Solution for case 9

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Radiographic interpretation: Lateral radiograph shows the loss of cardiac silhouette and loss of continuity of the diaphragmatic line. Gas filled loops of intestine are seen in the thorax. There are also poor thoracic details on the ventral caudal thorax. On VD view we can see fissure lines on the left thorax suggestive of the pleural effusion. On the right side of thorax we can see loops of gas filled intestine.

Diagnosis: Traumatic diaphragmatic hernia / pleuroperitoneal hernia.

Treatment and management: Surgery to repair the ruptured diaphragm after patient has been stabilized is the treatment of choice. Oxygen should be supplied if animal is dyspenic. If pleural effusion is present, thoracentasis should be performed. If animal is in shock, should be treated first for shock. If stomach is herniated surgery should be done at earliest possible as gastric dilatation may further compromise the respiration. Mortality is higher when surgery is performed within 24 hours or after 1 year of the injury.

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Case 9

Presentation:

A 6 month old intact male mix breed canine was presented to AcaseAweek Clinic as an emergency after being hit by car (HBC) the previous night. On physical exam the dog was bright, alert and responsive (BAR), has abrasions distal to the hock and on the metatarsal region of both hind limbs. Mild weight bearing lameness on the right hind limb was observed. Radiographs of the abdomen and pelvic region were normal. The abrasions were cleaned and dog was discharged on Rimadyl 25 mg BID for 5 days. Three weeks later the dog was brought to the clinic again with chief complaint of dyspnea and exercise intolerance.

Physical examination:

• Temp: 101.5
• HR/PR: 96
• Respiration: Laboured breathing
• Auscultation of thorax revealed muffled heart sounds and harsh lung sounds.

CBC, chemistry and electrolytes were all within normal range.

Thoracic radiographs were taken (lateral and VD view) and are shown below:

Give interpretation of the radiographs.

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