Artéria subclávia direita aberrante em cão - aspectos clínicos e de imagem / Aberrant right subclavian artery in a dog - clinical and imaging aspects

Background: Aberrant right subclavian artery is only rarely observed in veterinary medicine. Some animals may present postprandial regurgitation and progressive weight loss, which is considered an incidental finding unrelated to clinical alterations. Advanced imaging techniques such as thoracic CT scan, magnetic resonance imaging (MRI) and contrast angiography are used for the accurate detection of lesions, anatomical changes and specific information about vascular rings. This paper describes the clinical changes, imaging exams and therapeutic approach in a female dog with megaesophagus induced by an aberrant right subclavian artery. Case: A 2-month-old female bull terrier, weighing 1.6 kg, with a history of regurgitation immediately or a few minutes after a meal, diarrhea, polyphagia, progressive emaciation and apathy for 45 days, was treated at a University Veterinary Hospital. The dog's physical examination revealed 7% dehydration and body condition score 1 (scale 1 to 5), but no cardiac or pulmonary alterations upon auscultation. The hematological analysis and renal and hepatic serum enzymes were within the normal range for the species. In view of the presumptive clinical diagnosis of vascular anomaly, suggested by the contrast X-ray examination, a chest tomography was performed, which revealed altered aortic arch shape and contours, and a posterior aneurysm in the area of abnormal connection of the right subclavian artery. The patient was released with a prescription for conservative dietary management for megaesophagus. Within two weeks, the patient returned with a report of a good response to the prescribed therapy, absence of vomiting and diarrhea, and an increase in body weight. Surgical correction was recommended, but has not been performed so far, but conservative treatment for megaesophagus was continued. No further episodes of regurgitation were identified during the nine-month follow-up period. Discussion: In the case reported here, the right subclavian artery is considered anatomically atypical because it arises directly from the aortic arch. This vascular anomaly passes on to the right pectoral limb, dorsal to the esophagus, contracting it in its dorsal aspect. It tends to affect purebred dogs, occurring more frequently in Irish setters, German shepherds and Labrador retrievers, although it has been described in other breeds such as the bull terrier documented here and mixed breed dogs. Vascular ring anomalies may not cause clinical changes in animals and represent only incidental findings, or they may lead to gastrointestinal changes resulting from esophageal stricture, contributing to megaesophagus and clinical signs of esophageal obstruction, especially in recently weaned puppies. Such alterations were observed in this case, with the dog presenting regurgitation, immediately or a few minutes after a meal, megaesophagus, diarrhea and progressive weight loss. A CT scan was performed to confirm the type and location of the vascular anomaly and diagnostic accuracy, as recommended in the literature. Dietary therapy is one of the approaches adopted for patients presenting with regurgitation resulting from megaesophagus secondary to vascular anomalies. The dog in this report responded well to the medical therapy; nevertheless, the treatment of choice to correct the esophageal obstruction caused by this anomaly is surgical sectioning of the aberrant vessel by right intercostal thoracotomy, given that the degree of esophageal dilation and dysfunction tends to increase over time. However, at this time, the animal's owner decided to suspend the recommended surgical procedure.

Concurrent hiatal hernia and megaesophagus secondary to a nasopharyngeal polyp in a 6-month-old cat

