CT/MRI Society Case of the Month - January 2013
Copyright CT/MRI Society
Publication Date: 2012-12-04
History
5 year old, neutered male, Brussels griffon with difficulty breathing.
He is a dog that will typically eat anything and everything including kindling. Approximately 3 weeks ago he was acutely unable to breathe through his nose. Initially he was extremely resistant to breathing through his mouth and consequently he was not sleeping well at all. Although that has improved somewhat, since that time he has also been hyporexic and is only eating 60% of normal. Shortly thereafter he developed left sided mucopurulent nasal discharge.
Radiographs (skull and thoracic), a CBC/Chem, and lymph node aspirate were unremarkable. Treatment with doxycycline and cetirizine was prescribed. The nasal discharge resolved within 1-2 days; however, the congestion persisted. On 11/10/12 Gent/Dex nose drops were started with no appreciable improvement in the congestion. As such, on 11/15/12, he was started on prednisone (5 mg BID). There was partial improvement with this therapy; however, clinical signs returned to baseline with discontinuation of the steroid. Although he used to eat any type of food, at this point he will only eat canned w/d. No V/D/C/PU/PD.
85 images
Findings
On CT images of the head there is mild congestion in the nasal cavities bilaterally. There is soft tissue density material, roughly spheroid in shape and measuring 6 x 10 x 12 mm in diameter, located within the rostral nasopharynx and obstructing the nasal airway. The material does not exhibit contrast enhancement. There are no other abnormalities seen.
DDx
The CT findings are most compatible with a foreign body lodged in the rostral nasopharynx. Endoscopic exploration and removal is recommended.
Diagnosis
At endoscopy a pumpkin seed was identified lodged in the rostral nasopharynx causing obstruction of the airway. The pumpkin seed was removed and the patient recovered uneventfully with complete resolution of clinical signs.
Here is the endoscopy.
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