Vascular ring anomaly?

RE: Vascular ring anomaly?

Tim Charlesworth — Mon, 06 Feb 2017 15:33:28 GMT

[quote user="Julie Innes"]

How would you fix it- surgery? Is it specialist surgery?

[/quote]

The surgery for these can be q challenging - it basically involves gastropexy + oesophopexy + reducing the size of the hiatus and the latter bit can be tricky. The GA can be fiddly (pneumothorax once the hiatus is incised so ventilated and risk of aspiration) and can be difficult to decide on how small to leave the hiatus. You also need to be v careful of the vagus nerves at that site. Many can be tx'd medically/diff feeding regimes etc and correction of BOAS will certainly help but may not be enough to fully resolve the signs.

Tim

RE: Vascular ring anomaly?

Evelyn Barbour-Hill — Mon, 06 Feb 2017 13:13:58 GMT

Fixing/improving the BOAS has to be first priority – doesn't it?

After that it's even possible that the hernia can just be managed, with elevated feeding for instance.

RE: Vascular ring anomaly?

Anthony Dennison — Mon, 06 Feb 2017 13:10:10 GMT

Think you just pull it back through and suture it in place, no?

RE: Vascular ring anomaly?

Julie Innes — Sat, 04 Feb 2017 08:15:48 GMT

How would you fix it- surgery? Is it specialist surgery?

RE: Vascular ring anomaly?

Linda Filshie — Sat, 04 Feb 2017 01:34:24 GMT

If this works then the pink sort-of-arrow (fat fingers, sorry) is the narrowing at the hiatus and the blue circle is the contrast still cranial to the diaphragm that really shouldn't be.

RE: Vascular ring anomaly?

Linda Filshie — Sat, 04 Feb 2017 01:27:24 GMT

[quote user="Beats"]

[quote user="Linda Filshie"]With the delayed radiograph there is a well circumscribed region of contrast material cranial to the diaphragm and there is focal narrowing of the contrast at the level of the diaphragm. These radiographic findings are consistent with a hiatal hernia.[/quote]

thanks linda! Just so i'm totally clear, which xray is this best seen in (numbering 1 at top through to 6 at bottom of post; i.e. xray2 being the one in DV-standing)

[/quote]

number 6, i.e. the bottom one. If I was feeling spiffy with ms paint or whatever the iPad equivalent is I would draw around it, but my iPad skills are a bit rudimentary so probably not going to happen!

RE: Vascular ring anomaly?

Rach — Fri, 03 Feb 2017 19:57:01 GMT

To my mind it is the last two radiographs, they look very much like the picture on the quiz below (No prizes for guessing the answer - I did double check before posting it as supporting evidence!)

http://veterinarymedicine.dvm360.com/image-quiz-why-3-year-old-pug-acutely-regurgitating

RE: Vascular ring anomaly?

Beats — Thu, 02 Feb 2017 23:47:08 GMT

thanks linda! Just so i'm totally clear, which xray is this best seen in (numbering 1 at top through to 6 at bottom of post; i.e. xray2 being the one in DV-standing)

RE: Vascular ring anomaly?

Linda Filshie — Thu, 02 Feb 2017 23:41:51 GMT

[quote user="Beats"]

can someone describe / highlight what makes this look like hiatal hernia for me?

[/quote]

With the delayed radiograph there is a well circumscribed region of contrast material cranial to the diaphragm and there is focal narrowing of the contrast at the level of the diaphragm. These radiographic findings are consistent with a hiatal hernia.

RE: Vascular ring anomaly?

Beats — Thu, 02 Feb 2017 21:28:16 GMT

can someone describe / highlight what makes this look like hiatal hernia for me?

I'll try to remember to update follow-up for anyone interested.

Really appreciate the comments and pointers!

RE: Vascular ring anomaly?

Evelyn Barbour-Hill — Wed, 01 Feb 2017 13:10:24 GMT

[quote user="Kate Richardson"]

Secondary to boas?

