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Primary differentials for dorsal deviation of the trachea

Sonopath Forum

Sonopath Forum

Primary differentials for dorsal deviation of the trachea

  • 9 year old fs Miniature Dachshund with history of weight loss, polyphagia, polyuria/polydipsia
  • PE shows ventral abdominal and thoracic alopecia
  • Whole body radiographs show dorsal deviation of the trachea
  • CBC is wnl;  Chem prof shows decreased ALB=2.2.  U/A is pending.
  • rDVM wants to rule out mediastinal mass as the cause of the dorsal tracheal deviation.
  • I cannot find a cranial mediastinal mass on thoracic ultrasound, and I am not convinced that there is one. 

    • 9 year old fs Miniature Dachshund with history of weight loss, polyphagia, polyuria/polydipsia
    • PE shows ventral abdominal and thoracic alopecia
    • Whole body radiographs show dorsal deviation of the trachea
    • CBC is wnl;  Chem prof shows decreased ALB=2.2.  U/A is pending.
    • rDVM wants to rule out mediastinal mass as the cause of the dorsal tracheal deviation.
    • I cannot find a cranial mediastinal mass on thoracic ultrasound, and I am not convinced that there is one. 
    • What else can cause dorsal deviation of the trachea on radiographs?  Head and neck position? 
    • Echocardiogram shows stage B1 mitral valve disease.  Abdominal exam shows small intestinal mucosal striations.  Adrenal glands and kidneys appear normal.
    • My primary rule outs for this patient are PLE, emerging LSA, and PLN (until ruled out by U/A). My primary differentials for the alopecia are hyperadrenocorticism and paraneoplastic syndrome (BCS=4/9).
    • Any thoughts?

     

Comments

randyhermandvm
February 11, 2015 at 2:07 pm -

I can’t really see the head

I can’t really see the head and neck- but I have seen this before and the radiologists usually tell me it is artifact from positioning of the head and neck. 

randyhermandvm
February 11, 2015 at 2:07 pm -

I can’t really see the head

I can’t really see the head and neck- but I have seen this before and the radiologists usually tell me it is artifact from positioning of the head and neck. 

Electrocute
February 11, 2015 at 2:21 pm -

That’s what I am thinking,

That’s what I am thinking, too.  There is no cough, regurgitation, or dysphagia.

Electrocute
February 11, 2015 at 2:21 pm -

That’s what I am thinking,

That’s what I am thinking, too.  There is no cough, regurgitation, or dysphagia.

rlobetti
February 11, 2015 at 5:15 pm -

Looks like a postioning

Looks like a postioning artifact as the trachea is only focally elavated on the lateral view and on the DV view there is no widening of the mediastinum or deviation of the trachea to the side. In addition no clinical signs. For the skin consider primary skin issuses – bacterial/fungal, allergic dermatopathy, sebacous adenits, etc. Consider getting some skin biopsies to complete the work-up.

rlobetti
February 11, 2015 at 5:15 pm -

Looks like a postioning

Looks like a postioning artifact as the trachea is only focally elavated on the lateral view and on the DV view there is no widening of the mediastinum or deviation of the trachea to the side. In addition no clinical signs. For the skin consider primary skin issuses – bacterial/fungal, allergic dermatopathy, sebacous adenits, etc. Consider getting some skin biopsies to complete the work-up.

Electrocute
February 11, 2015 at 6:14 pm -

Ok, thank you!

Ok, thank you!

Electrocute
February 11, 2015 at 6:14 pm -

Ok, thank you!

Ok, thank you!

EL
February 11, 2015 at 10:34 pm -

I would think the head was in

I would think the head was in ventroflexion during the rad.

EL
February 11, 2015 at 10:34 pm -

I would think the head was in

I would think the head was in ventroflexion during the rad.

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