SYDNEY SCHALLER Laryngeal Mass

History Sydney is a nine year old female spayed Schnauzer/Poodle Mix. She has a history of chronic bronchitis and has been on Prednisone and Amoxicillin for the past two weeks with no improvement in her labored breathing and coughing (previously she had responded well to this therapy).

Clinical signs 1.Dyspnea 2.Coughing 3.Difficulty swallowing 4.Owner palpated ventral neck mass 1 week prior to presenting 5.Seizures – controlled with phenobarbital 6.Mitral valve insufficiency (not on medications)

Physical Exam 1. 4/6 holosystolic murmur 2. Inspiratory stridor but lungs clear. 3. Firm non-moveable mass palpated in the area of the larynx

Radiographs Cervical Radiogrpahs: There is increased soft tissue opacity around the larynx especially ventrally with narrowing of the laryngeal lumen indicating a mass effect. Thoacic Radiographs: There is a diffuse bronchointerstitial pattern consistent with an inflammatory infiltrate such as bronchitis but edema cannot be entirely ruled out. The cardiac silhouette is enlarged especially in the area of the left atrium. The pulmonary vessels are enlarged. There is mild hepatomegaly.

Cervical Ultrasound There is redundant hypoechoic tissue associated with the proximal esophageal wall (8.2 mm thick) and the adjacent larynx. Immediately deep to the esophageal thickening is a 1.3 mm thick hyperechoic linear structure with hypoechoic center that is possibly crossing left-to-right from the esophageal lumen to that of the adjacent trachea. (Ruleouts for this linear structure include a foreign body, portion of thyroid cartilage, or a displaced hyoid bone).

Enlarged left and right retropharyngeal lymph nodes

Laryngeal Mass Aspirate Numerous nondegenerate neutrophils are present in addition to lower numbers of macrophages and lymphocytes. The background contains an eosinphillic stippled proteinaceous appearance. No eitologic agent or evidence of neoplasia. Foreign body is a potential cause of this inflammation, however, underlying neoplasia with secondary inflammation cannot be excluded.

A laryngotomy was performed with a biopsy of laryngeal tissue, and placement of temporary tracheostomy tube (removed 10/20/06).