Abstract
A French poodle, fully grown and bred to extreme fineness, was noticed by his owner, a highly trained observer, to “save himself” in play and for this reason was suspected of having heart-disease. Except for these periods of rest. taken at unexpected and unusual times, the animal appeared physically perfect.
On January 12, 1915, the dog developed general convulsions which lasted one half hour, at the end of which he died. The autopsy, performed the following morning, revealed the following:
1. “Thorax-Lungs.—Right slightly congested posterially. Left deeply congested throughout.
“Heart.—Pericardial sac large. Right heart compressed by three lobes of liver, gall bladder, and great omentum, 7 by 15 cm. Liver and omentum congested. Gall bladder empty and connected with liver remaining within the abdomen by elongated adhesive band. Deficiency in pericardium measured 3 cm. in diameter and reinforced by fibrous tissue. Deficiency of equal size in central tendon of diaphragm. No hernial sac found.
2. “Liver.—Portion within pericardial sac shows extreme passive congestion and fibrosis, indicating that the circulatory obstruction caused by its position has been of long duration. Free portion shows moderate fat infiltration.
“Edge of Diaphragmatic Opening.—Appears well rounded and is covered by endothelium,—evidently a congenital defect.”
Many phrenic hernias in man have been reported to date. 1 Grosser and Thoma, alone, have collected 433 cases. Learning's radiograms of Freeman's case showed ante-mortem practically the entire colon in the chest. It entered the mediastinum in front of the heart curving backward over that organ. The liver was transposed. The hernia was through the right side. Besides the true and the false varieties, there is the analogous condition of eventration of the diaphragm. This is defined, 2 as a dislocation cephalad of the abdominal viscera, particularly of the stomach, on the left side under an abdominally high position of the left vault of the diaphragm.
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