PMC9083054_01
Orthogonal radiographs of a 7-month-old intact female Maine Coon showing severe enlargement of the cardiac silhouette and partial summation of its caudal border with the ventral margins of the diaphragm (white arrows)
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Thoracic and abdominal radiography revealed marked enlargement of the cardiac silhouette and a confluent silhouette between the diaphragm and the heart (Figure 1).
(a) Ultrasonographic image of the stomach showing the presence of a parenchymal structure on the left side of the screen compatible with a mass within the stomach. Visualisation of the transition (white arrow) between the gastric mass (red arrow) and the normal gastric wall (S). (b) Ultrasonographic image of the stomach showing the circumferential mass at the level of the cardia and surrounding the lower oesophageal sphincter (LES). Visualisation of the transition (white arrow) between the gastric mass (red arrow) and the rest of the stomach on the right side of the screen. (c) Ultrasonographic image of the stomach showing the circumferential mass (red arrow) affecting the cardia and surrounding the LES
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A segment of gastric wall adjacent to and surrounding the lower oesophageal sphincter showed marked thickening and loss of layering with a hypoechoic appearance (Figure 2).
(a) Post-contrast dorsal multiplanar reformatted CT image in a soft tissue window. Visualisation of the peritoneopericardial diaphragmatic hernia (PPDH; white arrow) with liver (L)and portal venous system involvement caudal to the heart (H). A large mass is seen arising from the cardia and protruding into the lumen of the stomach (red arrow). PV = portal vein. (b) Post-contrast sagittal multiplanar reformatted CT image in a soft tissue window. Visualisation of the PPDH with liver (L) and portal venous system involvement caudal to the heart (H). A large mass is seen within the stomach (white arrow). E = oesophagus. (c) Post-contrast transverse CT image in a soft tissue window. Visualisation of the large mass arising from the cardia and protruding into the lumen of the stomach (white arrow). Ao = aorta; CVC = caudal vena cava; PV = portal vein
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The mass was circumferential and showed heterogeneous contrast enhancement (Figure 3).
(a) Intraoperative photograph of the patient in dorsal decubitus showing pre-umbilical coeliotomy to correct peritoneopericardial diaphragmatic hernia (PPDH). The black arrow shows the intraluminal gastric mass. The fundus (F), body (B) and pylorus (P), and part of the spleen (S), are also shown. (b) Intraoperative photograph showing the intraluminal circumferential mass after gastrotomy. The black arrow shows the intraluminal gastric mass. Note the lumen of the lower oesophageal sphincter in the centre of the mass. (c) Intraoperative photograph showing the intraluminal circumferential mass after gastrotomy. The black arrow shows the intraluminal gastric mass after dissection of its superficial layer (white arrow). Note the lumen of the lower oesophageal sphincter in the centre of the mass. (d) Intraoperative photograph showing the dissection of intraluminal circumferential mass (black arrow). The white arrow shows the superficial layer of the mass after dissection. (e) Intraoperative photograph showing the dissection of intraluminal circumferential mass (black arrow). The white arrow shows the lumen of the lower oesophageal sphincter. (f) Postoperative photograph showing the circumferential mass. The scalpel was used as a scale
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An intraluminal mass was palpated within the stomach, at the oesophagogastric junction (Figure 4a). A gastrotomy was performed and a circumferential, ulcerated, submucosal mass was observed at the level of the LES (Figure 4b). The mucosal and submucosal layers surrounding the mass were incised and the mass was elevated (Figures 4c-e). The mass was resected and submitted for histopathology (Figure 4f).