1 Mediastinum Mediastinum Esophagus Esophagus Trachea Trachea VMB 960 2/28/2011 Mediastinum Mediastinum - definition definition Everything between right & left pleural sacs; bounded by mediastinal pleura Extends from thoracic inlet to diaphragm Fenestrated; may not contain unilateral disease Not a closed cavity – Communicates with neck and retroperitoneal space
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MediastinumMediastinumEsophagus Esophagus
Trachea Trachea
VMB 960
2/28/2011
Mediastinum Mediastinum -- definitiondefinition
Everything between right & left pleural sacs; bounded by mediastinal pleura
Extends from thoracic inlet to diaphragm
Fenestrated; may not contain unilateral disease
Not a closed cavity– Communicates with neck and retroperitoneal space
Aspiration pneumonia is a common complication of esophageal dysfunction
An intense alveolar pattern, primarily in the ventral lung lobes (lung patterns next week)the ventral lung lobes (lung patterns next week)
Assess the lungs for evidence of aspiration with megaesophagus
Assess the esophagus when evidence of aspiration – megaesophagus may not be evident on surveys
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Swallowing DisordersSwallowing Disorders
Review Fluoroscopy movies- via http://radstudents.ncsu.edu
Folder = fluoroscopy moviesFolder = fluoroscopy movies
Sliding Hiatal HerniaSliding Hiatal HerniaSharpei
Brachycephalic breeds
Siamese
Often manifests in patients with partial upper airway obstruction
Sliding hiatal hernia
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Inspiration during laryngeal collapse
Inspiration after intubation
Larynx and bronchi Larynx and bronchi –– ensure you know ensure you know normal anatomynormal anatomy
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Mediastinum Mediastinum
Case DiscussionsCase Discussions
3/01/20113/01/2011
Case 1Case 1
6 year old Golden Retriever 60096 year old Golden Retriever 6009
Male castrate Male castrate
Poor exercise tolerance, collapses with minimal Poor exercise tolerance, collapses with minimal iiexercise exercise
Rattles when breathing Rattles when breathing
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Case 1 Findings Case 1 Findings
The esophagus is gas distended in all views The esophagus is gas distended in all views There is no evidence of inhalation pneumonia There is no evidence of inhalation pneumonia
Note the ventral deviation of the cranial intrathoracic Note the ventral deviation of the cranial intrathoracic trachea.trachea.
What are some differentials for generalized megaesophagus?What are some differentials for generalized megaesophagus?
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Case 2Case 2
7 year old DSH7 year old DSH 7162471624
Male castrateMale castrate
Dyspnea, possible feline asthmaDyspnea, possible feline asthma
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Case 2 Findings Case 2 Findings
Pneumomediastinum, pneumoretroperitoneum and pneumothorax are Pneumomediastinum, pneumoretroperitoneum and pneumothorax are present.present.
A large amount of subcutaneous emphysema is present, predominantly A large amount of subcutaneous emphysema is present, predominantly located within the cervical and axillarylocated within the cervical and axillary soft tissues.soft tissues.
Th l l b h i fl t d i b l i f th l l i t thTh l l b h i fl t d i b l i f th l l i t th The lung lobes are hyperinflated, causing bulging of the pleural margins at the The lung lobes are hyperinflated, causing bulging of the pleural margins at the intercostal spaces and caudal displacement of the diaphragm.intercostal spaces and caudal displacement of the diaphragm.
The large amount of air in the thoracic cavity is resulting in caudal The large amount of air in the thoracic cavity is resulting in caudal displacement of the diaphragm as with tension pneumothorax, possibly displacement of the diaphragm as with tension pneumothorax, possibly exacerbated by pulmonary hyperinflation.exacerbated by pulmonary hyperinflation.
There is an alveolar pattern cranial to the cardiac silhouette on the lateral There is an alveolar pattern cranial to the cardiac silhouette on the lateral projections, likely secondary to recumbent atelectasis.projections, likely secondary to recumbent atelectasis. An endotracheal tube An endotracheal tube is present, presumably within the tracheal lumen.is present, presumably within the tracheal lumen.
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Case 3Case 3
8 year DLH8 year DLH 4895348953
Male castrate Male castrate
Recent weight lossRecent weight loss
Mass palpated on left kidney Mass palpated on left kidney
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Case 3 FindingsCase 3 Findings
There is an increase in soft tissue opacity caudal There is an increase in soft tissue opacity caudal to the cardiac silhouette that silhouettes with to the cardiac silhouette that silhouettes with both the diaphragm and the heart. There is poor both the diaphragm and the heart. There is poor distinction of the diaphragm at this level. distinction of the diaphragm at this level.
These findings are consistent with a peritoneal These findings are consistent with a peritoneal pericardial diaphragmatic hernia. pericardial diaphragmatic hernia.
How would you confirm this diagnosis?How would you confirm this diagnosis?
Case 4Case 4
10 year old Labrador Retriever 10 year old Labrador Retriever 8385783857
Female spayed Female spayed
Polydypsia and weight loss, non regenerative Polydypsia and weight loss, non regenerative anemia anemia
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Case 4 FindingsCase 4 Findings The trachea is dorsally displaced cranial to the heart by an ill The trachea is dorsally displaced cranial to the heart by an ill
defined soft tissue mass. defined soft tissue mass.
There is a soft tissue mass dorsal to the cranial sternebrae. There is a soft tissue mass dorsal to the cranial sternebrae.
The principal bronchi are displaced laterally and ventrally.The principal bronchi are displaced laterally and ventrally.
Findings are consistent with enlargement of the sternal, cranial Findings are consistent with enlargement of the sternal, cranial mediastinal and tracheobronchial lymph nodes. mediastinal and tracheobronchial lymph nodes.
The pulmonary parenchyma and cardiovascular structures are The pulmonary parenchyma and cardiovascular structures are within normal limits. within normal limits.
What are some differentials for thoracic lymphomegaly?What are some differentials for thoracic lymphomegaly?
Case 5Case 5
14 year old Siamese 14 year old Siamese
Male castrateMale castrate
Lethargy, anorexia Lethargy, anorexia
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Case 5 Findings Case 5 Findings
In lateral views there is an illIn lateral views there is an ill--defined soft tissue defined soft tissue and gas mass effect in the caudodorsal aspect of and gas mass effect in the caudodorsal aspect of the thorax. This is not apparent VD or DV the thorax. This is not apparent VD or DV views and is most consistent with a hiatal herniaviews and is most consistent with a hiatal herniaviews and is most consistent with a hiatal hernia. views and is most consistent with a hiatal hernia.
No other abnormalities are identified.No other abnormalities are identified.
Case 6 Case 6
9 year old Greyhound 9 year old Greyhound 6894468944
Male castrateMale castrate
Vomiting and diarrhea for 3 days Vomiting and diarrhea for 3 days
History of LSAHistory of LSA
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Case 6 Findings Case 6 Findings
There is gas dissecting around mediastinal There is gas dissecting around mediastinal structures indicating pneumomediastinum, structures indicating pneumomediastinum, possibly due to jugular venipuncture. possibly due to jugular venipuncture.
Residual barium persists in the peritoneal space, Residual barium persists in the peritoneal space, presumed cisterna chyli, and within the sternal presumed cisterna chyli, and within the sternal lymph nodes. lymph nodes.