Background: Nasopharyngeal polyps are benign and inflammatory masses assumed to arise from the middle ear or the eustachian tube with extension into the pharynx. The most common clinical signs associated with nasopharyngeal polyps include respiratory stertor, dyspnea, and otic discharge. Neurological signs, including head tilt, facial nerve paralysis, and ataxia, might indicate concurrent involvement of the middle or inner ear. The objective of the current report is to describe a case of a feline nasopharyngeal polyp with a concurrent hiatal hernia and megaesophagus, both spontaneously resolved after removal of the polyp. Case: A 6-month-old female intact domestic shorthair cat was presented for evaluation of lethargy, anorexia, and upper respiratory signs, such as stridor, stertor, and dyspnea. A thoracic radiography revealed esophageal dilation caudal to the cardiac silhouette, suggestive of megaesophagus with gaseous filtration. An esophagram confirmed a hiatal hernia and megaesophagus. Computed tomography revealed a nasopharyngeal mass adjacent to the soft palate and a soft-tissue density in the right tympanic bulla. A tentative diagnosis of a nasopharyngeal polyp was made. After the ventral bulla osteotomy, the nasopharyngeal mass was removed by a gentle traction avulsion technique. Six days after the surgery, hiatal hernia and megaesophagus were spontaneously resolved. Based on histopathologic exam, the mass was found to be an inflammatory nasopharyngeal polyp. Two months after surgery, the owner reported that the patient's condition had returned to baseline with a good appetite, and the thoracic radiography was within normal limit. Discussion: For successful treatment of a nasopharyngeal polyp, traction avulsion of the polyp with or without a ventral bulla osteotomy is recommended. However, in patients with otitis media, a ventral bulla osteotomy followed by traction avulsion of the polyp is recommended in order to reduce the rate of polyp recurrence. Common clinical signs of a nasopharyngeal polyp are stertor, stridor, dyspnea, dysphagia, and open-mouth breathing, which are identified in a chronic upper airway obstruction. A hiatal hernia secondary to a nasopharyngeal polyp has not been reported so far. However, a relationship between chronic upper airway obstruction and hiatal hernias has been proposed previously. Moreover, hiatal hernia resolved spontaneously after removal of the nasopharyngeal polyp suggests that the occurrence of the hiatal hernia was secondary to the nasopharyngeal polyp. In addition to the hiatal hernia, megaesophagus was also identified in the present case. Megaesophagus secondary to a chronic upper airway obstruction from a nasopharyngeal obstruction has been reported. However, megaesophagus is also thought to occur secondary to hiatal hernias. Therefore, in the current study, it is unclear whether the megaesophagus was solely a result of the obstructive nature of the nasopharyngeal polyp or a combination of the hiatal hernia and the nasopharyngeal polyp. In conclusion, any cat with clinical signs of an upper airway obstruction and a concurrent hiatal hernia and megaesophagus should be thoroughly investigated for a nasopharyngeal polyp, as well as other gastrointestinal and systemic causes. Furthermore, this case suggests that the prognosis for a concurrent hiatal hernia and megaesophagus is good in cats if the nasopharyngeal polyp is properly removed.

Surgical correction of esophageal stenosis by right aortic arch persistence in two cats

Background: Vascular ring anomaly is considered a hereditary change. It occurs when the fourth right aortic arch persists instead of the fourth left aortic arch, forming a vascular ring that compress the esophagus causing esophageal dilatation cranial to the compression site. Diagnosis is based upon anamnesis, physical examination, clinical signs and complementary exams (radiograph, complete blood count and biochemical tests). The clinical treatment is inadequate, since the dilatation persists and tends to progress causing irreversible tissue injury. Surgical correction is indicated and consists of the arterial ligament resection and correction of the esophageal stenosis. Case: The objective of the current study is to report two case of persistence of right aortic arch in two cats referred to the Veterinary Hospital of the Federal University of Santa Maria. On physical examination the patients were alert, in good nutritional status, adequately hydrated and presented normal colored mucous membranes. Each animal underwent radiography and esophagogram with barium sulphate. The exam demonstrated partial esophageal dilation cranial to the cardiac silhouette, suggestive of vascular ring anomaly. An exploratory thoracotomy was performed in order to achieve the definitive diagnosis. The arterial ligament was resected and esophageal stenosis corrected. Anesthesia, surgery and the [...]

Surgical correction of esophageal stenosis by right aortic arch persistence in two cats

Background: Vascular ring anomaly is considered a hereditary change. It occurs when the fourth right aortic arch persists instead of the fourth left aortic arch, forming a vascular ring that compress the esophagus causing esophageal dilatation cranial to the compression site. Diagnosis is based upon anamnesis, physical examination, clinical signs and complementary exams (radiograph, complete blood count and biochemical tests). The clinical treatment is inadequate, since the dilatation persists and tends to progress causing irreversible tissue injury. Surgical correction is indicated and consists of the arterial ligament resection and correction of the esophageal stenosis. Case: The objective of the current study is to report two case of persistence of right aortic arch in two cats referred to the Veterinary Hospital of the Federal University of Santa Maria. On physical examination the patients were alert, in good nutritional status, adequately hydrated and presented normal colored mucous membranes. Each animal underwent radiography and esophagogram with barium sulphate. The exam demonstrated partial esophageal dilation cranial to the cardiac silhouette, suggestive of vascular ring anomaly. An exploratory thoracotomy was performed in order to achieve the definitive diagnosis. The arterial ligament was resected and esophageal stenosis corrected. Anesthesia, surgery and the [...](AU)

