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interesting cases@ EHVH "TILLY"
Barium Radiograph
Left Lateral Thoracotomy |
“Tilly” - a very cute kitten presented to us for chronic vomiting; noticed to become more frequent after transitioning to dry food. Our initial concern was that she may have had a foreign body trapped in her gut; but further questioning, established that Tilly was regurgitating rather than vomiting. Radiographs of the chest showed a large mass just in front of her heart. A needle aspirate of the sample obtained under ultrasound guidance showed the mass was not a cancer but contained food particles. Barium was given (see xray image) to outline her oesophagus on radiographs, and showed a very dilated oesophagus, full of food in front of her heart. This was a very important finding as there are very few conditions that present in this way. We suspected that she was affected by a vascular ring anomaly. Vascular rings are rare developmental anomalies that arise whilst an embryo is developing in utero. There are a number of different types of anomalies; however the end result is the same: the oesophagus becomes entrapped by a ring of major blood vessels, including the aorta and pulmonary trunk. The most common presentation of this problem is a persistent right aortic arch. In this situation, the aorta arises from the embryonic right fourth aortic arch instead of the left fourth aortic arch. As a result, it becomes entrapped between the aorta, pulmonary trunk and a ligament called the ligamentum arteriosum. The ligamentum arteriosum is actually a blood vessel that allows blood to bypass the lungs whilst an embryo is developing (our lungs don’t need to do anything whilst we are developing in utero!). However, at birth, it closes down and turns into a ligament. It is a normal structure in the 4-chambered heart; however it can be very problematic if your heart has not followed the correct blueprint! “Tilly” required surgery in order to give her the best chance to recover and lead a normal, healthy life. We took her to surgery and performed a left lateral thoracotomy. This involved an incision between her 5th and 6th ribs to give us the best access to her heart and ligamentum arteriosum. We identified all the major nerves and vessels in her chest and then isolated her ligamentum arteriosum. The offending ligament was then bisected, thereby releasing her oesophagus. Her post operative recovery was nothing short of miraculous. Within 24 hours of surgery, she was eating again and most importantly, keeping her food down. We had concerns that her oesophagus would not return to full function because it had been dilated for so long; however “Tilly” has defied the odds. She is still on a soft food diet and is fed from a height. This allows gravity to assist the passage of food into her stomach. Her first post operative radiograph showed that the mass of food that had accumulated in her oesophagus had moved on and that her dilation was starting to shrink. We are all delighted at her progress & wish her a long and content life. |
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