Case Study

Peritoneal-pericardial diaphragmatic hernia in a 2 year old FS DSH cat

A 2-year-old SF DSH cat was presented for evaluation of a 3-day history of vomiting. The only finding on physical examination was mild discomfort on abdominal palpation. Abdominal and thoracic radiographs were read out by a boarded radiologist. Report states that there is a soft tissue/fat opacity caudal to the cardiac silhouette and continuous with the ventral aspect of the diaphragm. The cardiac silhouette size and shape are slightly enlarged and slightly angular.

A 2-year-old SF DSH cat was presented for evaluation of a 3-day history of vomiting. The only finding on physical examination was mild discomfort on abdominal palpation. Abdominal and thoracic radiographs were read out by a boarded radiologist. Report states that there is a soft tissue/fat opacity caudal to the cardiac silhouette and continuous with the ventral aspect of the diaphragm. The cardiac silhouette size and shape are slightly enlarged and slightly angular. The opacity caudal to the cardiac silhouette may represent a peritoneal-pericardial defect with a portion of the falciform ligament in it, or could represent fat in the caudal ventral mediastinum. Ultrasound of the caudal ventral thorax is recommended to rule out masses or a defect in the diaphragm.

DX

Peritoneal pericardial diaphragmatic hernia

Sonographic Differential Diagnosis

Diaphragmatic hernia of falciform fat. Peritoneal-pericardial diaphragmatic hernia is suspected as separation from the pericardium could not be seen. No major organ systems appear to be present in the chest, only falciform fat. Surgical consultation could be considered in this patient; however, this appears to be stable at the moment even though movement of the falciform through the herniated portion of the diaphragm appears to be an issue and dynamic. It does not appear to be a fixed strangulation.

Image Interpretation

The patient has a diaphragmatic hernia of falciform fat entering into the ventral thorax. This hernia measured 2.0 cm in width with a rent of 1.0 cm. The liver itself was normal yet the falciform fat appeared to enter into the pericardial space. There did not appear to be any functional defects in the heart.

Outcome

No further outcome at this time.

Comments

Due to the dynamic nature of these findings, no still images were created.

Clinical Differential Diagnosis

Vomiting – non-specific gastro-enteritis (viral/bacterial/helminths/protozoa/food/toxins), foreign body, lymphoma, IBD, pancreatitis, hepatic disease (cholangio-hepatitis complex, infectious (viral/bacterial), trauma, toxins), peritonitis