Acute pneumopericardium following abdominal surgery in a young dog with previously undiagnosed congenital peritoneopericardial diaphragmatic hernia

Abstract

A 5‐month‐old, entire, male labradoodle presented with acute respiratory distress following surgical repair of a congenital ventral abdominal wall defect performed earlier the same day. On admission, the dog was lethargic, tachypnoeic and tachycardic with normal peripheral pulses and muffled heart sounds. Thoracic point‐of‐care ultrasound revealed diffuse reverberation artefacts obscuring the cardiac silhouette. Radiographs identified pneumopericardium, pneumoperitoneum and a caudodorsal alveolar–interstitial lung pattern suggestive of pulmonary oedema, but did not clearly demonstrate an underlying peritoneopericardial diaphragmatic hernia. Arterial blood gas analysis confirmed severe hypoxaemia. The patient improved following supportive management, including fluid therapy, high‐flow nasal oxygen, and analgesia. Computed tomography subsequently confirmed a congenital peritoneopericardial diaphragmatic hernia. Acute respiratory distress was attributed to suspected non‐cardiogenic pulmonary oedema secondary to pneumopericardium that developed when air entered the pericardial sac via the previously undiagnosed peritoneopericardial diaphragmatic hernia during abdominal surgery. Compression atelectasis associated with the diaphragmatic hernia was also considered a potential contributor to the observed hypoxaemia and ventilation–perfusion mismatch. Elective surgical correction was performed, and the dog recovered uneventfully.