Case Study

CT – Complex upper airway stenosis and rhinitis wth chronic bronchitis in a 8 year old FS Brussels Griffon

This 8 year old FS Brussels Griffon presented woitj bilateral, chronic nasal discharge that was non-responsive to antibiotics.

PE- overwieght, dermatitis, loud harsh cough during endotracheal intubation and upon recovery.

CBC/Chem – CK 243, Conj bilirubin 0.2, chol 379, Cl 105. UA – ammonium phosphate crystals +2

This 8 year old FS Brussels Griffon presented woitj bilateral, chronic nasal discharge that was non-responsive to antibiotics.

PE- overwieght, dermatitis, loud harsh cough during endotracheal intubation and upon recovery.

CBC/Chem – CK 243, Conj bilirubin 0.2, chol 379, Cl 105. UA – ammonium phosphate crystals +2

DX

Complex brachycephalic upper airway stenosis, aberrant conchae and focal nasopharyngeal stenosis with rhinitis;chronic airway disease with tracheal and bronchial collapse and bronchitis

Image Interpretation

CT f the head and thorax –

Head- Both nasal cavities present a moderate amount of non-gravity dependent soft tissue,attenuating material without contrast enhancement between the nasal turbinates. Level with the temporomandibular joints marked circumferential thickening of the nasopharyngeal wall with contrast enhancement is noted dorsal to the soft palate. Severe narrowing of the nasopharyngeal pathway is seen. Turbinate structures are visible within the sphenoidal recess consistent with aberrant conchae. The left submandibular lymph-nodes and the left medial retropharyngeal lymph-node present mild enlargement.

Thorax –

The caudal compartment of the cranial lung lobe left presents a 3x2x2.6cm oval shaped well defined cavitary gas filled lesion that is outlined by a thin soft tissue attenuating wall. The surrounding lung parenchyma shows a mildly increased density and decreased volume. Multifocal moderate bronchial wall thickening is noted and associated with subpleural interstitial bands. mild tracheal collapse is noted throughout the caudal cervical and cranial thoracic trachea as well as cranial to the carina. Mild collapse of the main stem bronchi is seen as well. The cranial pole of the right adrenal gland presents moderate focal and nodular enlargement at 1.2cm transverse diameter.

Outcome

The cause for the focal ring like-enhancement of the nasopharyngeal mucosa is likely to be a chronic inflammation. Secondary reactive lymphadenitis of the mandibular lymph nodes and the left medial retropharyngeal lymph node. Recommend rhinoscopy with bacterial swap and if possible visual inspection and sampling of the stenotic area. Recommend endoscopy with
bronchoalveolar lavage as well.The thin-walled cavitary lung lesion in the left cranial
lung lobe is consistent with a bulla and is likely to be caused by chronic cough/chronic
airway disease here.