Case Study

RADS – Sliding Hiatal Hernia, Congenital, in a 4 year old MN French Bulldog

History: hind limb weakness, hemilamenectomy done 9/7/15, started regurging 9/9/15, suspect hernia

PE: Alert, responsive and very active. Weak in hind end. CP deficits on pelvic limbs, decreased to absent. Moderately painful mid-rib area. No abdominal pain palpated. Lung fields clear. No murmur auscultated. CRT, temp normal. Cutaneous trunci reflex present. Cranial nerve exam normal. Chemistry WNL

History: hind limb weakness, hemilamenectomy done 9/7/15, started regurging 9/9/15, suspect hernia

DX

The radiographic findings are compatible with a sliding hiatal hernia which most likely is congenital in origin. Theoretically a paraesophageal hernia has to be considered as a differential diagnosis but is less likely.

Image Interpretation

right lateral, left lateral and VD thorax- Osseous structures:
There were 14 thoracic vertebrae, the most caudal one was a thoracolumbar transitional vertebra with bilateral ribs. The intervertebral disc spaces T13/14 and T14/L1 presented wedge shaped narrowing. Mineral opaque material was noted superimposed onto the intervertebral disc space and vertebral canal T13/14. There was reduced opacity of the synovial joints T14/L1 compatible with the previous hemilaminectomy. The seventh sternebra was shortened.
Extrathoracic soft tissues:
The urinary bladder was severely distended.
Intrathoracic structures: There was an abnormal cone shaped soft tissue opacity level with the caudal thoracic esophagus in both lateral views. No abnormal caudal mediastinal widening was noted on the ventrodorsal view.
The cardiac silhouette presented within normal limits for size and shape.
No abnormalities oft he pulmonary parenchyma were noted. There were no signs of aspiration pneumonia.

Comments

The osseous changes are compatible with the previous hemilaminectomy after disc extrusion and suggest intervertebral disc disease with herniation level with T13/14.

Clinical Differential Diagnosis

Suspect that there is T3-L3 myelopathy and that can be due to disc buldging, herniating or can be due to congenital anomalies (cysts, hemivertebrae) or to tumor or to immune disease.

Patient Information

Patient Name : Lewi, Critical Care Vet

Gender : Male, Neutered

Species : Canine

Type of Imaging : Ultrasound

Status : Complete

Liz Wuz Here : Yes

Clinical Signs

Weakness

History

Weakness

Exam Finding

Neurologic signs

Images

Clinical Signs

Weakness