Hérnia diafragmática peritôniopericárdica congênita em uma gata / Congenital peritoniopericardial diaphragmatic hernia in a female kitten

Background: Peritoneopericardial diaphragmatic hernia is a rare pathogenesis of congenital origin, which occurs due to a failure in the communication between the diaphragm and the pericardium during embryogenesis. Symptoms may be non-existent or non-specific, depending on the herniated organ involved and, in most cases, the diagnosis is incidental. Regarding the most indicated treatment, there are still divergences in the literature concerning the indication of conservative or surgical treatment. This study reports the case of a feline peritoneopericardial hernia, for which surgical correction was the treatment of choice. Case: A 3-month-old female kitten, no defined racial pattern, was referred to the Veterinary Hospital of the Federal Rural University of Pernambuco for treatment of a peritoneopericardial diaphragmatic hernia. This condition was diagnosed through radiographic examination after the patient having been submitted to pediatric castration and presented anesthetic complications in the transsurgery. Blood count, biochemical profile and Doppler echocardiogram were performed, which showed no significant changes. To obtain a better study and surgical planning, computed tomography was performed to observe the heart located cranially in the pericardial cavity. Caudally to the heart, hepatic parenchyma located in the pericardial cavity was observed; and hepatic vessels presenting slightly enlarged dimensions. These tomographic findings suggested peritoneopericardial diaphragmatic hernia; being the liver present in the pericardial cavity and signs of congestion in the hepatic parenchyma. Due to the likelihood of future worsening of the hernia, surgical correction was performed, with an abdominal midline incision in the preumbilical region to reposition the liver to its normal anatomy, followed by diaphragm reconstitution through a herniorrhaphy. After the surgical procedure, the patient was referred for observation in internment and, after 15 days, the skin sutures were removed. Complete correction of the hernial defect was observed on radiography performed 30 days after the surgical procedure. However, the examination showed the presence of deviation/ deformity in the topography of the sternum and costal cartilages, with slight cardiac displacement to the right hemithorax, suggesting the presence of pectus excavatum. Discussion: Peritoneopericardial diaphragmatic hernia is considered rare and, despite being one of the most common causes of congenital pericardial anomaly in felines, it has a low prevalence ranging from 0.06% to 1.45%. They are usually diagnosed from two years of age, with prevalence for older animals. However, due to having presented anesthetic changes, the patient of this case report could be diagnosed early. Among the most common organs that migrate to the thoracic cavity, the liver is the most commonly observed, which is also the hernia content of the present report. Peritoneopericardial hernia is often diagnosed through radiography and ultrasound, and these imaging tests proved to be sufficient for the diagnosis in this report. However, computed tomography was important for providing a better study of case and for the adoption of median celiotomy as a treatment. Associations with other malformations are described in the literature, with pectus excavatum being the most common and also observed in this report. Peritoneopericardial diaphragmatic hernia is a rare anomaly, rarely reported in the literature and with divergences regarding its treatment. The adoption of early surgical treatment performed in this report showed satisfactory evolution and the possibility of a favorable prognosis.

Hérnia diafragmática peritoneopericárdica em um felino da raça Persa / Peritoneopericardial diaphragmatic hernia in a Persian cat

