Pericardial Diaphragmatic Hernia

by: Dr. Keeley McNeal at CARE Animal Emergency Services

Blu was presented to the CARE Animal Emergency service with the complaint of a swollen abdomen. His owner notes that Blu ingested a bag of chocolate chip cookies about 2 hours prior and he had been gagging and retching for about 30 minutes prior to arrival.

On presentation, it was noted that Blu was a neutered, 9 year old Weimaraner. His physical examination demonstrated a very large, distended abdomen that was tense and painful. His heart rate and respiratory rate were elevated. He was drooling heavily and seemed anxious.

After placement of an intravenous catheter, start of intravenous fluids and pain medication, radiographs were performed. It was determined at that time that Blu’s stomach was dangerously distended with food material and gas. It was recommended that an immediate procedure termed gastric lavage be performed to “wash” the excessive food material from his stomach. Blu was anesthetized and a stomach tube was passed to allow for release of stomach fluids, gas and food material. During this procedure, it was important to palpate (feel) the stomach return to normal size. Once this was determined to be, a second set of radiographs were taken to confirm the stomach had returned to normal size. It was with these second group of radiographs that it was determined that Blu had a condition termed Pericardial diaphragmatic hernia (PDDH).

PDDH is a congenital condition in which there is a connection between the abdomen and the sac that surrounds the heart. Despite this being a congenital condition, it is not commonly discovered until the animal is middle-aged or older because signs may be mild or occasional. Radiographic signs of this condition include an enlarged cardiac (heart) silhouette, elevation of the trachea, gas filled loops of bowel in the pericardial sac, interruption of the diaphragm border. Signs often displayed at home include, vomiting, diarrhea, weight loss, pain following ingestion of food, breathing difficulty, and heart abnormalities. Certain breeds like Weimaraners and Cocker Spaniels are at increased risk.

Correction of this condition is best done surgically and at an early age to prevent adhesions (connective tissues) between heart and abdominal organs. When discovered later in a pet’s life, there are risks of defects of the chest wall, heart, and lungs that can complicate recovery. Those risks are challenging and could require a prolonged hospitalized stay if they occur. The prognosis for a pet that survives postsurgical complications is excellent and reoccurrence is uncommon.

Unfortunately, in the days after Blu’s initial ER visit his condition worsened and his family elected humane euthanasia. They hoped to share Blu’s story to help educate other families about breed specific congenital disorders.