Diaphragmatic hernia in a cat mimicking a pulmonary mass

Porcine small intestinal submucosa biomaterial graft for repair of a congenital pleuroperitoneal hernia in a kitten

In this case, porcine small intestinal submucosa (pSIS) was used to repair a large congenital diaphragmatic hernia in a kitten. The pSIS was moistened in saline, folded in half, and sutured to the remnant of the right hemidiaphragm. The animal was determined to be doing well clinically and radiographically 12 wk after procedure. At 8.5 mo of age, the kitten was spayed, and the diaphragm was inspected, revealing a thin, semitransparent membrane at the central region of the previous pSIS graft. Serial thoracic radiographs may be an effective way to reach a diagnosis of a diaphragmatic hernia if not clearly identifiable on initial radiographs. Surgeons should be prepared to use alternative techniques to close large diaphragmatic defects. Porcine SIS was demonstrated to be a strong, easy-to-use, readily available, and effective technique to close a large defect in the diaphragm with excellent results in the short and medium terms. When hernia repair is employed in juvenile animals, reassessment of the diaphragmatic repair should be considered if future abdominal surgeries, such as ovariohysterectomies, are necessary. A functional 8-ply pSIS should be considered in cats and dogs as it has a lower complication and graft failure rate. Key clinical message: When serial radiographs fail to diagnose a diaphragmatic hernia when one is highly suspected, other modalities, such as ultrasonography or other contrast modalities, should be considered. A functional 8-ply pSIS should be considered to reconstruct the diaphragm, particularly in growing animals, as it is an effective graft with low complication and graft failure rates.

True Diaphragmatic Hernia (Morgagni Hernia) Incidentally Diagnosed with Positive Contrast Peritoneography in a Cat: A Rare Case Report and a Review

An 18-month-old neutered male domestic shorthair cat was presented for an emergency consultation after falling from the second floor. The cat sustained minor traumatic injuries but did not exhibit dyspnea. Routine radiographic examination raised suspicion of a diaphragmatic hernia, but the circumscribed nature of the soft tissues visible in the thorax was atypical for a classic traumatic diaphragmatic hernia. A positive contrast peritoneography highlighted the likely presence of a hernial sac, which strongly suggested a "true diaphragmatic hernia", also known as "pleuroperitoneal hernia". This diagnosis was confirmed during laparotomy, which allowed for the visualization of a 3 cm radial diaphragmatic defect in the right ventral quadrant of the pars sternalis. The diaphragm's edges were rounded. A portion of the falciform ligament and a part of the omentum were protruding through the defect and were contained within a hernial sac. Herniorrhaphy was performed. The cat recovered without complications. Given its presentation and location, ventrally and to the right, this anomaly is analogous to what is described in humans as "Morgagni hernia". Six other cases of Morgagni hernias have probably been reported in cats but were not identified as such. This case underscores the utility of peritoneography, a straightforward technique useful for diagnosing diaphragmatic hernias, which enables differentiation between acquired traumatic forms and congenital forms, particularly peritoneopericardial hernias and pleuroperitoneal hernias. True diaphragmatic hernias are almost always serendipitous discoveries.

Successful early diagnosis and surgical treatment of congenital caval foramen hernia in an 8-month-old mixed breed cat

An 8-month-old neutered female domestic mixed breed cat was presented to Dr. L. Kriaučeliūnas Small Animal Clinic due to coughing that persisted for 2 weeks. Lateral and dorsoventral chest radiographs revealed an unusual dome-shaped soft tissue opacity mass that had contact with the cranial part of the diaphragm. Together with heart and abdominal ultrasound findings, we decided that one of the differential diagnoses was a diaphragmatic hernia. During the diagnostic celiotomy, a vertical 4 cm in length diaphragmatic deficit was visualized. Left medial and lateral liver lobes were herniated, yet healthy-looking. Adhesions between the liver lobes and the pericardium sac were visualized and dissected. The pericardium was sutured with simple interrupted suture pattern. A herniorrhaphy was performed suturing the diaphragm with the continuous suture pattern. Successful surgical treatment resulted in fully resolved clinical symptoms.

Interval between injection of contrast material and positive contrast cheliography affects accurate diagnosis of diaphragmatic hernia

The aim of this study was to evaluate the clinical, surgical and diagnostic imaging findings in 11 cats and 3 dogs with suspected acute and chronic traumatic diaphragmatic hernia, and to compare the results of positive contrast cheliography (peritoneography) taken immediately and 5 min after the injection of contrast material. Thoracic and abdominal radiography, ultrasonography, and positive contrast cheliography of all animals were performed. Eight cases were considered as acute and six cases were considered chronic. The contrast images taken immediately after the injection of contrast material revealed the contrast material in the thoracic cavity in 8/8 acute trauma patients, but in none of the chronic cases. In 5/6 of these cases contrast material was seen in the thoracal cavity only in additional images taken after 5 min. One patient was diagnosed with FIP and excluded from the study. Twelve cases had complete resolution and one animal died during the early postoperative period. Our results suggest that positive contrast cheliography performed immediately after the injection of contrast material may not reveal chronic cases of diaphragmatic hernia and a second imaging (or imaging after 5 min) is indicated in order not to overlook chronic cases.

Mummified fetus in the thoracic cavity of a domestic short-haired cat

This short communication describes the diagnosis, treatment, and clinical course of a domestic short-haired cat with diaphragmatic hernia in which the herniated structure in the thoracic cavity contained a mummified fetus. The cat was pregnant when rescued from the street and, days later, gave birth without abnormalities. Some months later, during an ovariohysterectomy, an abnormal localization of the uterus was observed, and at that time the case was referred to our center. A thoracic radiograph showed an abnormal thoracic mass cranial to the heart. The main suspicion was the presence of a thoracic hernia with the uterus herniated and containing a mummified fetus. A thoracotomy was performed to confirm the nature of the mass and reduce the diaphragmatic hernia. Although this clinical case is quite rare, a mummified fetus can be observed in thoracic hernias.

Ectopic hepatic parenchyma attached to the diaphragm: simulating a pulmonary mass in a cat

A case of an ectopic lobe of the liver connected to a normal diaphragm is described. A 9-year-old, castrated male cat underwent thoracotomy for a pulmonary mass. The removed mass was attached to the diaphragm that histologically was ectopic liver. The ectopic liver had no connection with the main liver. Because the occurrence of ectopic supradiaphragmatic hepatic tissue is a possibility, this should be considered as a differential diagnosis for caudal pulmonary or caudal mediastinal masses in a cat. This report describes, to the authors' knowledge, the first case of ectopic hepatic tissue attached to the diaphragm of a cat. The authors also characterize the asymptomatic clinical presentation and radiographic findings of this cat and suggest further imaging with computed tomography in unusual case presentations.