Page 333 - Feline Cardiology

344 Section J: Pericardial Diseases

A

Pericardial Diseases

B

Figure 22.1. Lateral (A) and VD (B) radiographs from a cat with PPDH. Note the severely enlarged cardiac silhouette with overlap of
the caudal heart border and diaphragm and the presence of bowel loops containing gas within the pericardial sac.

major organ herniation is present. Similarly, the midabdominal organs from the abdominal cavity may
abdomen may feel “empty.” Other congenital defects be noted and they may be visualized within the pericar-
may also be noted such as sternebral abnormalities (i.e., dial sac. Echocardiography is a straightforward diagnos-
pectus excavatum). tic modality to confirm the diagnosis when abdominal
Electrocardiography may show reduced QRS ampli- organs are visible within the pericardium of affected cats
tude and/or axis deviation due to herniated abdominal (Figure 22.2). An important differential diagnosis is
contents and shifted cardiac position. Radiographs typi- consolidation of the accessory lung lobe, because hepa-
cally are diagnostic, with an enlarged cardiac silhouette tization of the lung mimics herniated liver tissue adja-
and overlap of the caudal heart border and diaphragm cent to the heart; a radiologist should be consulted to
when organ herniation is moderate or extensive (Figure clarify the diagnosis on radiographs if uncertainty exists.
22.1). When only the omentum is herniated, thoracic Surgical correction is warranted if clinical signs are
radiographs may be unremarkable. Persistence of the present, since the prognosis is excellent if the PPDH is
dorsal mesothelial remnant, a meniscus-like connection uncomplicated and repaired. In one study, 60% of the
between the caudal cardiac silhouette and the dia- 66 PPDH cases had clinical signs secondary to the
phragm, ventral to the caudal vena cava on a lateral PPDH, which prompted the owner to present the cat to
radiograph, strongly suggests PPDH (O’Sullivan 2007). a veterinarian (Reimer et al. 2004). Twenty-nine cats
With herniation of one or more liver lobes, the gastric were treated conservatively and 37 were treated surgi-
axis may be displaced cranially. Absence of cranial or cally (most often those with overt clinical signs related