Fusion of the distal sesamoid and distal phalanx in a yearling colt

This paper describes a rare malformation of the distal portion of the left foredigit of a 15-month-old half-bred colt which was severely lame. Radiological, pathological and tomographic studies revealed hypoplasia of the metacarpophalangeal skeleton, absence of the distal sesamoid and deformation of the distal phalanx. Morphological analysis of the lesion and computerised measurement of the width of the articular surface of the distal phalanx suggested an early fusion between the distal sesamoid and distal phalanx.     

SCINTIGRAPHIC DETECTION OF SUBCUTANEOUS METASTASIS IN A DOG WITH APPENDICULAR OSTEOSARCOMA

This report describes the detection of subclinical soft tissue metastasis of an appendicular osteosarcoma in a dog using bone scintigraphy. A 7-year-old spayed female Rottweiler was presented with a biopsy confirmed diagnosis of osteosarcoma. Initial radiographs revealed an aggressive bone lesion of the left distal radius. At presentation, there was no clinical or radiographic evidence of metastasis; however, a nuclear bone scan showed the primary bone lesion of the distal left radius and numerous soft tissue lesions consistent with diffuse soft tissue metastases. A left foreleg amputation was performed and cisplatin chemotherapy was given post-operatively. A second bone scan performed one month following initial presentation showed progression in size and number of soft tissue masses. Many of the lesions had become apparent on physical exam and survey radiographs. Excisional biopsy was performed on one of the soft tissue masses and a diagnosis of metastatic osteosarcoma was made. The dog was euthanized 2 months after initial presentation at the owners request due to deterioration of the animals physical condition.     

Disseminated cryptococcosis including osteomyelitis in a horse

A 4-year-old Arab mare was diagnosed with disseminated cryptococcosis, including osteomyelitis of the proximal phalanx of the left hind limb, osteomyelitis with associated soft tissue granuloma of a rib and disseminated, large cryptococcal nodules in the lungs. The lesion in the dorsoproximal aspect of the proximal phalanx had a large area of cortical lysis with spiculated periosteal new bone and extensive soft tissue swelling. The affected rib had a pathological fracture. Cryptococcal osteomyelitis has not been previously reported in horses but should be considered as a differential diagnosis, particularly in endemic regions.     

IMAGING DIAGNOSIS—NUCLEAR SCINTIGRAPHIC,RADIOLOGICAL, AND PATHOLOGIC CHARACTERISTICS OF METASTATIC PILOMATRICOMA IN A DOG

A 6‐year‐old castrated Goldendoodle dog was presented for left‐sided lameness of 3 weeks’ duration. Focal, moderate to marked increased ^99mTc‐methylene diphosphonate (^99mTc‐MDP) uptake was detected in the right caudal lung lobe, caudal angle of the left scapula, and the distal aspect of the left femur with whole body bone phase scintigraphy. Radiographs identified a well‐circumscribed, oval‐shaped soft tissue opaque mass in the right caudal lung lobe; a suspect oval‐shaped osteolytic lesion in the proximal third of the left scapula; and an osteolytic lesion in the distal aspect of the left femur. Metastatic pilomatricoma was confirmed histologically at all three sites.     

Cutaneous metastasis of primary appendicular osteosarcoma in a dog

A 6-year-old, neutered male Rottweiler was presented to the University of Illinois Veterinary Teaching Hospital because of a lytic bone lesion involving the distal portion of the right radius and possible pulmonary metastases on thoracic radiographs. Results of serum biochemical analysis were unremarkable. Aspiration and cytologic examination of the bone lesion indicated likely sarcoma with reactive bone. Cutaneous masses were found on the left thigh, interscapular region, and dorsal lumbar region, 4 weeks after initial presentation. Neoplastic spindle cells were found in aspirates from 2 of the masses. The neoplastic cells stained positive for alkaline phosphatase activity using cytochemistry. Re-evaluation of serum biochemical values at this time revealed a marked increase in alkaline phosphatase activity (413 U/L, reference interval 12-110 U/L) compared with the initial value (26 U/L). Due to progressive disease, the dog was euthanized and a necropsy was performed. Histologic findings included primary osteosarcoma of the distal portion of the right radius, with metastases in the lungs, spleen, left fourth and fifth ribs, soft tissue of the right medial thigh, and T1-T3/interscapular region. Cutaneous metastasis of primary appendicular osteosarcoma has been reported rarely in animals and humans. Increased serum alkaline phosphatase activity may be a potential indicator of poor prognosis for this neoplasm.     

