Signalment: 4 years, Male, castrated, Mixed breed
Presenting Complaint: Increased respiratory rate and respiratory distress.
Presenting History

Lateral view

DV view

Lateral View:
	Evidence of Chamber Enlargement learn more
		Left Ventricle: No
		Right Ventricle: Indeterminate    Loss of cardiac silhouette.
		Left Atrium: Indeterminate    Loss of cardiac silhouette.
		Right Atrium: Indeterminate    Cannot assess in this view.
		Left Auricle: Indeterminate    Cannot assess in this view.
		Right Auricle: Indeterminate    Loss of cardiac silhouette.
	Abnormalities of Great Vessels learn more
		Aortic Dilation: Indeterminate    Structure obscured by lung densities.
		Main Pulmonary Artery Dilation: Indeterminate    Structure obscured by lung densities.
		Caudal Vena Caval Enlargement: Indeterminate    Structure obscured by lung densities.
	Pulmonary Venous Distention learn more: No
	Airway Changes learn more
		Peribronchial Pattern: Yes
	Alveolar Changes learn more
		Air Bronchograms: No    But lung is really dense.
		Cotton-like Densities: No
		Lobar Sign: Yes
	Pleural Effusion learn more
		Fissure Lines: No
		Leafing of Lung Lobes: No
	Pulmonary Edema learn more: No    Not cardiogenic.
	Evidence of Heartworm Disease learn more: Indeterminate    Structures obscured by lung densities.
	Other Findings
		Loss of continuity of diaphragmatic line, free air in thorax mixed with free fluid in thorax.
	Radiographic Diagnosis
		Diaphragmatic hernia, Pulmonary contusion, Pleural effusion, Pneumothorax
	Description
		Pulmonary contusion and pleural effusion under the caudal lung lobes. These changes obscure the cardiac silhouette.

DV View:
	Evidence of Chamber Enlargement learn more
		Heart too Wide: Indeterminate    Loss of cardiac silhouette.
		Left Ventricle: Indeterminate    Loss of cardiac silhouette.
		Right Ventricle: Indeterminate    Loss of cardiac silhouette.
		Left Atrium: Indeterminate    Loss of cardiac silhouette.
		Right Atrium: Indeterminate    Loss of cardiac silhouette.
		Left Auricle: Indeterminate    Loss of cardiac silhouette.
		Right Auricle: Indeterminate    Loss of cardiac silhouette.
	Abnormalities of Great Vessels learn more
		Aortic Dilation: Indeterminate    Structure obscured by lung densities.
		Main Pulmonary Artery Dilation: Indeterminate    Structure obscured by lung densities.
		Caudal Vena Caval Enlargement: Indeterminate    Structure obscured by lung densities.
	Pulmonary Venous Distention learn more: Indeterminate    Structure obscured by lung densities.
	Airway Changes learn more
		Peribronchial Pattern: Yes    Mild, difficult to assess due to lung densities.
	Alveolar Changes learn more
		Air Bronchograms: No
		Cotton-like Densities: Yes
		Lobar Sign: No
	Pleural Effusion learn more
		Fissure Lines: Yes
		Leafing of Lung Lobes: Yes
	Pulmonary Edema learn more: No    Not cardiogenic.
	Evidence of Heartworm Disease learn more: Indeterminate    Structures obscured by lungs.
	Other Findings
		Free air as bubbles in chest, pleural effusion present, loss of continuity of diaphragmatic line.
	Radiographic Diagnosis
		Diaphragmatic hernia, Pulmonary contusion, Pleural effusion, Pneumothorax
	Description
		There is a loss of the diaphragmatic line particularly on the right. The pleural effusion and free air obscure cardiac structures rendering assessment of these structures impossible.

Clinical Diagnosis   Diaphragmatic hernia, traumatic

Comment   Thoracic radiographs revealed evidence of pulmonary contusions, pneumothorax, loss of the cardiac silhouette and loss of a discrete diaphragmatic line. Abdominal radiographs indicated abnormal positioning of the abdominal organs with loss of the liver silhouette and an absence of the small intestines radiographically. Abdominal ultrasound confirmed the suspicion of a diaphragmatic hernia with the right middle liver lobe and most of the small intestines in the thoracic cavity.