07/21/2024
How about a fun case for this lovely Sunday!
This is Skeeter. He is an 11yo chihuahua. He was adopted as a stray at a year old and been with his current owner ever since. Skeeter has an unknown history before being adopted. He was seen for the first time by our clinic last week. His owner did not bring records but did explain that he has had no pertinent medical history beyond preventative care and mild ailments.
He presented for a general exam due to coughing after activity. On exam, it was found that the left side of his heart was severely muffled and almost impossible to hear on auscultation. We did some radiographs to screen for heart and lung diseases (pictured below).
Radiographic findings:
To even the untrained eye, it is very clear to see that the left side of the chest is abnormal. This is due to a diaphragmatic hernia. His intestines are currently residing in the left side of his chest. His heart also appears enlarged.
What is a diaphragmatic hernia?
The diaphragm is a thin wall of muscle that separate the chest and abdominal cavity, aids with breathing a d maintains a negative pressure in the chest. Skeeter's has a hole in it.
How does this happen?
1. Congenital (born with it)
2. Abdominal trauma, typically hit by a car
In Skeeter's case, this was likely either congenital or caused by an accident that occurred in the first year of life as he has no know trauma since being with his current owner.
Why is it an issue now?
Probably due to his heart. The heart and lungs work closely together for oxygen balance. When 1 is compromised, the other "picks up the slack". The heart is no longer able to compensate as it has been.
What can be done?
In short, surgical repair. However, this case would need to be referred to a surgical specialist. This is a delicate procedure that will be complicated by the chronic state. A chronic diaphragmatic hernia will involve adhesions, altered architecture of both body cavities and possible need for grafts.
For Skeeter, his owner is opting for treatment of the heart condition and no surgery. This is very fair decision due to Skeeter being a high risk anesthetic patient because of his heart and the inevitable high cost of veterinary specialty care. Skeeter is feeling pretty well overall and likely has a lot of life left in him.
If you enjoyed this case or have questions, please leave a comment. If like seeing cases, I'll try to post them more often.
Dr. Jamie 👩⚕️
*all photos posted with owner's permission