Megaesophagus in sheep and goats / Megaesôfago em ovinos e caprinos

Megaesophagus is a rare disease in ruminants characterized by regurgitation of rumen contents. In this paper it was described cases of megaesophagus in two sheep and two goats on a farm in the state of Paraíba, Northeastern Brazil. All animals showed regurgitation of rumen contents and weight loss, with a clinical course of several months. At necropsy all animals presented megaesophagus. Histological examination showed segmental muscle necrosis in the esophagus and skeletal muscles. Serum samples from one sheep and one goat were negative for the presence of blue tongue antibodies by ELISA, and whole blood and muscle samples from one goat were negative for this virus by RT PCR. Epidemiological data and pathology suggested that the disease could have been caused by some toxic plant, but known plants causing segmental muscle necrosis were not observed in the areas where the disease occurred.(AU)

Megaesôfago é uma enfermidade rara em ruminantes caracterizada por regurgitação do conteúdo ruminal. Neste trabalho, descrevem-se casos de megaesôfago em dois ovinos e dois caprinos no Estado da Paraíba. Todos os animais apresentaram regurgitação do conteúdo ruminal e emagrecimento, com evolução de vários meses. Nas necropsias dos animais, observou-se dilatação esofágica e, em exames histológicos, necrose muscular segmentar no esôfago e músculos esqueléticos. Não foram encontrados anticorpos para o vírus da língua azul nos soros de um ovino e um caprino pela técnica de ELISA. Sangue total e músculo de um caprino resultaram negativos para esse vírus por RT PCR. Sugere-se que a doença seja causada por alguma planta tóxica, mas não foram encontradas plantas conhecidas por causarem necrose segmentar muscular nos piquetes onde ocorreu a doença.(AU)

Megaesófago secundario a la miastenia gravis / Megaesophagus secondary to myasthenia gravis / gravis

Astenia esofágica o megaesófago se define por una dilatación patológica del esófago y caracterizado por una insuficiencia progresiva de las olas peristálticas. Esta enfermedad se puede clasificar en: idiopática, congénita o adquirida secundaria. La causa más común del megaesófago secundario es Miastenia gravis. Esta enfermedad se caracteriza por ser una neuropatía que desencadena un trastorno neuromuscular que causa debilidad del músculo esquelético, el esófago, la faringe y la laringe. La debilidad muscular se correlaciona con la mejoría tras el descanso y empeora con el ejercicio. El megaesófago secundario adquirido a la miastenia gravis se caracteriza por la interrupción del reflejo nervioso, controlador de la deglutición que afecta el funcionamiento de los músculos del esófago, lo que lleva a la dilatación pasiva del órgano. Razas como Pastor Alemán, Golden Retriever y Setter Irlandés tienen una mayor predisposición a la enfermedad.(AU)

Esophageal asthenia or megaesophagus is defined as a pathological dilation and progressive failure of peristaltic waves. This disease can be classified in: idiopathic, congenity or acquired secondary. The most common cause of acquired secondary megaesophagus is myasthenia gravis. This disease is defined as a neuropathy that develops a neuromuscular disorder, resulting in muscle weakness, of the esophagus, of the larynx and of the pharynx. The muscle weakness is related to improvement after rest and worsening with exercise. The megaesophagus secondary to myasthenia gravis is defined to nervous reflex breakdown, swallowing controller or lesions that affect the esophageal muscle function, resulting in an organ passive dilation. Breeds like German Shepherd, Golden Retriever and Irish Setter have a greater predisposition to disease.(AU)

Astenia esofágica ou megaesôfago é definido por uma dilatação patológica do esôfago e caracterizado por uma falha progressiva das ondas peristálticas. Essa doença pode ser classificada em: idiopática, congênita ou secundária adquirida. A causa mais comum de megaesôfago secundário adquirido é a miastenia gravis. Tal doença é caracterizada por ser uma neuropatia que desencadeia uma desordem neuromuscular, provocando fraqueza de musculatura esquelética, esôfago, faringe e laringe. A fraqueza muscular está correlacionada com melhora após o descanso e piora com o exercício. O megaesôfago adquirido secundário a miastenia gravis é caracterizado pelo rompimento do reflexo nervoso, controlador da deglutição ou que afeta o funcionamento da musculatura esofágica, levando a dilatação passiva do órgão. Raças como Pastor Alemão, Golden Retriever e Setter Irlandês possuem maior predisposição à doença.(AU)

