Dixie is a 10 year old female spayed Beagle, who was referred to VRCC for further evaluation of chronic nasal congestion since December 2015. She was placed on several courses of antibiotics to treat a possible sinus infection and symptoms did not improve. Dixie saw one of our Internal Medicine Specialists, Dr. Ed Fallin.
Dr. Fallin performed a thorough physical exam on Dixie, noting marked inspiratory stertor, or respiratory sounds such as snorting or gasping that would indicate a partial obstruction over the nasopharynx. There was also decreased air movement through Dixie's right nostril. The plan was to procede with a rhinoscopy procedure.
What is a Rhinoscopy
A rhinoscopy is an endoscopic procedure which involves feeding an endoscope into the mouth and up to view the back of the nasal passages, as well as through each nostril. The patient must be sedated for the procedure. The endoscope is a long, tube-like instrument that has a lense on the tip for viewing as well as taking images and videos. It also has a passage to feed forceps through for the purpose of getting tissue samples.
During the procedure, we have a licensed veterinary technician dedicated to running anesthesia to ensure the safety of the patient. We also have an assistant available to help the veterinarian in retrieving biopsies.
Before Dixie could be anesthetized for her endoscopy, Dr. Fallin ordered a full blood panel to test for any clotting abnormalities. A rhinoscopy can cause the nose to bleed during and following the procedure, so it is important that these values are assessed before hand.
Dixie's lab results were all normal, so Dixie was placed under anesthesia. Before the actual procedure, technicians took three-view skull radiographs to look for the presence of a mass or foreign body. These radiographs revealed diffuse radiopacity in the right caudal nasal and frontal sinuses. The rest of the nasal structures appeared normal.
Things got a little more interesting when the procedure began. Dr. Fallin began by retroflexing the scope up into the back of the oral cavity to view the nasal passages. Here, he found a choanal (posterior nasal aperture) mass that was obstructing 85% of the choana and continuing into the right nasal passage. This was the cause of Dixie's respiratory problems.
After the mass was found, Dr. Fallin began to take biopsies with a 1.8mm biopsy forcep. With this size of forcep, the biopsies tend to be quite tiny, though still have a high rate of yielding a diagnosis. However, with a little gentle tugging, Dr. Fallin was able to pull the entire mass out of the choana.
Above you can see what Dixie's choana looked like before and after the mass was extracted. Dr. Fallin sent the mass to a pathologist for analysis and we are happy to report that the results came back as a benign polyp! Dixie is breathing much easier now that her airway is free of obstruction.