Findings
- The intrathoracic portion of the esophagus is severely distended with a large amount of heterogeneous, granular and soft tissue to mineral opaque material . The trachea is segmentally compressed cranial to the carina and there is ventral extension of the described granular material at the same level.
- Within the ventral aspect of the pulmonary parenchyma, a severe homogenous increase in soft tissue opacity is identified and partially border effacing the cardiac silhouette. There is complete border effacement of the cranial aspect of the cardiac silhouette.
- Dorsal to the distended esophagus in the mid and caudal thoracic regions, a small amount of gas is identified.
Conclusions
- Diffuse feed retention within intrathoracic esophagus with suspected diverticulum formation.
- Mild pneumomediastinum, compatible with esophageal perforation.
- Pleuropneumonia likely due to aspiration. The presence of pulmonary abscesses cannot be ruled out.
Thoracic ultrasound
Esophagram (2 weeks prior)
- Within the caudal thoracic region, the esophagus is severely dilated and contains a large amount of gravity-dependent positive contrast medium.
Resource: How to Perform an Esophagram (link)
Case Outcome
NECROPSY:
- Esophageal diverticulum, focally extensive, severe, chronic, with focal rupture, distal thoracic aspect of the esophagus.
- Pleuropneumonia, necrotizing and fibrous, pyogranulomatous and lymphoplasmacytic, locally extensive, with pulmonary abscesses.
A little bit more…
- Esophageal diverticulum are more commonly an acquired disease process.
- Result in focal expansion of the esophageal lumen, two types: Traction (true diverticulum) or Pulsion (false diverticulum).
- Limited reported cases of caudal cervical and intrathoracic diverticula.
- A diagnosis is made with contrast radiography or endoscopy.
- Common complications include aspiration pneumonia, mediastinitis and/or pleuritis.
- Pulsion diverticula often require surgical management.
References:
- Southwood, L. L. “Gastrointestinal tract diverticula: What, when and why?.” Equine Veterinary Education 20.11 (2008): 572-574.
- Bezdekova, Barbora. “Esophageal disorders in horses-a review of literature.” Pferdeheilkunde 28.2 (2012): 187-192.
- Feige, Karsten, et al. “Esophageal obstruction in horses: a retrospective study of 34 cases.” The Canadian Veterinary Journal 41.3 (2000): 207.
- Craig, D. R., et al. “Esophageal disorders in 61 horses: results of nonsurgical and surgical management.” Veterinary surgery18.6 (1990): 432-438.
- Murray, Rachel C., and Earl M. Gaughan. “Pulsion diverticulum of the cranial cervical esophagus in a horse.” The Canadian Veterinary Journal 34.6 (1993): 365.
- Acutt, Elizabeth V., and M. F. Barret. “How to perform an equine esophagram.” AAEP Proc. Vol. 67. 2021.
