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What are differentials for laryngeal masses? (5)
- abscess
- neoplasia
- granulation tissue
- polyps
- foreign body
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How do laryngeal masses appear radiographically? (2)
- gas outlines masses
- distort normal structures
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What is the typical signalment of nasopharyngeal polyps?
young cats
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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
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What is the most useful secondary diagnostic if you suspect a laryngeal foreign body?
oral exam, laryngoscope
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Thickened soft palate is common in...
brachycephalic dogs, especially bulldogs
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Thickened soft palate may appear...
to cause ventral displacement of the epiglottis.
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The soft palate should normally end...
at the hyoid apparatus
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How does gutteral pouch tympany appear radiographically? (2)
- narrowed nasopharynx
- hugely dilated gutteral pouch with air opacity
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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
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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
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What are chondroids?
- soft tissue roundish opacities in the gutteral pouch
- dried out empyema
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What are DDx for soft tissue-filled gutteral pouch on radiographs? (5)
- empyema
- hemorrhage
- retropharyngeal lymphadenopathy
- abscess
- neoplasia
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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
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Describe the clinical picture of tracheal collapse.
- older small breed dogs d/t chondromalacia
- goose honking cough
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How does tracheal collapse appear on radiographs?
- normal diameter trachea on inspiration
- forced expiration (elicit a cough)- tracheal diameter narrows by greater than 50%
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Describe the discrepancy b/w tracheal narrowing extra- and intra-thoracic trachea.
- Inspiration- extra-thoracic tracheal collapse
- Expiration- intra-thoracic tracheal collapse
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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)
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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
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To detect tracheal collapse in a yorkie, you make thoracic radiographs after...
forced expiration (elicit a cough)
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What are indications of esophogram (barium in esophagus)? (4)
- pytalism
- dysphagia
- gagging
- regurg
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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]
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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
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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
- fluroscopy
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Describe a normal esophogram.
- no contrast retention
- some coating of esophageal mucosa is normal- longitudinal folds in dogs, herringbone pattern in cats
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What are the types of megaesophagus? What are causes of each?
- segmental/ focal: FBs, masses, strictures, vascular ring anomaly, redundant esophagus
- generalized: acquired, congenital
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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
- esophageal
- gastroesophageal: passage through caudal esophageal sphincter
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What are the most common locations for esophageal FBs? (4)
- cranial cervical
- thoracic inlet
- heart base
- cranial to esophageal hiatus
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What are differential diagnoses for esophageal masses? (4)
- neoplasia
- granuloma
- abscess
- +/- cyst (least likely)
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How does esophageal stricture appear radiographically?
- focally dilated esophagus with air opacity
- add contrast--> focal narrowing of esophagus
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___________ is a common radiographic sign with megaesophagus.
Tracheo-esophageal stripe sign
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__________ is avery common sequeala of megaesophagus, which appears as a(n) ___________ radiographically.
Aspiration pneumonia; alveolar pattern
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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
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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)
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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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