Background: Peritoneopericardial diaphragmatic hernia is a congenital defect characterized by an anomalous communication between the abdominal cavity and pericardial sac, which can lead to displacement of the abdominal viscera into the thoracic cavity. The occurrence in felines is higher among long-haired breeds, mainly the Persian breed, possibly based onan autosomal recessive inheritance. The diagnosis of PPDH is performed by means of chest radiography with or without contrast, in association with other imaging tests such as ultrasonography and echocardiography. Our objective in this study was to report the occurrence and macroscopic changes in a case of peritoneopericardial diaphragmatic hernia in a Persian feline. Case: A 9-year-old male Persian cat weighing 3.4 kg was referred to the HPET-Private Veterinary Clinic, Salvador, Bahia, with an history of weight loss and chronic intermittent vomiting during the preceding 6 months, with lateral decubitus and breathing difficulties. Ultrasonography revealed findings suggestive of an infiltrative process in the stomach and duodenum, enlarged gastric lymph nodes, and some nodular images indicating slight displacement of the liver. Chest radiography revealed a cardiac silhouette with markedly enlarged dimensions associated with a dorsal deviation of the terminal trachea, and echocardiography revealed a small amount of pericardial effusion. The patient showed initial clinical improvement after blood transfusion; however, after 2 days, he exhibited significant clinical worsening and was therefore euthanized with the owner's consent. Post mortem evaluation revealed partial herniation of the liver and gallbladder into the chest cavity through a diaphragmatic hernia ring. The heart was partially surrounded by the left medial lobe of the liver, which was displaced into the pericardial sac. Herniated hepatic lobes had an irregular capsular surface with evident lobulation and tension lipidosis. In the abdominal cavity, the remainder of the liver (right lateral and medial lobes) was observed to be slightly enlarged, with an irregular surface, diffusely reddish with intense evidence of the lobular pattern and white and firm multifocal areas (fibrosis). In the duodenum, close to the pylorus, there was a nodule measuring 2.8 x 2.5 x 1.0 cm, with a whitish and ulcerated surface. When cut, it was soft and exhibited a homogeneous, whitish compact surface. Histopathological examinationshowed marked proliferation of fibrous connective tissue, which for the most part separated the lobes by septa and surrounded the portal space (fibrosis), a marked diffuse chronic inflammatory infiltrate composed of lymphocytes and plasma cells. In addition, marked bile duct hyperplasia and multifocal areas of fatty degeneration (steatosis). Discussion: The diagnosis was based on the association of clinical and pathological findings. Considering the age and clinical signs presented by the patient in this report, as well as the presence of few radiographic signs that were indicative of PPDH, the first differential diagnosis thought was pericardial neoplasia. Peritoneopericardial diaphragmatic hernia in felines is always of congenital origin and may occur asymptomatically depending on the number and involvement of herniated viscera. In this case, the patient's diagnosis of peritoneopericardial hernia was a necropsy finding; the fact that in agreement with previous reports of high rates of incidental diagnoses reinforces the importance of performing necropsy for confirmation or diagnosis of unexpected pathologies. In the present case, peritoneopericardial diaphragmatic hernia in isolation may not have led to severe anemia that culminated in the patient's death. The anatomopathological findings were compatible with biliary cirrhosis and multifocal liver fibrosis, accompanied by the presence of anemia and consequent hypovolemia.

Diagnosis and treatment of a peritoneopericardial hernia in an adult dog: a case report / Diagnóstico e tratamento de hérnia peritoniopericárdica em cão adulto: relato de caso

Peritoneopericardial diaphragmatic hernia is a common congenital pericardial anomaly in dogs and cats, characterized by a communication between the abdomen and the pericardial sac. Animals may be asymptomatic or show nonspecific clinical signs related to the gastrointestinal and cardiorespiratory systems. In this report, we present a case of a 3-year-old female Schnauzer, weighing 7,7 kg, with a history of easy fatigue and cyanosis triggered by stress. The diagnosis of peritoneopericardial diaphragmatic hernia was confirmed through echocardiography and simple and contrast radiography findings that showed the presence of hepatic lobes in the pericardial sac. The animal underwent supra-umbilical celiotomy to correct the hernia and subsequently presented immediate improvement of clinical signs.

A hérnia diafragmática peritoniopericárdica é uma anomalia congênita pericárdica comum em cães e gatos, sendo caracterizada pela comunicação entre abdômen e saco pericárdico. Os animais podem ser assintomáticos ou apresentar sinais clínicos inespecíficos relacionados aos sistemas gastrointestinal e cardiorrespiratório. Expõe-se um caso de um cão Schnauzer, fêmea, 3 anos de idade, pesando 7,7 kg, com histórico de cansaço fácil e cianose em momentos de estresse. O diagnóstico de hérnia peritoniopericárdica foi confirmado por meio de ecocardiografia e exame radiográfico simples e contrastado que evidenciaram a presença de lobos hepáticos no saco pericárdico. O animal foi submetido a celiotomia pré-umbilical para correção do defeito, apresentando melhora imediata dos sinais clínicos após a correção cirúrgica.

