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The Diaphragm

What is the diaphragm?

a musculocutaneous partition between the thorax and abdomen

What diaphragmatic structures can you distinctly visualize radiographically?

The right and left crura
The intercrural cleft
The cupula

Where is the most dependent (lowest) crus usually displaced on lateral radiographs?

Cranial to the "Up" Crus

What factors will influence diaphragmatic position and shape?

inspiration (shallow)
expiration (deep)
intraabdominal pressure

What are the most frequent radiographic changes to the diaphragm?

general or focal outline loss of the thoracic diaphragmatic surface
changes in diaphragmatic shape and position

What is the most frequent radiographically observed diaphragmatic disease in the dog and cat?

Hernias (Traumatic and Congenital)

What information can radiographs help discover about a hernia?

location, extent, contents and secondary complications

What are the most consistent radiographic signs of a traumatic diaphragmatic hernia?

Abdominal viscera within the thorax
Displacement of the abdominal or thoracic organs (or both)
Partial or complete loss of the thoracic diaphragmatic surface outline
Asymmetry or altered slope to the diaphragm on a lateral view
The presence of pleural fluid

What are the types of Congenital diaphragmatic hernias?

Peritonealpericardial diaphragmatic hernia
Hiatal hernia
and Diaphragmatic defects

When does a peritonealpericardial diaphragmatic hernia occur?

When abdominal viscera herniates into the pericardial sac through a congenital hiatus formed between the tendinous portion of the diaphragm and the pericardial sac.

When do Hiatal hernias occur?

When a portion of stomach enters thorax through the esophageal hiatus

What are the two types of hiatal hernias?

Sliding (the gastroesophageal junction itself slides through the defect into the thorax)

Paraesophageal (the gastro-esophageal junction remains where it belongs, but part of the stomach is squeezed up into the thorax beside the esophagus)

What is a gastroesophageal intussusception?

When the stomach invaginates through the esophageal hiatus into the caudal esophagus.

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