Patient: 8 week old male sled dog pup
Chief Complaint: Since weaning he can't hold any food down. He eats vigorously and almost immediately afterward the food passively comes back up, which he then eats again, and the process repeats itself.
Physical exam: BAR, temp. 100.1, pulse 100 bpm, no murmurs, regular rhythm, lungs auscult clear, mm pink, body condition score 3/9, both testes descended, no abdominal hernias palpable, normal bite occlusion, oral palate normal.
Problem list: Regurgitation (this is not the same as vomiting), thin body condition.
Specific rule outs: Congenital megaesophagus, congenital esophageal stricture, vascular ring anomaly, hiatal hernia, pericardio-peritoneal diaphragmatic hernia, dysphagia, achalasia, gastrointestinal parasites.
First line diagnostics: Offer food and observe.
Assessment: Pup eats ravenously, swallows fine, immediately seems uncomfortable, within 1 minute regurgitates all food.
Second line diagnostics: Radiographs, contrast esophagram with barium.
Assessment of radiographs: Esophageal stricture at heart base, dilated esophagus cranial to stricture, cardiac silhouette wnl, lung fields clear, no evidence of aspiration pneumonia.
Diagnosis: Vascular Ring Anomaly. There are multiple types of vascular ring anomalies described, by far the most common is a persistent 4th right aortic arch.
Plan: Preanesthetic bloodwork and surgery, left 4th intercostal thoracotomy, ligation and transection of the ligamentum arteriosum. Feed high calorie gruel while holding pup upright until day of surgery.
Prognosis: Good to excellent given that there don't appear to be any other congenital defects or secondary aspiration pneumonia.
So there it is, a blog. If interested in pictures and a description of the condition, see this link.
Hope you found this interesting,
Sam Smith, DVM
