Tonight’s session had a variety of interesting cases as usual. One of them was a young, large breed dog who presented for vomiting. On the abdominal radiographs, there was increased soft tissue opacity cranial to the diaphragm, which was centered on midline on the d/v projection. Of course, thoracic radiographs were requested, and they showed an enlarged cardiac silhouette with gas-filled bowel loops within it. The diagnosis was PPDH (peritoneal-pericardial diaphragmatic hernia).
This is a congenital condition in dogs and cats, and is often associated with sternebral anomalies. There is a communication between the peritoneum and the pericardium in the caudal mediastinum. Most traumatic diaphragmatic hernias (properly called ruptures) occur in the left or right crus, rather than the middle of the cupula. The other feature of PPDH is that it is usually an incidental finding. Unless something becomes entrapped or torsed, the organs that end up in the pericardium are usually normal. So we had a diagnosis, but no explanation for the vomiting.
The next thing to request would be an abdominal ultrasound or an upper GI. We happened to get an upper GI, which showed the stomach and proximal duodenum in the pericardium. And there was a very faint linear filling defect in the proximal duodenum. Diagnosis: mechanical obstruction from ingestion of a popsicle stick!
This case is a good example of not falling prey to “satisfaction of search”. If you find an obvious abnormality, don’t assume that it is the cause of the animal’s clinical signs. Going the extra mile in this case demonstrated the foreign body, and the dog went to surgery to repair his hernia and remove the popsicle stick. Ultrasound would have been less helpful because the pericardium was surrounded by aerated lung (the popsicle stick was in the pericardium). Sometimes you can get a limited view of the caudal mediastinum and accessory lung lobe from just caudal to the xiphoid cartilage, but I don’t think it would have helped here. It’s always good to have imaging options to use as the case warrants.
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