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778 Peritoneopericardial Diaphragmatic Hernia

for any reason. It does not take much formulated to reduce plaque and calculus Client Education
time. • An effective prevention strategy should be • Dogs and cats manage very well without
accumulation (i.e., dental diets).
VetBooks.ir (www.vohc.org) provides a standard for built into every animal’s wellness program • Clinicians should teach owners about
• The Veterinary Oral Health Council
teeth.
efficacy of products marketed to control
from a young age.
methods of prevention.
plaque and calculus accumulation and awards
its Seal of Acceptance to those that have been Technician Tips SUGGESTED READING
shown to meet its standards. • Proper toothbrushing can easily be dem- McFadden T, et al: Consequences of untreated
onstrated to owners and is a vital part of periodontal disease in dogs and cats. J Vet Dent
Prevention long-term maintenance of oral health. 30:266, 2013.
• Home oral hygiene: owner education about • The technician can help the owner to select AUTHOR: Ana C. Castejon-Gonzalez, DVM, PhD,
the combination of brushing or rubbing the oral health care products (dental diets, treats, DAVDC, DEVDC
tooth surfaces (once daily or every other day), toys, gels, and rinses) based on scientific EDITOR: Alexander M. Reiter, DVM, Dr. med. vet.,
the use of oral health care products, and information. DAVDC, DEVDC
offering pets nutritionally complete diets

Video
Peritoneopericardial Diaphragmatic Hernia Bonus Material Client Education Available
Online
Sheet
Clinical Presentation
BASIC INFORMATION • Pleuroperitoneal diaphragmatic hernias do
HISTORY, CHIEF COMPLAINT not involve the presence of abdominal viscera
Definition • Incidental finding in up to 50% of cases in the pericardial space.
• Embryologic malformation of the diaphragm • Nonspecific signs (lethargy, anorexia, pyrexia,
results in communication between peritoneal weight loss) Initial Database
and pericardial cavities and allows herniation • Respiratory signs most common (dyspnea, • CBC and serum biochemistry panel: Often
of cranial abdominal organs and omentum tachypnea, coughing) unremarkable. Elevated alanine aminotrans-
into the pericardial space (from most to least • Gastrointestinal (GI) signs (vomiting, ferase (ALT) concentration most common
common: liver, gallbladder, small intestine, diarrhea) finding in dogs; elevated calcium level in cats
spleen, stomach). • Uncommonly, signs of cardiac tamponade • Thoracic radiographs
• Can result in vascular compromise or and right-heart failure (weakness, collapse, ○ Cardiomegaly
obstruction of herniated organs and cardiac ascites) ○ Silhouetting of caudal cardiac border with
tamponade diaphragm
PHYSICAL EXAM FINDINGS ○ Discontinuity of diaphragm
Synonyms • May be normal ○ Irregular and heterogeneous radiopaci-
Pericardioperitoneal diaphragmatic hernia, • Muffled heart sounds (most common ties (soft tissue, fat, gas) within cardiac
pericardial diaphragmatic hernia, PPDH abnormality) silhouette
• Displaced heart sounds ○ Dorsal mesothelial remnant on lateral
Epidemiology • Cardiac murmur (physiologic or concurrent view in cats: curvilinear soft-tissue opacity
SPECIES, AGE, SEX structural heart disease) ventral to caudal vena cava, representing
• Uncommon defect; prevalence in cats > • Decreased lung sounds dorsal aspect of hernia
dogs • Palpable sternal or cranial abdominal defects ○ Pleural effusion (uncommon)
• Age at diagnosis variable (30% diagnosed • Inability to palpate cranial abdominal ○ Sternal deformities possible
at > 4 years of age) organs • Abdominal radiographs
• No sex predisposition • Borborygmi (GI sounds) over heart ○ Small or absent liver
○ Cranial displacement or absence of
GENETICS, BREED PREDISPOSITION Etiology and Pathophysiology stomach or spleen
• Not known to be hereditary • Abnormal development of septum transver- ○ GI gas pattern extending from abdomen
• Predisposed breeds: domestic long-haired sum (forms ventral portion of the diaphragm) into pericardial space
cat, Maine coon, Persian, Himalayan, ± pleuroperitoneal folds (form dorsolateral
Weimaraner diaphragm), resulting in joined peritoneal Advanced or Confirmatory Testing
and pericardial cavities • Ultrasound: fat or abdominal organs within
RISK FACTORS • A congenital abnormality, not acquired pericardial sac ± small amount of pericardial
Prenatal injury, systemic illness, or toxin effusion and discontinuity of diaphragm (see
exposure affecting pregnant dam DIAGNOSIS first Video). Consolidation of the accessory
lung lobe can be a misleading impostor for
ASSOCIATED DISORDERS Diagnostic Overview peritoneopericardial diaphragmatic hernia
• Cranioventral abdominal hernia Definitive diagnosis can be made based on (PPDH) ultrasonographically (see second
• Caudal sternal abnormalities (pectus exca- history, physical exam, and thoracic radiographs. Video). If uncertainty exists, a radiologist’s
vatum, malformed/absent sternebrae) evaluation is strongly recommended.
• Ventricular or atrial septal defect, pulmonic Differential Diagnosis • Echocardiography: indicated in the presence
stenosis, pericardial cyst • Other causes of generalized cardiomegaly of a heart murmur to investigate concurrent
• Portosystemic shunt ○ Pericardial effusion structural heart disease or for signs of cardiac
• Chylothorax ○ Congenital or acquired cardiac diseases tamponade.

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