Megaesófago secundario a la miastenia gravis / Megaesophagus secondary to myasthenia gravis / gravis

Astenia esofágica o megaesófago se define por una dilatación patológica del esófago y caracterizado por una insuficiencia progresiva de las olas peristálticas. Esta enfermedad se puede clasificar en: idiopática, congénita o adquirida secundaria. La causa más común del megaesófago secundario es Miastenia gravis. Esta enfermedad se caracteriza por ser una neuropatía que desencadena un trastorno neuromuscular que causa debilidad del músculo esquelético, el esófago, la faringe y la laringe. La debilidad muscular se correlaciona con la mejoría tras el descanso y empeora con el ejercicio. El megaesófago secundario adquirido a la miastenia gravis se caracteriza por la interrupción del reflejo nervioso, controlador de la deglutición que afecta el funcionamiento de los músculos del esófago, lo que lleva a la dilatación pasiva del órgano. Razas como Pastor Alemán, Golden Retriever y Setter Irlandés tienen una mayor predisposición a la enfermedad.

Esophageal asthenia or megaesophagus is defined as a pathological dilation and progressive failure of peristaltic waves. This disease can be classified in: idiopathic, congenity or acquired secondary. The most common cause of acquired secondary megaesophagus is myasthenia gravis. This disease is defined as a neuropathy that develops a neuromuscular disorder, resulting in muscle weakness, of the esophagus, of the larynx and of the pharynx. The muscle weakness is related to improvement after rest and worsening with exercise. The megaesophagus secondary to myasthenia gravis is defined to nervous reflex breakdown, swallowing controller or lesions that affect the esophageal muscle function, resulting in an organ passive dilation. Breeds like German Shepherd, Golden Retriever and Irish Setter have a greater predisposition to disease.

Astenia esofágica ou megaesôfago é definido por uma dilatação patológica do esôfago e caracterizado por uma falha progressiva das ondas peristálticas. Essa doença pode ser classificada em: idiopática, congênita ou secundária adquirida. A causa mais comum de megaesôfago secundário adquirido é a miastenia gravis. Tal doença é caracterizada por ser uma neuropatia que desencadeia uma desordem neuromuscular, provocando fraqueza de musculatura esquelética, esôfago, faringe e laringe. A fraqueza muscular está correlacionada com melhora após o descanso e piora com o exercício. O megaesôfago adquirido secundário a miastenia gravis é caracterizado pelo rompimento do reflexo nervoso, controlador da deglutição ou que afeta o funcionamento da musculatura esofágica, levando a dilatação passiva do órgão. Raças como Pastor Alemão, Golden Retriever e Setter Irlandês possuem maior predisposição à doença.

DISTÚRBIOS DO SISTEMA DIGESTÓRIO EM BOVINOS NA PARAÍBA E INTOXICAÇÕES POR PLANTAS EM RUMINANTES E EQUÍDEOS NO ESTADO DE SERGIPE

