Page 340 - Feline diagnostic imaging

348 22 Gastrointestinal Disease

Figure 22.1 Fluoroscopy showed decreased motility in a cat with gangliosidosis. A bolus can be seen in the esophagus caudal
to the heart base.

11 cats that had a total of 15 videofluoroscopic examina- 22.2 Esophageal Masses
tions. In these cats, dilation of some part of the esophagus
was apparent in seven cats, indicating esophageal dysmotil- Esophageal masses (Figure 22.3) fall into three categories:
ity. Diagnostic findings included strictures in three cats, an extramural or periesophageal masses that actually involve
opacity in the caudodorsal thorax of one cat that was structures external to the esophagus, intramural masses, and
believed to represent an esophageal mass or hiatal hernia, intraluminal masses. Masses in the first category include
pneumonia in three cats, and hiatal hernia in five cats. lymphadenopathy, granulomas, neoplasms affecting tissues
None of the cats had oropharyngeal or cricopharyngeal such as lymph nodes, and occasionally cardiac enlargement.
abnormalities and these conditions may be less common in Radiographically, there may be an opacity in the area of the
cats than in dogs. Additionally, multiple studies were neces- esophagus. On an esophagram, the esophagus is displaced
sary in some cases to obtain a diagnosis and some studies but the esophagram has a normal appearance.
were nondiagnostic because of poor patient compliance [8]. Intramural masses may be caused by neoplasia, fungal
or parasitic granulomas or parafungal disease (including
22.1.3 Bronchoesophageal Fistula pythiosis) although all of these are more commonly
reported in dogs than in cats. In one report of a nodule in a
Bronchoesophageal fistula is a rare condition in which cat caused by a spirurid nematode with characteristics sim-
there is a connection between the esophagus and pulmo- ilar to Spirocerca, the nodule was located in the pylorus
nary parenchyma. It may be secondary to a previous [11]. Survey radiography may be normal or there may be an
esophageal foreign body but the cause is often unknown. area of increased opacity in the area of the esophagus. In
The classic clinical sign on presentation is coughing after some cases, a dilated esophagus is apparent, suggesting a
drinking liquids. On survey radiography, there may be a motility disorder. When barium paste is administered, it
fluid radiopacity in the lung. A low osmolar nonionic may travel slowly through the affected portion of the
iodinated contrast is best for evaluation. Iodine flowing esophagus or there may be retention of barium secondary
from the esophageal lumen to the lung opacity confirms to obstruction. The esophageal wall may appear rigid in
the diagnosis. places. Filling defects may be seen where the mass extends
into the lumen.
Most intraluminal masses are actually foreign bodies in
22.1.4 Esophageal Strictures
the esophageal lumen but some intramural masses pro-
Esophageal strictures (Figure 22.2) may occur secondary to trude into the lumen, as mentioned above. Gastroesophageal
previous foreign bodies, gastroesophageal reflux, or prior intussusception is rare but has been reported in cats and
administration of drugs such as doxycycline and clindamy- causes an opacity to be seen in the caudodorsal thorax. On
cin [9,10] but many cases are idiopathic. Fluoroscopy can an esophagram with barium paste, some barium will flow
be useful if available but many cases can also be diagnosed around the intraluminal mass but a filling defect may also
by using serial radiography following esophagography. be present.