IMAGING DIAGNOSIS-POSITIVE CONTRAST PERITONEOGRAPHIC FEATURES OF TRUE DIAPHRAGMATIC HERNIA

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.

Ability of positive and negative contrast computed tomographic peritoneography to delineate canine liver lobe fissures

OBJECTIVE

To determine the efficacy of contrast peritoneography in delineating liver lobe fissures by using computed tomography (CT).

STUDY DESIGN

Prospective cross-sectional study.

ANIMALS

Canine cadavers (n = 10).

METHODS

An abdominal CT image of each cadaver was obtained under three conditions: without peritoneal contrast (precontrast), after insufflation of the peritoneal cavity with CO₂ (negative contrast), and after intraperitoneal administration of iohexol (positive contrast). Images were reconstructed in three planes. Three reviewers independently scored each plane/contrast combination. Observers measured the length of each fissure in each plane. The measurable length of fissures was compared between techniques but was not compared with the actual length on cadavers.

RESULTS

When assessment of all fissures was combined, measurements were obtained in 96 to 108 of 120 (80%-90%) positive contrast studies, 56 to 96 of 120 (47%-80%) negative contrast studies, and 12 to 32 of 120 (10%-27%) precontrast CT images. All observers measured fissures in all planes that were approximately two times longer on positive compared with negative contrast studies and two times longer on negative contrast studies compared with CT images without contrast. Measurable fissure lengths were greater on positive contrast CT images (P < .0001) than on other CT images.

CONCLUSION

Positive contrast CT peritoneography improved the delineation of hepatic interlobar fissures in normal canine cadavers.

CLINICAL SIGNIFICANCE

These results justify further studies to determine the ability to locate large hepatic masses in dogs with positive CT. Positive contrast CT peritoneography may assist treatment planning in dogs with large hepatic tumors.

Congenital peritoneopericardial diaphragmatic hernia in a family of Persian cats

Case series summary

The congenital midline defects of peritoneopericardial diaphragmatic hernia (PPDH) and omphalocele are believed to be related developmental defects, and have both been described in cats and dogs. This case series describes multiple cases of PPDH and omphalocele in related cats. The majority of cats affected with midline defects (PPDH or omphalocele) were male, consistent with previous reports of male overrepresentation.

Relevance and novel information

This is the first report of a family of Persian cats affected by PPDH and/or omphalocele. Clinical findings and pedigree information are suggestive of an autosomal recessive mode of inheritance. However, other modes of inheritance cannot be ruled out owing to limited sample size. The findings in this family and previous reports of Persians affected by PPDH warrant further investigation. Based on this information, recommendations for breeding populations of Persians and long-haired cats should include thoracic radiographs to screen for PPDH until a DNA-based genetic test is available.

Radiographic and computed tomographic features of caval foramen hernias of the liver in 7 dogs: mimicking lung nodules

This study describes the imaging features and characteristics of caval foramen hernias in 7 dogs diagnosed by computed tomography (CT). On lateral radiographs, 6 of 7 dogs showed dome-shaped, broad-based, caudal mediastinal lesions. CT findings included caudal vena cava (CVC) compression (n=7), right lateral (n=6) or medial (n=1) liver lobe involvement, hepatic vein dilation (n=5) and biliary tract involvement (n=1) with partial (n=6) or entire (n=1) liver lobe hernias. A caval foramen hernia should be part of the differential diagnosis when the aforementioned imaging features are detected. CT is considered as a useful tool for diagnosis and evaluation in dogs with a caval foramen hernia.

The impact of surgical timing and intervention on outcome in traumatized dogs and cats

OBJECTIVE

To review the relevant human and veterinary literature regarding the timing of surgical intervention for trauma patients and the impact on outcome.

DATA SOURCES

Original research, clinical studies, and review articles with no date restrictions from both human and veterinary literature.

HUMAN DATA SYNTHESIS

Despite extensive research into the ideal timing of surgical intervention for human trauma victims, debate is ongoing and views are still evolving. Prior to the 1970s, the standard of care consisted of delayed surgical treatment, as these patients were considered too ill to undergo surgery. Beginning in the 1970s, and continuing for nearly 2 decades, early definitive surgical treatment was recommended. The most recent evolution of human trauma management incorporates the concept of damage control surgery, which acknowledges the importance of early skeletal stabilization or laparotomy for reducing morbidity while attempting to avoid complications such as acute respiratory distress syndrome or multiple organ dysfunction syndrome.

VETERINARY DATA SYNTHESIS

Despite a relatively large amount of literature available regarding veterinary trauma, no evidence exists to provide the clinician guidance as to the ideal timing of surgery for trauma patients. With the exception of diaphragmatic hernia, no studies were identified that attempted to evaluate this variable.

CONCLUSIONS

Veterinary-specific studies are needed to evaluate the impact of surgical timing on outcome following trauma. The information that can be obtained from studies in this area can improve veterinary trauma care and may be used as models for human trauma care through translational applications.