Veterinary Medicine - October 2008 - (Page 538)

Clinical Exposures illuminating images from patient files PEER-RE VIE WED Incidental finding of a peritoneopericardial hernia in a cat Michal O. Hess, DVM castrated male domestic longhaired cat of unknown age was presented for a preanesthetic evaluation before a dental treatment. The cat was bright, alert, and responsive. A physical examination revealed a palpable pectus excavatum and severe gingivitis with dental tartar. The cat’s temperature and heart and respiratory rates were normal. No abnormalities were identiﬁed on thoracic auscultation. The owner had not reported that the cat was symptomatic. A RADIOGRAPHIC FINDINGS A thoracic radiographic examination (Figures 1-3) done as part of the preanesthetic evaluation revealed a caudoventral deviation of the xiphoid process and productive remodeling changes at the juncture between the seventh and eighth sternebrae. A mild diffuse bronchointerstitial pattern was noted, which may have resulted from a chronic respiratory disease such as feline asthma. thought to be the falciform fat. The size of the pulmonary vessels was normal. On the left lateral view, a dorsal peritoneopericardial mesothelial remnant connected the cardiac silhouette with the cranial diaphragmatic border (Figure 1). On the ventrodorsal view (Figure 3), a pleural ﬁssure line was visible between the right cranial and middle lung lobes. This ﬁssure line could indicate previous pleuritis. Partial atelectasis of the caudal subsegment of the left cranial lung lobe was also seen, with an associated lobar sign. A coexisting lobar inﬁltrate could not be ruled out. As a result of the atelectasis, a mediastinal shift to the left was present. Radiographic attenuation of the left caudal lobar bronchus was also seen. In addition, a loss of normal diaphragmatic contour with conﬂuence with the cardiac silhouette was noted. Also on the ventrodorsal view, a small mineralized interstitial nodule could be seen in the right ﬁfth intercostal space. This nodule could represent a benign nodule such as pulmonary osteoma, an old inﬂammatory lesion such as an abscess, or an early pulmonary mass. DIAGNOSIS Because of the loss of clear diaphragmatic outline, the enlarged cardiac silhouette with normal-sized pulmonary vessels, and pectus excavatum, congenital peritoneopericardial hernia was the most likely diagnosis. DISCUSSION Peritoneopericardial hernia is the most common congenital diaphragmatic defect in dogs and cats.1 This condition often goes unnoticed for years, and many cases are discovered incidentally on radiographs. It is often associated with abnormalities of the sternum, such as pectus excavatum, as seen in this cat. Abdominal viscera can herniate into the pericardial sac; in most cases, the liver, bowel, or falciform fat are involved. The radiographic features of peritoneopericardial hernia are 1. A left lateral thoracic radiograph reveals an enlarged cardiac silhouette and a linear soft tissue band (arrow) connected to the diaphragm, caudoventral deviation of the xiphoid process, and a diffuse bronchointerstitial pattern. The cardiac silhouette was markedly enlarged on all views, causing an elevation of the tracheal carina as seen on both lateral views (Figures 1 & 2). The right border of the cardiac silhouette was outlined by a fat opacity (Figure 2), which was This report was provided by Michal O. Hess, DVM, 620 Stephen Hands Path, East Hampton, NY 11937. Dr. Hess’s current address is 17 Hedges Banks Drive, East Hampton, NY 11937. 538 October 2008 VETERINARY MEDICINE

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Veterinary Medicine - October 2008 Contents Leading Off Clinical Exposures Idea Exchange Stalking Stones Vaginitis in Dogs CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - October 2008

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