Case Study

RAD & US – Megaesophagus with diverticulum, Addison’s disease, maldigestion in a M German Shepherd

This M German Shepherd dog presented for intermittent vomiting of 2-3 months duration.

Physical exam:gassy small bowel, mild ataxia hind end

This M German Shepherd dog presented for intermittent vomiting of 2-3 months duration.

Physical exam:gassy small bowel, mild ataxia hind end

DX

Generalized megaesophagus with diverticulum formation and accumulation of solid and fluid ingesta • Maldigestion & aerophagia • German shepherd dog hypersplenism • Microhepatica • Suspicion of adrenal hypoplasia • Hypovolemia with mild microcardia and underperfusion of the lung

Image Interpretation

Rads of the thorax and abdomen –

There is degenerative lumbosacral stenosis, spondyloses and spondylarthroses, left-sided hip dysplasia with moderate osteoarthritis, bilateral elbow dysplasia with coronoid pathology and mild osteoarthritis.

The gastrointestinal tract is moderately gas filled. The gastric axis is oriented cranially and the liver shadow shows a reduced volume.

The esophagus is severely distended and gas filled. At the level of the first to second intercostal space the esophagus shows a saccular ventral outpouching that is filled with mineral opaque granular material. In the subsequent radiographs within a 5-minute interval the material stays within the ventral outpouching of the esophagus. There is a tracheal stripe sign visible and the trachea shows a moderate ventral bending and is mildly displaced to the right on the dorsoventral view.

Ultrasound:

The stomach contains a moderate amount of fluid, chyme and gas.

An exceptional high amount of gas is noted throughout the small intestine. The peristaltic rate is elevated.

The adrenal glands are flat and long.

Outcome

The findings are suggestive for hypoadrenocorticism (Addison disease) with secondary megaesophagus, microhepatica and hypovolemia which causes the microcardia. The gas filled gastrointestinal tract is also compatible with Addison disease that can lead to unspecific gastrointestinal symptoms.
Myasthenia gravis, idiopathic megaesophagus systemic lupus erythematosus, polymyositis, heavy metal (lead) or thallium toxicity, glycogen storage disease, neurotoxin-induced cholinesterase inhibition, dysautonomia, CNS disorders including neoplasia, and possibly hypothyroidism. There was no evidence of an esophageal stricture, foreign body, neoplasia, or extraesophageal compression. Lab work with special interest on sodium/potassium levels, Acetylcholine antibody test, T4 levels, also consider mestinon challenge.
– If these are inconclusive neuromuscular and liver biopsy may be considered.