Anomalous broncho‐oesophageal arteries and peripheral systemic‐to‐pulmonary connections in an asymptomatic puppy

Abstract

A clinically healthy four-month-old puppy had a grade 2/6 left basilar, continuous heart murmur and was presented for further evaluation. Echocardiography revealed multiple small diastolic colour signals around the main right pulmonary artery. Mild pulmonary overcirculation and left ventricular enlargement were observed on thoracic radiography. Contrast enhanced CT with angiography revealed anomalous broncho-oesophageal arteries with peripheral pulmonary shunting, consistent with systemic-to-pulmonary connections. Six months after diagnosis, the patient continued to lack clinical signs, had no progression in left atrial or left ventricular size, and there was no progression in pulmonary overcirculation. This report shows that dogs with congenital anomalous broncho-oesophageal arteries and mild-to-moderate peripheral pulmonary shunting can remain asymptomatic over a long period of time.

Case report: Echocardiographic and computed tomographic features of congenital bronchoesophageal artery hypertrophy and fistula in a dog

“…Continuous murmurs are usually heard in PDA and APW ( 2 , 4 ), generally at the base and apex ( 4 , 27 ). All previous cases of BEA hypertrophy had various grades of left-sided murmur, either apical or basal ( 11 , 14 , 15 , 17 ); however, no study has reported BEA hypertrophy with a right basal murmur. In previous reports regarding BEA hypertrophy, shunt insertion locations were the proximal left pulmonary artery, between the aorta and the pulmonary artery, and the proximal RPA.…”

“…The clinical significance of L-to-R shunts depends on their size and the blood flowing through them ( 1 ). The types of L-to-R shunts include patent ductus arteriosus (PDA) ( 2 , 3 ), aortopulmonary window (APW) ( 4 – 7 ), L-to-R arteriovenous fistulae ( 8 ), arteriovenous shunts ( 9 ), and various atypical L-to-R shunts ( 10 – 17 ). Bronchoesophageal artery (BEA) hypertrophy, also referred to as an aberrant BEA, is a relatively rare type of L-to-R shunt in dogs ( 10 , 11 , 14 , 15 , 17 ).…”

“…The types of L-to-R shunts include patent ductus arteriosus (PDA) ( 2 , 3 ), aortopulmonary window (APW) ( 4 – 7 ), L-to-R arteriovenous fistulae ( 8 ), arteriovenous shunts ( 9 ), and various atypical L-to-R shunts ( 10 – 17 ). Bronchoesophageal artery (BEA) hypertrophy, also referred to as an aberrant BEA, is a relatively rare type of L-to-R shunt in dogs ( 10 , 11 , 14 , 15 , 17 ). The BEA usually arises from the fifth right dorsal intercostal artery and courses next to the esophagus, which is known to play a major role in supplying oxygen to the airways and supporting pulmonary structures ( 18 ).…”

“…To date, five studies on aberrant BEA, BEA hypertrophy, and anomalous BEA have been reported in dogs ( 10 , 11 , 14 , 15 , 17 ); additionally, there is a lack of reports on BEA anomalies in other animals. However, these cases have differences in the locations of shunt insertion, and there are no reports of cases with right-sided murmurs.…”