Today’s case is a 13-year-old male neutered domestic shorthair cat with intermittent chronic cough, presenting in respiratory distress. What are your differential diagnoses?
There is marked enlargement of the cardiac silhouette. The cardiac silhouette silhouettes with the diaphragm, and there is a soft tissue opacity with apparent connection between the cardiac silhouette and diaphragm. There are multiple lobular soft tissue opacities and fat opacities superimposed on the cardiac silhouette on the lateral projections. There is a diffuse bronchointerstitial pattern throughout the lungs. The liver is not clearly visualized within the abdomen. The spleen and stomach are located more cranially than expected. There is gas lucency in the soft tissues dorsal to the thoracic spine likely secondary to subcutaneous injection.
The appearance of the cardiac silhouette is most consistent with a pericardial peritoneal diaphragmatic hernia. Ultrasonography could be considered to evaluate the organs displaced into the pericardial space.
The diffuse bronchointerstitial pattern is likely due to chronic lower airway disease. This may have infectious and noninfectious inflammatory components.
Both of these conditions can be contributing to the current clinical signs of dyspnea. Airway sampling is recommended to further evaluate the lower airway disease. Echocardiography could be performed to rule out cardiac disease.
PPDH and chronic lower airway disease.
The dyspnea improved with medical therapy for the chronic lower airway disease. Surgery to correct the PPDH was discussed however not performed at this time.