No primeiro capítulo descrevem-se os aspectos epidemiológicos e as alterações clínicopatológicas de um surto de alterações digestórias em bovinos alimentados com Agave sisalana. O rebanho acometido era formado por 22 animais adultos, criados de forma semiextensiva, que, devido à escassez de forragem, receberam no cocho, quase que exclusivamente, durante dois meses, o caule do A. sisalana cortado manualmente. Um animal foi encaminhado ao Hospital Veterinário da Universidade Federal de Campina Grande, com diagnóstico presuntivo de compactação ruminal e obstrução intestinal, no segundo dia de internamento o animal morreu, na necropsia observou-se rúmen, retículo e omaso repletos, com conteúdo fibroso e ressecado constituído por fibras de A. sisalana. Em todos os préestômagos e no abomaso havia fitobezoares, que mediam entre 4 e 12 cm de diâmetro e no duodeno um fitobezoar obstruía parcialmente a luz do órgão, com a porção anterior repleta de conteúdo e a posterior vazia. Conclui-se que a alimentação com caules de A. sisalana por longos períodos causa compactação de pre-estômagos e formação de fitobezoares. No segundo capítulo descreve-se um levantamento sobre plantas tóxicas para ruminantes e equídeos, feito entre os anos de 2015 e 2016 no Estado de Sergipe, o levantamento foi realizado em 16 municípios do Estado de Sergipe, abrangendo as três mesorregiões do estado: Litoral, Agreste e Sertão, aplicando-se um questionário a 32 produtores e 10 médicos veterinários, sobre ocorrência de plantas tóxicas e suas intoxicações. De acordo com o levantamento os entrevistados relataram 20 plantas tóxicas. No terceiro capítulo descreve-se um surto de megaesôfago e degeneração muscular esofágica em bovinos, que ocorreram numa propriedade no município de Ibiara Paraíba, com 12 mortes e recuperação de 6 animais, os sinais clínicos eram de apatia, salivação, diminuição dos movimentos ruminais, emagrecimento, timpanismo, diarreia e regurgitação. Dois animais foram necropsiados e observou-se que o esôfago estava difusamente dilatado e com áreas pálidas. Na histologia constatou-se degeneração e necrose segmentar difusa e severa da túnica muscular esofágica, além de marcada reação inflamatória de células mononucleares. Dados epidemiológicos sugerem que os casos tenham relação com uma planta tóxica. Novas pesquisas são necessárias para a determinação da etiologia da doença.

In the first chapter we describe the epidemiological aspects and the clinical-pathological changes of the digestive change in six cattle fed with Agave sisalana. The herd consisted of 22 adult animals, raised in a semiextensive system, which, due to the scarcity of forage, received in the trough, almost exclusively, for two months the A. sisalana stem cut manually. One animal referred to the Veterinary Hospital of the Federal University of Campina Grande, showed with a presumptive diagnosis of ruminal compaction and intestinal obstruction. On the second day of hospitalization, the animal died. The necropsy showed rumen, reticulum and omaso replete, with fibrous content and resected constituted by A. sisalana fibers. In all the pre-stomachs and in the abomasum there were phytobezoars measuring 4-12 cm in diameter. In the duodenum a phytobezoar partially obstructed the light of the organ, with the anterior portion filled with content and the later empty. It is concluded that feeding with stems of A. sisalana for long periods causes composting of pre-stomachs and formation of phytobezoars. The second chapter describes a survey on toxic plants for ruminants and equidae, carried out between 2015 and 2016 in the state of Sergipe. The survey was carried out in 16 municipalities in the state of Sergipe, covering the three mesoregions of the state: litoral, agreste and sertão, applying a questionnaire to 32 farmers and 10 veterinarians about the occurrence of toxic plant poisonings. According to the survey respondents reported 20 toxic plants. The third chapter describes an outbreak of megaesophagus and esophageal muscle degeneration in cattle, which occurred in a farm in the municipality of Ibiara, state of Paraíba, with 12 deaths. Six animals recovered. Clinical signs were apathy, salivation, decreased ruminal movements, weight loss, diarrhea, and regurgitation. Two animals were necropsied. The esophagus was diffusely dilated and with pale areas. Histology revealed degeneration and diffuse and severe segmental necrosis of the esophageal muscle tunica, in addition to marked inflammatory reaction of mononuclear cells. Epidemiological data suggest that cases are related to a toxic plant. New research is needed to determinate the etiology of the disease.

Incidência de doenças esofágicas em cães e gatos atendidos no setor de radiologia do hospital veterinário da Universidade Estadual de Londrina nos anos de 2006 a 2016.

As doenças esofágicas muitas vezes são negligenciadas por ter sinais clínicos similares às doenças gástricas. No primeiro capítulo está presente o estudo que relata a incidência de doenças esofágicas em cães e gatos atendidos no Setor de Radiologia do Hospital Veterinário da Universidade Estadual de Londrina nos anos de 2006 a 2016. Os dados foram coletados dos livros de registro do Setor e posteriormente analisados os prontuários e radiografias. Setenta e um animais foram incluídos no estudo, pois foram submetidos à radiografia esofágica simples ou contrastada. Quarenta e quatro animais foram submetidos à radiografia simples e em vinte e nove foi realizado esofagograma. Dos setenta e um animais, dezessete foram positivos para doenças esofágicas, tendo sido nove diagnosticados por meio de radiografias simples e oito por radiografias contrastadas. Oito animais tinham megaesôfago, seis tinham corpo estranho esofágico, um esofagite secundária ao tubo esofágico (diagnóstico presuntivo) e um estenose. No capítulo 2 há um relato de caso que foi submetido à publicação na revista clínica veterinária que descreve a ocorrência de dilatação esofágica cervical em uma felina de 18 meses secundário a esofagite causada pela administração de comprimidos de doxiciclina.

