This week’s case is a 7-year-old male neutered Giant Schnauzer with abdominal discomfort and vomiting after being groomed. This case is a common presentation in the emergency room. What is your interpretation?
Findings
Abdomen: The stomach is mildly distended with gas. The fundus appears to be ventrally positioned on the lateral projection with rugal folds visible. The pylorus is dorsally positioned. On the ventrodorsal projection, both the fundus and pylorus are positioned on the left side of the abdomen. The duodenum appears to cross midline and join the pylorus on the left side. The spleen is malpositioned, with the proximal extremity not visible on the v/d, and the distal extremity and body in a curved shape in the ventral abdomen on the lateral projection. The remainder of the small intestine and colon appear normal.Thorax: The cardiovascular structures are normal in size and shape. Megaesophagus is visible on multiple images. The left 5th and 6th costochondral junctions are prominent.
Differential Diagnosis
- Gastric dilation and volvulus with splenic torsion
- Secondary megaesophagus
Diagnosis
- 180 degree gastric dilation and volvulus. Derotation and gastropexy were performed.
Good morning!
I ‘ve’ been following this page for a long time and, I have to say I had learned a lot. I am just a general practitioner. Thank you for sharing. Now, about this case. I do not see the megaesophagus. Can you please, show how I can see it in these images.
Thank,
Alfonso
Hola Alonso. .Some times it is difficult to see megaesophagus because the density of luminal air of the esophagus and the pulmonary air overlap.
You must to find two parallel subtle linear density. .one dorsal, one ventral.
The subtle dorsal radiopaque ‘line’ cross the thoracic aorta on oblique sense, ventral to 6th and 7th thoracic vertebra.
The second subtle ventral radiopaque ‘line’ cross traquea at thoracic inlet on oblique sense, and then runs parallel just little ventrally to the same traqueal tube. Pass ventrally to the carina and continuos caudaly to diafragm.