Page 316 - Feline diagnostic imaging

322 19 Diaphragm
intermittent or continual. In some cases, the hiatal hernia the stomach displaces cranially adjacent to the thoracic
is subclinical and found incidentally. In the dog, most esophagus, through the hiatus.
reported cases of congenital hiatal hernia have been in Radiographic signs of hiatal hernia include a soft tissue
brachycephalic breeds. Increased inspiratory effort second- opacity in the caudal and dorsal thorax, associated with the
ary to upper airway obstructive disease can cause an left diaphragmatic crus (Figures 19.8 and 19.9). Gas opacity
increase in negative intraesophageal and intrapleural pres- and rugal folds within the soft tissue mass effect may be
sures and a tendency to pull the esophagus and stomach seen depending on gas content of the herniated stomach.
into the thorax [14]. The same mechanism may have been The gastric cardia is displaced cranially, and megaesopha-
responsible for a cat with hiatal hernia and nasopharyn- gus may be present. Aspiration pneumonia is a potential
geal stenosis [10]. complication. The hernia may be transient, and only visu-
Paraesophageal hernia (type II) is much less common alized intermittently. Fluoroscopy or positive contrast
than type I, and has not been reported in cats. With this esophagram is needed for a definitive diagnosis. If the gas-
type of hernia, the gastroesophageal junction and abdomi- troesophageal junction is visualized cranial to the dia-
nal esophagus remain in a normal location but a portion of phragm, the diagnosis is confirmed.

References

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