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- One-week history of right thoracic limb lameness or ataxia.
- On presentation the patient had neck pain, right sided Horner’s syndrome, pain on flexion and extension of the right shoulder, and elevated temperature (103.6F).
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Study Performed:
- MRI of the neck (6 sequences, 152 images) in transverse (T2, T1), sagittal (T2, STIR) and dorsal (STIR) planes.
Findings:
- In the esophagus, there is a large cylindrical, hypointense foreign body. The cranial margin of the foreign body beings at the level of C4-C5 and extends caudally past T4 (caudal extent of the scan). At the level of the right second intercostal space, a large appendage of the foreign body extends through the right-ventral wall of the esophagus into the mediastinum.
- The cranial mediastinum has severe, locally extensive T2 hyperintensity that extends into the region of the right brachial plexus.
- The sternal lymph nodes are mildly enlarged and have mixed intensity.
- The included portion of the pleural space contains a small amount of fluid and the right cranial lung lobe is reduced in volume with a small, patchy region of hyperintensity.
- At C5, the right multifidus muscle has patchy T2 hyperintensity.
Summary:
- Large, penetrating esophageal foreign body with locally extensive mediastinitis, sternal lymphadenopathy, pleural effusion, and focal, right cranial lung lobe consolidation
- Focal, right multifidus myopathy, level of C5
Conclusions:
The right forelimb lameness, right Horner’s and neck pain are attributed to penetrating esophageal foreign body and locally extensive mediastinitis (eg. secondary neuritis). The primary differential diagnosis for the pleural effusion is pyothorax. The pulmonary consolidation may be secondary to contusions, focal pneumonia, and/or atelectasis.
Outcome/Follow up:
- A CT was performed for surgical planning. Below are curved MPR reconstructions of the foreign body in the esophagus, extending from C5-6 to the fundus of the stomach. The pleural space contains a small to medium volume of fluid.
- The patient had the esophageal foreign body removed via gastrotomy (images below) and esophageal perforation was repaired via sternotomy.
- The patient recovered and was discharged without substantial complication