Diagnosis and treatment of a peritoneopericardial hernia in an adult dog: a case report / Diagnóstico e tratamento de hérnia peritoniopericárdica em cão adulto: relato de caso

Peritoneopericardial diaphragmatic hernia is a common congenital pericardial anomaly in dogs and cats, characterized by a communication between the abdomen and the pericardial sac. Animals may be asymptomatic or show nonspecific clinical signs related to the gastrointestinal and cardiorespiratory systems. In this report, we present a case of a 3-year-old female Schnauzer, weighing 7,7 kg, with a history of easy fatigue and cyanosis triggered by stress. The diagnosis of peritoneopericardial diaphragmatic hernia was confirmed through echocardiography and simple and contrast radiography findings that showed the presence of hepatic lobes in the pericardial sac. The animal underwent supra-umbilical celiotomy to correct the hernia and subsequently presented immediate improvement of clinical signs.(AU)

A hérnia diafragmática peritoniopericárdica é uma anomalia congênita pericárdica comum em cães e gatos, sendo caracterizada pela comunicação entre abdômen e saco pericárdico. Os animais podem ser assintomáticos ou apresentar sinais clínicos inespecíficos relacionados aos sistemas gastrointestinal e cardiorrespiratório. Expõe-se um caso de um cão Schnauzer, fêmea, 3 anos de idade, pesando 7,7 kg, com histórico de cansaço fácil e cianose em momentos de estresse. O diagnóstico de hérnia peritoniopericárdica foi confirmado por meio de ecocardiografia e exame radiográfico simples e contrastado que evidenciaram a presença de lobos hepáticos no saco pericárdico. O animal foi submetido a celiotomia pré-umbilical para correção do defeito, apresentando melhora imediata dos sinais clínicos após a correção cirúrgica.(AU)

Avaliação ultrassonográfica torácica em cães com efusão pleural e/ou periocárdica / Thoracic ultrasonographyc evaluation of dogs with pleural and/or pericardial effusion

Com o objetivo de avaliar a ultrassonografia torácica (incluindo a ecocardiografia) como método de exame complementar em pacientes portadores de efusão pleural e/ou pericárdica, realizou-se a ultrassonografia torácica em 30 cães, machos e fêmeas de raças e idades variadas. Animais atendidos nos serviços de Pronto-Atendimento, Clínica Médica ou Clínica Cirúrgica do HOVET/USP com efusão pleural e/ou pericárdica, detectadas por meio de exame radiográfico, ultrassonografia emergencial ou toracocentese exploratória foram incluídos no estudo. Observou-se efusão pleural em 12 cães (40%), efusão pericárdica em oito (26,66%) e efusão pleural e pericárdica em outros dez cães (33,33%). A causa da efusão pleural e/ou pericárdica foram avaliadas ultrassonograficamente como sendo: nódulo/tumor cardíaco (5 - 16,66%), nódulo/tumor intratorácico (5 16,66%), insuficiência cardíaca congestiva por cardiomiopatia dilatada (4 13,33%) ou endocardiose de mitral e tricúspide (3 10%), efusão pericárdica idiopática (3 - 10%), li fossarcoma (2 - 6,66%), piotórax (2 6,66%), ruptura diafragmática (1 3,33%), hérnia peritônio-pericárdica (1 –3,33%), pneumonia e pleurite (1 - 3,33%), tumor de ovário com metástases torácicas (1 3,33%), pericardite infecciosa (cinomose) (1 3,33%) e hipoalbuminemia (1 3,33%).(AU)

To evaluate diagnostic accuracy of thoracic ultrasonography (including echocardiography) of patients with pleural and/or pericardial effusion, thoracic ultrasonography was performed in 30 dogs, males and females, of different breeds and ages. The animals were admitted to the Emergency, Internal medicine or Surgery department of the Faculty of Veterinary Medicine, University of São Paulo, presenting with pleural and/or pericardial effusion, diagnosed by thoracic radiography, emergency thoracic ultrasonography or exploratory thoracocentesis. Twelve (40%) dogs had pleural effusion, 9 (30%) had pericardial effusion and 9 (30%) had both pleural and pericardial effusions. The definitive cause of effusion were obtained by thoracic ultrasonography as follows: heart mass (5 –16,66%), intrathoracic mass (5 16,66%), congestive heart failure by dilated cardiomyopathy (4 13,33%) or mitral and tricuspid insufficiency (3 10%), idiopathic pericardial effusion (3 10%), lymphosarcoma (2 6,66%), pyothorax (2 - 6,66%), traumatic diaphragmatic hernia (1 3,33%), congenital peritoneopericardial hernia (1 3,33%), pneumonia and pleuritis (1 3,33%), ovarian neoplasia and thoracic metastasis (1 3,33%), infectious pericarditis (distemper) (1 3,33%) and hypoalbuminemia (1 3,33%). The conclusion was that thoracic ultrasonography was an excellent auxiliary exam in animals with pleural and/or pericardial effusion, and its not invasive and safe for the patient, allowing to guide biopsies and perform the exam in different decubits, avoiding patient stress.(AU)

