Lateral thoracic radiography was performed on a 3-year-old French bulldog with a history of multiple episodes of daily vomiting or regurgitation. Radiographs revealed a hiatal hernia (ie, movement of the stomach into the chest cavity; Figure).
FIGURE Hiatal hernia seen in a French bulldog
Hiatal hernias may be mistaken for masses or esophageal foreign bodies. These hernias are common in dogs with brachycephalic obstructive airway syndrome (BOAS) and thought to develop as a result of excessive negative intrathoracic pressure associated with increased upper airway resistance from airway disease. The narrowed upper airway makes breathing more difficult, leading to movement of the stomach through the esophageal hiatus in the diaphragm into the chest.
Clinical signs typically include vomiting or regurgitation, apparent nausea, and excessive salivation. Dogs may cough or develop aspiration pneumonia associated with regurgitation.
Treatment includes weight loss if the dog is overweight and palliative airway surgery (eg, resection of stenotic nares, staphylectomy [ie, soft palate resection]) in patients with BOAS. Promotility agents (eg, cisapride, metoclopramide) and proton pump inhibitors (eg, omeprazole) may be helpful.
Owners of brachycephalic dogs often indicate belief that daily vomiting or regurgitation is normal for their dog; they should be educated that it may be common but is not normal.