Page 313 - Feline diagnostic imaging

19.4 iatal ernia 319

(b)

(a)

Figure 19.5 Lateral (a) and ventrodorsal (b) thoracic images of a 4-week-old kitten presented for unknown trauma. The left femur
was fractured. A focal soft tissue opacity is noted in the left caudoventral thorax, with border effacement of the left diaphragmatic
border. Both pulmonary mass and diaphragmatic hernia are considerations based on the radiographs. Herniation of a liver lobe was
detected on ultrasound examination. A radiolucent paddle used for patient restraint is superimposed over the caudal thorax and
abdomen on the lateral view.

Generalized enlargement of the cardiac silhouette, often radicals following reperfusion of hypoperfused herniated
with a convex caudal border, is present (Figures 19.6 and liver lobes have been reported [9].
19.7). Gas‐filled opacities may be visualized within the car-
diac silhouette if intestines or stomach are displaced into
the pericardial sac. Border effacement is present between 19.4 Hiatal Hernia
the cardiac silhouette and diaphragm. As in traumatic dia-
phragmatic hernias, cranial displacement of nonherniated Hiatal hernias are uncommon, but have been reported in
abdominal viscera is often noted. A distinct curvilinear both dogs and cats as an acquired or congenital lesion
radiopacity (dorsal mesothelial remnant) between the car- [10–14].
diac silhouette and diaphragm, located ventral to or super- A sliding hiatal hernia (type I) is most common, and is
imposed over the caudal vena cava, is a feature of PPDH described as a cranial displacement of the abdominal
often seen in cats (Figures 19.6 and 19.7) [7]. Associated portion of the esophagus, gastroesophageal junction, and
defects such as pectus excavatum, abnormal numbers of occasionally a portion of the stomach into the thoracic
sternebrae, congenital cardiac defects or umbilical hernia, cavity. This displacement from the hiatus decreases lower
may be present. Ultrasound of the enlarged cardiac silhou- esophageal sphincter pressures, allowing gastroesophageal
ette is a reliable means of diagnosis. A barium upper reflux and esophagitis. Esophagitis may affect esophageal
gastrointestinal series is also diagnostic if the stomach or motility, resulting in decreased clearance of acid reflux,
proximal small intestines are displaced. A barium‐filled furthering the disease process.
stomach will also aid in identification of cranial displace- Clinical signs of hiatal hernia are attributed primarily to
ment if the liver is herniated. reflux esophagitis and include regurgitation, vomiting,
Surgical correction of the hernia can be performed based cough, anorexia, and hypersalivation. Respiratory signs
on clinical signs. Some complications related to reduction may occur secondary to aspiration pneumonia or lung
of herniated organs and release of endotoxins or free compression by herniated organs. Clinical signs may be