Nasopharyngeal stenosis with concurrent hiatal hernia and megaesophagus in an 8-year-old cat

Abstract

A case of nasopharyngeal stenosis with secondary hiatal hernia is described. An 8-year-old castrated male domestic shorthair cat was referred for a chronic upper respiratory problem and presumptive vomiting. Despite conservative management by the primary care veterinarian, the cat's condition progressed. The cat was presented to an emergency facility prior to referral to a specialty hospital. On presentation, inspiratory stridor was evident. Thoracic radiography revealed a hiatal hernia. Computed tomography indicated pharyngeal edema and probable nasopharyngeal stenosis. Endoscopy confirmed the presence of nasopharyngeal stenosis consistent with either stricture or choanal atresia. Balloon dilation of the choana was performed. The hiatal hernia regressed spontaneously post-resolution of the nasopharyngeal stenosis. The cat remained asymptomatic at recheck 3 months later.

Fig 1.

Right lateral (A) and ventrodorsal (B) radiographic views of the thorax of an 8-year-old castrated male domestic shorthair cat evaluated for inspiratory stridor and vomiting. There is gaseous dilation of the mid and caudal extent of the thoracic portion of the esophagus. An ill-defined soft tissue opacity is seen in association with the esophagus, just cranial to the crura of the diaphragm. Cardiovascular and pulmonary parenchyma are unremarkable. Skin staples are noted along the cranioventral abdominal wall. There is reduced serosal detail in the cranial ventral abdomen and previously administered barium is evident in the intestines.

Fig 2.

A CT evaluation of the skull was performed acquiring helical series and reconstructing transverse images at 2-mm slice thicknesses. There is an ill-defined soft tissue opacity in the dorsal aspect of the pharyngeal region and caudal aspect of the nasopharynx (white arrow) along with an unusual associated gas opacity (red arrowhead).

Fig 3.

Retroflexed endoscopic view of the nasopharyngeal opening with nasopharyngeal stenosis (white arrows). The opening is reduced to a small hole (red arrowheads).

Fig 4.

Retroflexed endoscopic view of the nasopharyngeal opening after balloon dilation of nasopharyngeal stenosis.

Fig 5.

A right lateral radiographic view of the thorax post-balloon dilation of the choanae. The previously noted esophageal dilation and increased opacity at the caudal aspect of the esophagus, cranial to the diaphragmatic crura, are no longer evident. Cardiovascular and pulmonary parenchyma are unremarkable.

Fig 6.

Left lateral (A) and right lateral (B) radiographic views of the thorax at 3 months post-balloon dilation of the choanae. There is no evidence of hiatal hernia or esophageal dilation. A small amount of esophageal fluid is evident on the left lateral radiograph. The cardiovascular and pulmonary structures are unremarkable.