Case of the month: Siberian Forest Cat with dyspnea, heavy breathing and lethargy

Signalment and anamnesis:

Siberian Forest Cat, 1-year old, male castrated, outdoor cat. Dyspnea, heavy breathing and lethargy since two days.

For further clarification the following radiographs were taken:

Radiographic description:

An ovoid, cavitary, gas-filled mass can be identified in the left caudal hemothorax. The mass occupies the entire dorsoventral diameter of the thorax and extends from the level of T5 caudally up to the level of L1. The mass displaces the mediastinum, including the cardiac silhouette, to the right and the diaphragm caudally.

The liver is radiologically enlarged and shows rounded margins. The collimated musculoskeletal structures are unremarkable, with no evidence of fracture formation.

Diagnosis:

• Pleuroperitoneal diaphragmatic hernia (PlPDH) and tension-gastrothorax. → Most likely traumatic and due to diaphragmatic rupture, less likely congenital.
• Enlarged hepatic parenchyma: most likely due to congestion secondary to gastrothorax. However, a benign metabolic or vacuolar hepatopathy or a diffuse inflammatory (hepatitis) or neoplastic (lymphoma) infiltration cannot be excluded and should be considered as differential diagnosis.

Outcome:

Laparotomy and repositioning of the stomach into the peritoneal cavity. Closure of the diaphragmatic rupture. The patient has recovered well.

Discussion:

A tension gastrothorax is a rare, life-threatening consequence of a gastric prolapse through a diaphragmatic defect into the pleural space. Prompt diagnosis and subsequent surgical intervention are crucial and lead to a good prognosis. Cavalier King Charles Spaniels are predisposed to congenital pleuroperitoneal hernias and associated gastrothorax.

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

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