When Liver Meets Lungs – Diaphragmatic Hernia in a Cat

Up a TreeOne evening whilst playing outside, a little 6 month old kitten (let’s call her Tilly) climbed up a tree. A rather inexperienced hunter, when she saw a little birdie on the end of the branch she reached out to get it and, crash! The branch was too thin to support her weight and she fell to the ground. Now what they say is often true, cats do tend to land on their feet, but not always and poor Tilly landed on her side. She got up though and ran into the house, so her owner assumed she was OK. A few hours later her owner noticed that she was quieter than normal and not interested in her dinner. She was also breathing faster than normal but otherwise seemed OK, purring and affectionate, so her owner went to bed and planned to take her to the vet if she was still not right in the morning.

As you could probably guess, at 8:00 the next morning I got a phone call from Tilly’s owner, as she had not gotten any better overnight – she was still very quiet and breathing even faster than before. We told her to come straight down and we would take a look right away. A few minutes later Tilly arrived, looking quite sorry for herself, but still happy enough to give me a little purr. I did a full physical exam and found her to be in good health except for her breathing, which sounded quieter than normal through the stethoscope. Her respiratory or breathing rate was very high and she seemed to be struggling to get enough air in. She also seemed depressed, certainly not what I would expect of such a lively young kitten. Once we were certain that everything else seemed to be OK, we gave her some pain medicine and then a little bit of sedation so she would sit still while we took some x-rays of her chest. What we found was no surprise given her history, but still always comes as a bit of a shock when we see it – Tilly had a diaphragmatic hernia.

What is a diaphragmatic hernia?

The diaphragm is a large, thin muscle that separates the chest cavity (with the heart and lungs) from the abdomen (with the stomach, liver and intestines among other things). It is normally an air-tight barrier which allows the chest cavity to achieve negative pressure, in other words there is pressure on the lungs to expand out rather than collapse in. When the diaphragm moves down with each breath, the lungs move with it causing them to expand even further when you breathe in. And when it moves back up again, it helps the lungs to contract so the air is forced out when you exhale. Without a diaphragm or with a damaged one you can still breathe, just not very well, and this is what poor Tilly was experiencing. A hernia is the protrusion of an organ through a hole in the body cavity which normally contains it. In the case of a diaphragmatic hernia, a hole develops in the diaphragm which allows the organs of the abdomen to enter the chest cavity. As you can imagine, this is neither good for chest, as the invading organ takes up precious lung space, nor for the organ itself as sometimes its blood supply can get cut off in the process. Some diaphragmatic hernias are emergencies and need to be corrected immediately, while some can go on for weeks without anybody even noticing, it depends on the size of the hole and which organs get displaced. Some animals are even born with them. In Tilly’s case, the sudden pressure on her belly from hitting the ground caused her diaphragm to tear and some of her liver to move up through the hole. It was a serious condition but not a life-threatening emergency, and it has been shown that there is a higher success rate in some cases if surgery is done after 24-48 hours, so she was scheduled for surgery to repair the hernia the following day and kept in hospital under close observation until then.

This is an image of Tilly’s chest – the dotted line shows where the diaphragm usually sits and the solid line shows Tilly’s diaphragm, with the liver sitting inside the bulge.  A relatively easy but dramatic diagnosis!

This is an image of Tilly’s chest – the dotted line shows where the diaphragm usually sits and the solid line shows Tilly’s diaphragm, with the liver sitting inside the bulge. A relatively easy but dramatic diagnosis!

So what happened?

We took Tilly to surgery the following day and once we could see inside, the extent of the injury became apparent. There was a 5 cm tear in the diaphragm muscle, and about half of her liver was now sitting right next to her lungs! We were able to carefully pull the liver back into the abdomen and sew up the hole, making sure that all the organs looked happy and healthy before finishing the surgery. Our nurse did a fantastic job keeping Tilly stable under the anaesthetic, and even had to breathe for her for a few minutes while we sewed up the hole. Just before we woke her up, we inserted a needle into the chest to drain out all the extra air so that her chest cavity could regain its negative pressure. Her breathing was immediately improved, and stayed that way throughout her recovery. The next day she was eating and even trying to play with the notes on her cage, so she was able to go home.

It has now been nearly a week and Tilly is still doing really well. Her owner says she is even trying to climb things, despite being told that she must stay very quiet to allow her injuries some time to heal. If only you could explain to her how she got into this trouble in the first place! All the best to brave Tilly and her brave owners, I expect she will make a full recovery and be back to her usual kitten acrobatics in no time.

If you are worried about any problems with your cat, talk to your vet or try our Interactive Cat Symptom Guide to help decide what to do next.

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