Hi all, I would appreciate some reassurance on this case. After much deliberating, I am quite convinced that this is PPDH.
– 6 y old, FN, DSH. Adopted 1 year ago from stray life in a community carpark. History of on and off vomiting of undigested food. Normal stools. When playing she is not really very active. No respiratory sings.
-Exam: no heart murmurs. Mild pot belly. No other significant findings. Laboratory findings WNL.
Hi all, I would appreciate some reassurance on this case. After much deliberating, I am quite convinced that this is PPDH.
– 6 y old, FN, DSH. Adopted 1 year ago from stray life in a community carpark. History of on and off vomiting of undigested food. Normal stools. When playing she is not really very active. No respiratory sings.
-Exam: no heart murmurs. Mild pot belly. No other significant findings. Laboratory findings WNL.
-Xrays: incidental finding of rounded cardiac silhouette. It appears asymmetrical and dis-homogeneous lucidency on the lateral view and made me thick of not typical pericardial effusion.
-Echo: I do not find enough findings that can suggest pericardial effusion due to cardiogenic-neoplastic origin. Liver appears to be in direct contact with cardiac tissue. Hepatic silhouette appears mildly abnormal in abdominal approach, like something is missing…
-Questions:
1- Is there any possibility this is not PPDH but just a simple DH? Or any other DDx to consider? Sometimes I struggle to identify pericardium. If I see effusion a bit around atriums and aorta is that still possible with PPDH?
2-How can I be sure of diagnosis? is CT scan needed? I can re-scan this patient and try some tricks-new views if needed.
3- I do not see abnormalities in heart…do you agree?
Thanks so much for input.
Comments
I forgot to mention that
I forgot to mention that those xrays were taken in September 2015. I repeated them yesterday and the opacity around heart appears similarly asymmetric in lateral view and slightly smaller in comparisson. Which makes me think of the dinamics of a herniated liver more or less herniated in the pericardial sac (or caudal mediastinum…?)
great case and images!
yes
great case and images!
yes pericardial diaphragmatic hernia of the liver into the pericardium and pericardial effusion. These will slide and build up effusion on occasion that you have to drain periodically when clinical. Surgery is often problematic but could be attempted wiht a surgeon that has dealt with this before.
Here is a similar case with liver in the pericardium:
http://sonopath.com/members/case-studies/cases/peritoneopericardial-diaphragmatic-hernia-ppdh-12-year-old-fs-dlh-cat
For more hernias from the sonoraphic, CT and rad perspective just search “hernia” in the basic search:
http://sonopath.com/members/case-studies/search?text=hernia&species=All
Thanks so much! I am very
Thanks so much! I am very pleased with your reassurance. Kitty is doing quite well. Except for the vomiting…How do we minimize the vomiting? I adviced small meals a bit more frequent and reduce stress from other cats in the household at mealtimes. Draining the effusion probably won’t help with the vomiting, right?
Any other tips for conservative management if no surgery?
Thanks again:)
Hmm tough to say. Thats a lot
Hmm tough to say. Thats a lot of pc effusion and it may be pulling the Gi tract cranially. Maybe check basal respiratory rate if > 30 rpm thats abnormal. It may be indicative to drain and maybe driainign allows for more “room” for the G tract to not be pulled on. Would need upper Gi imaged maybe a c-loop or position 11 SDEP to know what the GI angle is doing. Your rad shows some densities in the gastric lumen so maybe another reason for vomiting… hairball and such.