The esophageal diseases are many times neglected for having clinical signs similar to gastric diseases. In the first chapter, there is this research which reports the incidence of esophageal diseases in dogs and cats attended on the radiology department of the state university of Londrinas veterinary hospital in between the years of 2006 and 2016. These datas were colected from the sectors register books and later the medical records and radiographs were analysed. Seventy one animals were included in the research, because they had been submitted to a simple or contrasted esophageal radiography. Fourty four animals were submitted to a simple radiography and in twenty nine of them was accomplished an esophagogram. Off these seventy one animals, seventeen were positive for esophageal disease, nine of them were simple radiographies and eight of them were contrasted studies. Eight animals had megaesophagus, six of them had esophageal foreign bodies and the following diseases were confirmed in one animal each: esophagitis, stenosis and esophagitis secondary to an esophageal tube (presumptive diagnosis). On the chapter two, there is the article which has been submitted to publishing and it describes the report of the case about the occurrence of a esophageal dilation in an eighteen months female cat secondary to the esophagitis caused by the administration of doxycycline pills.

Megaesôfago em suínos / Megaesophagus in Swines

Background: Megaesophagus is a disease characterized by widespread dilation of the esophagus, with partial or total loss of the organ peristalsis, produced by a neuromuscular disorder and it can be present as manifestation of several diseases. The most common sign on animals is the regurgitation, which usually happens right after the ingestion of solids. The diagnosis is based on the clinical signs and radiographic exam, where it is possible to observe a contrasted and extensive esophagus. The clinical treatment consists of small semi-solid or liquid meals served in small amounts, with the animal in elevated position. This work reports a swine megaesophagus, occurred in one of the animals housed in the Sector of Clinic and Reproduction of Swine of the Universidade Federal de Santa Maria (UFSM), RS, Brazil.. Case: A male swine, six months of age was housed in the center of artificial insemination, showing some adaptation difficulties to the new facilities, climate, as well as feeding. A reduced feed intake was observed, however, without alterations behavioral or sanitary. The animal was trained progressively for semen collection, presenting eventually regurgitation, which became more frequent with the insistence in feeding. Usually the reflux happened five to ten minutes after the ingestion of ration and/or water, with variable volume, texture and aspect similar to the saliva and pH varying from eight to nine. The animal kept normal appetite, however with slow and progressive loss weigh. It was submitted to endoscopy and contrast radiographic study, leading to megaesophagus confirmation. After the diagnostic, it was suggested the hypothesis that the pathology was developed due to a serious stressful situations of adaptation imposed to the animal, which might contributed triggering the process. Discussion: Megaesophagus is characterized basically by dilation and increase of the organ, peristaltism absence, presence of tertiary contractions and the absence of total or partial inferior sphincter relaxation. These changes could lead to dysphagia that, consequently could compromise the nutritional state. Besides regurgitation, loss weight and anormal development, it is possible to observe cough, mucoid and purulent nasal discharge, as well as dyspnea with pneumonia due to the concomitant aspiration. Among the clinical signs presented by the animal, it is possible to report the regurgitation time in variable frequencies and the loss weight. The diagnosis performed in this animal was based on observation of clinical signs and radiographic exam, where it was possible to visualize a dilated esophagus. The treatments in cases like this usually are in order to provide support conditions or through surgical procedures. The first is characterized by changes on animal management practices, besides the utilization of drugs such as antibiotics, prokinetic and antacids. By the other hand the surgical methods are supported by several techniques, such as the esophagus-diaphragmatic cardioplasty, Heller myotomy, associated to fundoplication. Some animals with congenital idiopathic megaesophagus are able to recover themselves while the ones which are acquired are irreversible. Regarding to the secondary megaesophagus, once the cause is removed the animal has chance of recovering. Therefore, the prognostic for secondary and congenital megaesophagus range from reserved to favorable, while for the acquired cases it is not favorable (as this case report).