[/quote]

Extremely likely

RE: Vascular ring anomaly?

Kate Richardson — Wed, 01 Feb 2017 11:58:56 GMT

Secondary to boas?

RE: Vascular ring anomaly?

Anthony Dennison — Wed, 01 Feb 2017 11:49:43 GMT

Me three

RE: Vascular ring anomaly?

Evelyn Barbour-Hill — Wed, 01 Feb 2017 00:33:57 GMT

[quote user="Rach"]

Hi, hopefully someone with a bit more experience/knowledge will be along to offer you better advice, thats what I imagine a hiatal hernia would look like...

[/quote]

I think so too.

RE: Vascular ring anomaly?

Rach — Tue, 31 Jan 2017 20:06:23 GMT

Hi, hopefully someone with a bit more experience/knowledge will be along to offer you better advice, thats what I imagine a hiatal hernia would look like...

RE: Vascular ring anomaly?

Beats — Tue, 31 Jan 2017 14:48:28 GMT

no sign of stricture in esophagus at heart base

thanks again!

RE: Vascular ring anomaly?

Beats — Fri, 27 Jan 2017 19:20:06 GMT

Thanks everyone.

Want to leave couple of weeks before giving another anesthetic, so will do the consicous barium/food xray first and then open up nostrils in week or two's time. Had been on omeprazole+metoclopramide for about a week prior to scoping and will stay on omeprazole at least for now.

RE: Vascular ring anomaly?

Andrew Kent — Wed, 25 Jan 2017 21:29:21 GMT

Hi Beats,

Trying to look at the rads on my phone and can't get them to open in a new window to make bigger but from a distance it seems in the anaesthetised image there is a diffuse mild distension of the oesophagus but this is not present on the conscious view so more likely to be an artefact of GA. I don't see any narrowing at the heart base.

I agree with the comments above that regurgitation is very common in BOAS cases - this can be due to hiatal hernia or due to the gastro-oesophageal reflux that is common due to the disease. The latter of these typically responds very quickly to treatment with omeprazole and metoclopramide so could be worth trialling that.

Longer-term the vast majority improve more permanently with surgery to improve the BOAS.

Andy

RE: Vascular ring anomaly?

Sarah Keir — Wed, 25 Jan 2017 21:04:06 GMT

I would be to vote that this regurgitation is related to the concurrent BOAS problem, may not even have a hiatal hernia to have signs.

RE: Vascular ring anomaly?

David Mills — Wed, 25 Jan 2017 20:09:44 GMT

And if you get chance, they're actually quite fun surgeries to do if you're a confident surgeon

RE: Vascular ring anomaly?

Kate Richardson — Wed, 25 Jan 2017 20:07:40 GMT

Also chat to a specialist about BOAS- could very much be related. One of our nurses has a frenchie and it had lots of gi problems as a pup secondary to boas

RE: Vascular ring anomaly?

Beats — Wed, 25 Jan 2017 19:40:09 GMT

Great tips folks!

Cheers :-)

RE: Vascular ring anomaly?

David Mills — Wed, 25 Jan 2017 19:17:05 GMT

Do the barium almost as soon as they've swallowed it, normally starve from night before so they eat it.

RE: Vascular ring anomaly?

Evelyn Barbour-Hill — Wed, 25 Jan 2017 19:15:35 GMT

[quote user="Beats"]Just some tinned dog food mixed with say 30ml normal liquid barium, feed, wait 5mins, hold for conscious lateral (right/left does it matter?) radiograph?[/quote]

Bit more barium and don't wait so long.

To be really sophisticated, why not take two or three radiographs at intervals?

RE: Vascular ring anomaly?

Jenny Harris — Wed, 25 Jan 2017 19:06:29 GMT

Yeah I think they can be hard to diagnose, apparently you can try Occluding the airway for a couple of breaths under GA whilst you are scoping them and see if you can see it bulging out the LOS.