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222 Cricopharyngeal Achalasia/Dysphagia

Acute General Treatment PROGNOSIS & OUTCOME Prevention
• Mediastinal masses: depending on tumor • Prognosis depends on severity of underlying • Avoid jugular catheters in hypercoagulable
VetBooks.ir motherapy, or radiation therapy (alone or illness; presence of CrVC syndrome does not • Consider prophylactic anticoagulant therapy
patients.
type, treatment may include surgery, che-
in combination).
in patients with hypercoagulable disorders.
appear to confer a worse prognosis than that
• Fungal granulomas: systemic antifungal drugs
of the underlying disorder alone.
antiplatelet therapy (e.g., clopidogrel) to
(e.g., itraconazole, fluconazole), depending • Head, neck, and forelimb edema may abate • If thrombolysis is successful, the use of
on type of mycosis if CrVC obstruction is removed and/or if reduce vascular re-occlusion because of
• CrVC thrombosis adequate collateral circulation develops. residual thrombus or endothelial injury is
○ Treat underlying cause. recommended.
○ Remove jugular catheters if present. PEARLS & CONSIDERATIONS
○ ± Anticoagulants (e.g., heparin): efficacy Technician Tips
unproven Comments Monitoring plans will depend on underlying
○ ± Thrombolytic agents (e.g., streptokinase, • Although similarly named, heartworm disease process and therapy chosen.
tissue plasminogen activator): efficacy caval syndrome is an entirely different
controversial; may result in life-threatening clinical entity involving right-sided heart SUGGESTED READING
hemorrhage failure, hemolysis, and hemoglobinuria as Ricciardi M et al: Acquired collateral venous pathways
○ ± Balloon venoplasty a consequence of severe heartworm disease in a dog with cranial vena cava obstruction. J Vet
• ± Diuretics (to minimize edema formation): (p. 418). Med Sci 79(11):1772-1775, 2017.
efficacy limited • If presentation is unusual, consider intercur- AUTHOR: Lyndsay Nichole Kubicek, DVM, DACVR
rent disease (fungal and neoplastic).
Chronic Treatment • Human medicine offers promising alterna- EDITOR: Meg M. Sleeper, VMD, DACVIM
Directed to improving/resolving underlying tives to the current therapies available in
disease veterinary medicine.
○ Surgical bypass of the CrVC obstruction
Possible Complications ○ Endovascular therapy—a combination of
Thrombolytic agents may result in life- ■ Stent placement at the level of vascular
threatening hemorrhage. Careful monitoring obstruction
and titration of treatment are essential. ■ ± Anticoagulants

Cricopharyngeal Achalasia/Dysphagia Client Education
Sheet

BASIC INFORMATION • Signs include gagging, retching, regurgitating • Asynchronous cricopharyngeal relaxation
food, coughing, and nasal reflux. Repeated results in repeated caudal movement of a bolus
Definition attempts to swallow may be seen with careful against the persistently contracted cricopha-
A rare condition representing failure of the observation during eating. ryngeal muscle. Boluses may eventually reach
upper esophageal sphincter (cricopharyngeus • Dogs are often thin and in poor body condi- the upper esophagus, may be regurgitated, or
muscle) to relax (achalasia) or asynchrony tion because of ineffective food intake and may be aspirated into the trachea.
between contraction of pharyngeal muscles may lose weight despite an increased appetite.
and relaxation of the cricopharyngeus muscle DIAGNOSIS
(dysphagia) PHYSICAL EXAM FINDINGS
• Patients are usually thin, may be smaller in Diagnostic Overview
Synonyms stature compared to littermates. The history of successful prehension of food
Cricopharyngeal dysphagia, cricopharyngeal • The dog should be observed while eating; but inability to swallow is highly suggestive.
asynchrony repeated ineffective attempts to swallow Confirmation is obtained with fluoroscopic
suggest cricopharyngeal achalasia. evaluation of the oropharyngeal and esophageal
Epidemiology • Observation of respiratory effort and thoracic processing of liquids and solids. Clinical signs
SPECIES, AGE, SEX auscultation may suggest the presence of and static imaging (even with contrast) may not
• Spaniel dogs overrepresented (springer, aspiration pneumonia (p. 793). differentiate oral, pharyngeal, and cricopharyn-
cocker) geal disorders. A correct diagnosis is imperative
• Often congenital; most cases present when Etiology and Pathophysiology before surgical treatment to avoid worsening of
young, usually on weaning but may be up • Cricopharyngeal achalasia results from failure clinical signs and aspiration pneumonia.
to 1 year of age of relaxation of the cricopharyngeus muscle,
• Rarely diagnosed in older animals or in preventing food bolus movement into the Differential Diagnosis
conjunction with other conditions, including proximal esophagus. • Pharyngeal dysfunction usually results in the
hypothyroidism • The cricopharyngeus muscle contracts during inability to form a food bolus.
normal activity. When a bolus, formed by • Oral dysfunction interferes with prehension
Clinical Presentation pharyngeal muscular activity, is pushed • Oropharyngeal or proximal esophageal
HISTORY, CHIEF COMPLAINT caudally by the base of the tongue, the crico- obstruction by mass or foreign body apparent
• Clinical signs often begin at the time of pharyngeus muscle relaxes, allowing passage radiographically, on sedated oropharyngeal
weaning on introducing solid food. of the bolus into the upper esophagus. exam, or endoscopically

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