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===Description===

===Description===

Pericardio-Peritoneo-Diaphragmatic Hernia (PPDH) is a congenital abnormality characterised by incomplete formation of the septum transversum during early embryonic development, meaning that the peritoneal cavity and pericardial sac remain continuous in later life.  The defect may also result from a failure of the septum transversum to fuse with the pleuroperitoneal folds.  Since the diaphragm (which is formed by the septum transversum) does not separate the two cavities, abdominal organs are able to move into the pericardial sac.  The defect may occur more commonly in the Weimaraner breed of dog and in Himalayan and Domestic Long Hair cats and it is often accompanied by other congenital defects, such as umbilical hernias, sternal malformations, cardiac septal defects and pulmonary vascular anomalies.  Many animals are diagnosed as adults and show few clinical signs on presentation.

Pericardio-Peritoneo-Diaphragmatic Hernia (PPDH) is a congenital abnormality characterised by incomplete formation of the septum transversum during early embryonic development, meaning that the peritoneal cavity and pericardial sac remain continuous in later life.  The defect may also result from a failure of the septum transversum to fuse with the pleuroperitoneal folds.  Since the diaphragm (which is formed by the septum transversum) does not separate the two cavities, abdominal organs are able to move into the pericardial sac.  Many animals are diagnosed as adults and show few clinical signs on presentation.

 

The defect may be inherited in the Weimaraner breed and it occurs most commonly in Himalayan and Domestic Long Hair cats.  It is often accompanied by other congenital defects, such as umbilical hernias, sternal malformations, cardiac septal defects and pulmonary vascular anomalies.   

===Diagnosis===

===Diagnosis===

====Clinical Signs====

====Clinical Signs====

*The disease is frequently asymptomatic.

The disease is frequently asymptomatic but clinical signs may include:

*'''Gastro-intentinal signs''' may be reported, including vomiting, diarrhoea, abdominal pain, anorexia and weight loss.

*'''Gastro-intentinal signs''', including vomiting, diarrhoea, abdominal pain, anorexia and weight loss.

*'''Respiratory distress''' may occur if abdominal contents occupy a large amount of the thoracic cavity.

*'''Respiratory distress''' may occur if abdominal contents occupy a large amount of the thoracic cavity.

*'''Cardiac signs''' are unusual but cardiac tamponade (with right-sided heart failure) may develop if abdominal organs are incarcerated in the pericardial sac.  The heart sounds will be muffled on auscultation and borborygmi may be apparent.  A heart murmur may be present if the animal has concurrent septal defects.

*'''Cardiac signs''' are unusual but cardiac tamponade (with right-sided heart failure) may develop if abdominal organs are incarcerated in the pericardial sac.  The heart sounds will be muffled on auscultation and borborygmi may be apparent.  A heart murmur may be present if the animal has concurrent septal defects.

On plain radiographs of the chest, the cardiac silhouette is enlarged and continuous with that of the diaphragm.  If loops of small intestine have passed into the pericardial sac, areas of lucency may be apparent overlying the cardiac silhouette and, if necessary, this can be confirmed by a barium contrast study.  The trachea may also be displaced dorsally.  In cats, an area of radio-opacity may be apparent in the area of the dorsal diaphragm on a lateral radiograph, referred to as the 'dorsal peritoneo-pericardial remnant.'  

On plain radiographs of the chest, the cardiac silhouette is enlarged and continuous with that of the diaphragm.  If loops of small intestine have passed into the pericardial sac, areas of lucency may be apparent overlying the cardiac silhouette and, if necessary, this can be confirmed by a barium contrast study.  The trachea may also be displaced dorsally.  In cats, an area of radio-opacity may be apparent in the area of the dorsal diaphragm on a lateral radiograph, referred to as the 'dorsal peritoneo-pericardial remnant.'  

====Echocardiography====

====Ultrasonography====

Definitive diagnosis generally relies on the identification of abdominal organs within the pericardial sac.  Septal defects may also be diagnosed during the scan.

Definitive diagnosis generally relies on the identification of abdominal organs within the pericardial sac.  Septal defects may also be diagnosed during the scan.

'''Reimer SB, Kyles AE, Filipowicz DE, Gregory CR''' Long-term outcome of cats treated conservatively or surgically for peritoneopericardial diaphragmatic hernia: 66 cases (1987-2002) ''J Am Vet Med Assoc. 2004 Mar 1;224(5):728-32''

'''Reimer SB, Kyles AE, Filipowicz DE, Gregory CR''' Long-term outcome of cats treated conservatively or surgically for peritoneopericardial diaphragmatic hernia: 66 cases (1987-2002) ''J Am Vet Med Assoc. 2004 Mar 1;224(5):728-32''

'''Gorman N''' Canine Medicine and Therapeutics ''Blackwell Science'' Fourth Edition

'''Gorman N''' 1997 Canine Medicine and Therapeutics ''Blackwell Science'' Fourth Edition

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