Presentation
Intermittent chronic cough, presenting in respiratory distress.
Patient Data
There is marked enlargement of the cardiac silhouette. The cardiac silhouette silhouettes with the diaphragm and there is a soft tissue opacity with apparent connection between the cardiac silhouette and diaphragm. There are multiple lobular soft tissue opacities and fat opacities superimposed on the cardiac silhouette on the lateral projections. There is a diffuse bronchointerstitial pattern throughout the lungs. The liver is not clearly visualized within the abdomen. The spleen and stomach are located more cranially than expected. There is gas lucency in the soft tissues dorsal to the thoracic spine likely secondary to subcutaneous injection.
Case Discussion
These findings are indicative of pericardial peritoneal diaphragmatic hernia (PPDH) and chronic lower airway disease.
The dyspnea improved with medical therapy for the chronic lower airway disease. Surgery to correct the PPDH was discussed however not performed at this time.
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