringbone pattern in cats
What are the types of megaesophagus? What are causes of each?
- segmental/ focal: FBs, masses, strictures, vascular ring anomaly, redundant esophagus
- generalized: acquired, congenital
What are the phases of swallowing?
- oropharyngeal: oral bolus formation, pharyngeal passage of food through pharynx to cranial esophageal sphincter, cricopharyngeal passage through cranial esophageal sphincter
- gastroesophageal: passage through caudal esophageal sphincter
What are the most common locations for esophageal FBs? (4)
- cranial cervical
- thoracic inlet
- heart base
- cranial to esophageal hiatus
What are differential diagnoses for esophageal masses? (4)
- +/- cyst (least likely)
How does esophageal stricture appear radiographically?
- focally dilated esophagus with air opacity
- add contrast--> focal narrowing of esophagus
___________ is a common radiographic sign with megaesophagus.
Tracheo-esophageal stripe sign
__________ is avery common sequeala of megaesophagus, which appears as a(n) ___________ radiographically.
Aspiration pneumonia; alveolar pattern
What is the tracheo-esophageal stripe sign?
- looks like a very thick dorsal wall of the trachea compared the the ventral wall of the trachea
- is really a summation of the ventral aspect of the esophagus and dorsal wall of the trachea
- seen with megaesophagus
How does persistent right aortic arch appear radiographically? (4)
- severe dilation of the esophagus
- segmental dilation- cranial to heart base
- ventral deviation of the trachea
- alveolar pattern in right middle lung lobe (if concurrent aspiration pneumonia)
What is a common sequela to hiatal hernia? How does this appear radiographically?
gastroesophageal reflux- ill-defined soft tissue opacity in caudal esophagus
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