Recurrent aspiration pneumonia and esophageal dysmotility in a 2-year-old Bernese Mountain Dog Monika Mostowy

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A 2-year old, castrated male Bernese Mountain Dog was presented to Cornell for nasal discharge and productive cough of two days duration. The dog was initially seen by his primary care veterinarian earlier that day, who found a fever of 104F and an interstitial-alveolar lung pattern on thoracic radiographs. The dog was diagnosed with pneumonia and referred to Cornell for further workup and care. He had a history of recurrent upper respiratory disease and multiple previous episodes of pneumonia, treated successfully with antibiotics and supportive care.

Physical examination by Cornell’s Emergency Service revealed a fever of 104.8F, tachypnea, bilateral mucopurulent nasal discharge and harsh lung sounds in all fields. His problem list, which included mucopurulent nasal discharge, productive cough, fever, harsh lung sounds, tachypnea and interstitial-alveolar radiographic lung pattern, was consistent with a diagnosis of pneumonia. He was admitted to the ICU and treated with intranasal oxygen, nebulization, intravenous isotonic crystalloids, ampicillin with sulbactam (Unasyn), enrofloxacin, maropitant and pantoprazole. He remained hospitalized for seven days until he was able to achieve a hemoglobin oxygen saturation of 95% on room air, as measured by a pulse oximeter. He was then discharged with oral antibiotics and antiemetics.

The primary differential for his recurrent aspiration pneumonia was dysphagia, so the dog was brought back to CUHA after recovery for a swallow study with contrast videofluoroscopy. Contrast videofluoroscopy is the current gold standard test for diagnosis of dysphagia, and fluoroscopic imaging characteristics have been described for oral, pharyngeal, cricopharyngeal, esophageal and gastroesophageal dysphagias. This patient’s swallow study revealed esophageal dysmotility and a sliding hiatal hernia. Additional diagnostics were performed to rule out toxic, metabolic and immune-mediated causes of esophageal dysmotility. There is not much data available concerning the treatment of esophageal dysmotility at this time. Recommendations for this patient included elevation of food bowls, feeding soft food and encouraging slower eating.

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Canine -- Aspiration pneumonia; Bernese Mountain dog -- Dysphagia -- Esophageal Dysmotility -- swallow study


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