Sonographic Findings of a Congenital Pericardial-Peritoneal Diaphragmatic Hernia in a 6 month old Ragdoll. Case of the Month August 2021.

Patient Information:

Age: 6 months

Gender: Female (intact)

Species: Feline

History:

An abdominal ultrasound was recommended due to a persistently elevated ALT/ALKP (ALT: 915 U/L; ALKP 195 U/L). Although the patient’s ALT improved mildly with 10 days of metronidazole, repeat lab work revealed persistently elevated ALT/ALKP. The patient had no GI symptoms or signs of respiratory distress. Pre and post-prandial bile acids were WNL. AUS was recommended prior to spay to help determine anesthetic risks.

Image Interpretation and Analysis:

Abdominal sonographic findings:

A defect in the diaphragm was seen along the medial aspect near the right-side of the liver creating a “bulge” of liver parenchyma within the thoracic cavity.

Upon, closer examination the gall-bladder was also seen prolapsed into the thorax.

The left liver, stomach, spleen, and small bowel remained within the abdominal cavity. No effusions were observed.

In one view, liver parenchyma can be seen in the intercostal space abutting the heart.

The patient was referred for to VSC for a surgical consultation to repair the hernia and OHE. Upon surgery, a pericardial-peritoneal diaphragmatic hernia was present. The herniated right liver and gallbladder were reduced back into the abdomen and the hernia was repaired. OHE was also performed at this time.