DIAGNOSIS AND TREATMENT OF A PERITONEOPERICARDIAL HERNIA IN AN ADULT DOG: A CASE REPORT

Peritoneopericardial diaphragmatic hernia is a common congenital pericardial anomaly in dogs and cats, characterized by a communication between the abdomen and the pericardial sac. Animals may be asymptomatic or show nonspecific clinical signs related to the gastrointestinal and cardiorespiratory systems. In this report, we present a case of a 3-year-old female Schnauzer, weighing 7,7 kg, with a history of easy fatigue and cyanosis triggered by stress. The diagnosis of peritoneopericardial diaphragmatic hernia was confirmed through echocardiography and simple and contrast radiography findings that showed the presence of hepatic lobes in the pericardial sac. The animal underwent supra-umbilical celiotomy to correct the hernia and subsequently presented immediate improvement of clinical signs.

Hérnia diafragmática peritônio pericárdica: “relato de caso" / Diaphragmatic hérnia peritoneopericardial: “reporto of case”

A hérnia diafragmática ocorre devido a um defeito no diafragma freqüentemente encontrado nos pequenos animais, principalmente após o trauma. O diagnóstico precoce da enfermidade é de extrema importância para que se possa realizar o tratamento cirúrgico, antes que complicações mais sérias possam ocorrer em virtude do encerramento dos órgãos herniados envolvidos. Em alguns casos, as hérnias diafragmáticas permanecem assintomáticadas acidentalmente em exames de rotina. O presente artigo tem como objetivo revisar os aspectos clínicos, meios de diagnósticos e tratamento, bem como relatar um caso de hérnia diafragmática atendido no Hospital Veterinário do Centro Universitário Vila Velha no ano de 2005, de origem congênita denominada hérnia peritônio-pericárdica(AU)

The diaphragmatic hérnia occurs due to a defect in the diaphragm frequently found in the small animals, mainly after the trauma. The precocious diagnosis of the disease is of extreme importance so that if it can carry through the surgical treatment, before more serious complications can occur in virtue of the imprisonment of the involved herniated organs. In some cases, the diaphragmatics hernias remain asymptomatics and can accidentally be diagnosised in routine examinations. The present article has as objective to revise clinical aspects, diagnostic ways and treatment, as also to tell one taken care of case of diaphragmatic hernia in the Hospital Veterinarian of the University Center of vila Velha in the year of 2005, of congenital origin called peritoneopericardial hernia(AU)

Hérnia diafragmática peritônio pericárdica: “relato de caso" / Diaphragmatic hérnia peritoneopericardial: “reporto of case”

A hérnia diafragmática ocorre devido a um defeito no diafragma freqüentemente encontrado nos pequenos animais, principalmente após o trauma. O diagnóstico precoce da enfermidade é de extrema importância para que se possa realizar o tratamento cirúrgico, antes que complicações mais sérias possam ocorrer em virtude do encerramento dos órgãos herniados envolvidos. Em alguns casos, as hérnias diafragmáticas permanecem assintomáticadas acidentalmente em exames de rotina. O presente artigo tem como objetivo revisar os aspectos clínicos, meios de diagnósticos e tratamento, bem como relatar um caso de hérnia diafragmática atendido no Hospital Veterinário do Centro Universitário Vila Velha no ano de 2005, de origem congênita denominada hérnia peritônio-pericárdica

The diaphragmatic hérnia occurs due to a defect in the diaphragm frequently found in the small animals, mainly after the trauma. The precocious diagnosis of the disease is of extreme importance so that if it can carry through the surgical treatment, before more serious complications can occur in virtue of the imprisonment of the involved herniated organs. In some cases, the diaphragmatics hernias remain asymptomatics and can accidentally be diagnosised in routine examinations. The present article has as objective to revise clinical aspects, diagnostic ways and treatment, as also to tell one taken care of case of diaphragmatic hernia in the Hospital Veterinarian of the University Center of vila Velha in the year of 2005, of congenital origin called peritoneopericardial hernia