19.May 2023

Case of the month: 16-year-old european shorthair cat with sudden shortness of breath without acute trauma

 

Signalment and anamnesis

  • European shorthair cat, 16 years female neutered
  • Sudden shortness of breath with no known trauma. Two years ago, she had an unclear trauma during a free walk, since then she is rather scared

For further clarification the following radiographs were taken:

Radiographic description

  • The right part of the diaphragm is not completely delineated on the ventrodorsal image
  • The right hemithorax is also less transparent and diffusely fat opaque on the VD image
  • In the lateral image, the cardiac silhouette is separated from the sternum by this fatty material
  • The mediastinal structures are displaced to the right (mediastinal shift) and the right lung is displaced dorsally
  • The right cranial thorax shows a low-grade soft tissue effusion in the pleural space
  • The gastric axis in the cranial abdomen is slightly displaced medially
  • The splenic head appears to be dislocated cranially
  • Numerous ribs on the right side have focal, smooth-edged thickening in their proximal sections, suggestive of old fractures

Diagnosis

  • Because of the fatty opacity of the right hemithorax and decreased delineation of the right diaphragmatic portion, the changes are suspicious for an old traumatic diaphragmatic rupture with prolapse of the omental adipose tissue
  • The focal changes in the rib area are probably due to old fractures, supporting the theory of an older traumatic diaphragmatic rupture

Outcome

  • A computed tomographic examination confirmed a diaphragmatic defect and prolapse of omentum as well as the left pancreatic limb
  • An old diaphragmatic rupture is most likely
  • Lesser consideration is given to a congenital pleuroperitoneal hernia

Description of the computed tomography

  • Computed tomography and dorsal view of the thorax and abdomen
  • On the right side, a defect of the diaphragm with prolapse of fat-opaque material into the thoracic cavity is visible

 Discussion

  • Diaphragmatic hernia is a common consequence of automobile accidents in dogs and cats
  • Many of these hernias are detected soon after the traumatic event and subsequently treated through surgery
  • The contents of the hernia vary depending on the location of the rupture and the anatomical position of the structures
  • Previous studies have shown that the liver is the most commonly herniated organ within the thoracic cavity
  • Other organs that can herniate include the small intestine, stomach, omentum, and uterus (in a pregnant queen)
  • In cats, an exclusive protrusion of omentum and omental fat has been described, which makes radiographic diagnosis difficult due to the transparent density of the fat and the relatively normal conditions in the cranial abdomen

Many thanks to Dr. ECVDI Thorsten Rick for this case report!

Once more special thanks to the Öffnet externen Link in neuem FensterVetklinikum Vienna for making the case available!

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