Arlett is a 10 month old MN DSH cat referred for ultrasound to confirm suspected diagnosis of PPDH on X-rays.
In comparisson with my previous case with PPDH…this one looks different to me and I do not think it is a PPDH but a plain hiatal hernia, based on the lack of pericardial effusion, lack of clear pericardial sac containing abdominal viscera and amount of herniated content (liver lobes, omentum and small intestines).
What are your views on these clips?
Any input is very much appreciated.
Arlett is a 10 month old MN DSH cat referred for ultrasound to confirm suspected diagnosis of PPDH on X-rays.
In comparisson with my previous case with PPDH…this one looks different to me and I do not think it is a PPDH but a plain hiatal hernia, based on the lack of pericardial effusion, lack of clear pericardial sac containing abdominal viscera and amount of herniated content (liver lobes, omentum and small intestines).
What are your views on these clips?
Any input is very much appreciated.
Comments
Well…I take that back. I
Well…I take that back. I did not mean a hiatal hernia, but a diaphragmatic (pleural-peritoneal vs pericardio-peritoneal). I have asked for the X-rays cause I think they will help in differentiation of those both, unless somebody can suggest a way of US differentiation) After searching on the archive, I now think that it is a PPDH…Viscera appear too attached to heart and what I thought was a good pericardial layering of the heart it does not seem so obvious now…Also, I found that there might not be effusion in PPDHs…
Your comments are still very welcome!
Thanks!
I have never seen intestine
I have never seen intestine herniated into a pericardial hernia and there is intestine in the chest in th esecond video. Im thinking pleuroperitoneal and the extracardiac tissue subtly seems to move separately and not with the heart like you get with Pericardial peritoneal.
Thanks EL… I’m trying to
Thanks EL… I’m trying to get the X-rays… They were sent to me in a small icon form. From the gross look of them… It would look like…PPDH… In the meantime, let me share a photo I have taken from the recently acquired book “Feline Cardiology”- Etienne Côté: Will post in a minute:
here are the pics from the
here are the pics from the book, which shows intestinal loops and the very rounded pericardial shape. Im sending as well the JPGs that I received in case you can manage to do something with that…(doubt it!)…
finally got the
finally got the xrays…thanks for the patience!
Radiographs look typical for
Radiographs look typical for a pericardio-peritoneal hernia. I tend to find radiographs better in making the call between a pleural-peritoneal and pericardio-peritoneal hernia rather than ultrasound.
Thanks, Remo. After revising
Thanks, Remo. After revising and researching and changing my mind twice, I decided asking for the X-rays and I think the same… In this case after seeing the X-rays it looks all too well encapsulated to be outside the pericardium. But the scan by itself I found it too difficult to discern…
Yep i take back too:)
Yep i take back too:) honestly thats the first ppdh I have seen with intestinal loops inside the pericardium!! Peristalsis next to a heart rate…. that’s just wacked:)
Thanks for posting this!