Congenital bilateral aplasia of the metacarpophalangeal joints in a foal

A 2‐day‐old Warmblood filly was presented for examination of an angular limb deformity of the left front limb and an upright conformation of both metacarpophalangeal joints. Radiological examination revealed bilateral absence of the metacarpophalangeal joint space with fusion of the third metacarpal bone and first phalanx (synostosis). No treatment was undertaken. The filly was readmitted to the clinic 10 weeks later for bilateral front limb lameness. On radiological examination, the synostosis of the front metacarpophalangeal joints was still present. Physitis of the distal growth plate of the right third metacarpal bone and proximal growth plate of the right proximal phalanx, and an avulsion fracture of the palmaromedial and proximal aspect of the left middle phalanx, with a cystic like lesion on the medial aspect of distal first phalanx and proximal middle phalanx were diagnosed. Given the poor prognosis, the foal was subjected to euthanasia. Post mortem examination confirmed the absence of the metacarpophalangeal joint space with a trabecular bony union between the third metacarpal bone and the first phalanx. A rudimentary joint capsule was present at the level of the absent joints as well as a small zone of articular cartilage, which invaginated over a short distance into the dorsal trabecular bone on the right front limb. On the medial aspect of the left proximal interphalangeal joint, a focal defect of articular cartilage with exposure of subchondral bone was observed. This is the first case report of a foal born with congenital aplasia of both metacarpophalangeal joints. Congenital malformations should be considered as differential diagnosis in lame foals or foals born with angular or flexural limb deformities.     

Intracranial abscess caused by Rhodococcus equi infection in a foal

CASE DESCRIPTION: A 4-month-old Missouri Fox Trotter colt was examined for a 5-week history of head tilt after treatment for suspected pulmonary Rhodococcus equi infection. CLINICAL FINDINGS: Computed tomography revealed osteolysis of the occipital, temporal, and caudal portion of the parietal bones of the left side of the cranium. A soft tissue mass compressing the occipital region of the cerebral cortex and cerebellum was associated with the osteolytic bone. TREATMENT AND OUTCOME: A rostrotentorial-suboccipital craniectomy approach was performed to remove fragmented occipital bone, debulk the intracranial mass, and obtain tissue samples for histologic examination and bacterial culture. All neurologic deficits improved substantially within 3 days after surgery. Bacterial culture of the resected soft tissue and bone fragments yielded R equi. CLINICAL RELEVANCE: Intracranial surgery in veterinary medicine has been limited to dogs and cats; however, in select cases, extrapolation of surgical techniques used in humans and small animals can assist with intracranial procedures in horses.     

Forelimb amputation for the treatment of distal radius osteosarcoma in an African pygmy hedgehog (Atelerix albiventris)

Neoplasia is a common finding in African pygmy hedgehogs. Both skeletal and extraskeletal osteosarcomas have been previously reported in this species, but the only reported case of appendicular osteosarcoma was diagnosed postmortem. A 3-year-old intact female African pygmy hedgehog presented with a 10-day history of left foreleg swelling and lameness. Radiographs performed by the referring veterinarian confirmed the presence of a lytic lesion affecting the distal radius. A whole-body computed tomography scan was performed and confirmed a marked osteolytic lesion affecting the distal radius, which was consistent with bone neoplasia, however osteomyelitis could not be excluded. There was no evidence of thoracic or abdominal metastasis. Ultrasound-guided fine needle aspiration of the lesion yielded a nondiagnostic sample. The affected forelimb was amputated and along with the axillary lymph node, was submitted for histological analysis which confirmed a well differentiated osteosarcoma within the distal radius. The patient made a full recovery with no complications and remained disease free at the time of writing, 12 months after presentation. Osteosarcoma is rarely diagnosed antemortem in African pygmy hedgehogs. This case describes the management, diagnostic techniques, and successful treatment of an osteosarcoma affecting the distal radius by forelimb amputation.     

Surgical treatment of tarsal sheath effusion associated with an exostosis on the calcaneus of a horse

A 2-year-old Thoroughbred colt was referred for evaluation of effusion within the tarsal sheath and associated lameness of the right hind limb. Conservative treatment consisting of needle aspiration and pressure bandaging had been unsuccessful. Radiography of the right tarsus revealed proliferative periosteal reaction along the distal caudal border of the sustentaculum tali and medial aspect of the calcaneus. The owners elected conservative treatment, using a local injection of corticosteroid and pressure bandaging the tarsus. Five months later, the severity of the effusion and lameness had increased. Radiography revealed increased reactive bone along the sustentaculum tali and mineralization of the plantar tarsal ligament and tarsal sheath. Surgical exploration revealed fibrous adhesions between the medial aspect of the calcaneus and the flexor tendon and associated soft tissue mineralization. The adhesions were broken down and the reactive bone along the calcaneus was removed. The mineralized soft tissue within the tarsal sheath was excised. Five months after surgery, the horse was sound at the trot, with only minimal tarsal sheath effusion. The response to treatment for tarsal sheath effusion and lameness caused by bony changes of the sustentaculum tali is often unsatisfactory. After responding poorly to conservative treatment, the horse in this report had a favorable outcome to the surgical intervention of this condition.     

The bovine digital cushion--a descriptive anatomical study

The properties of the suspensory and supporting structures of the bovine claw are of particular importance in the pathogenesis of claw lesions since both must function optimally to prevent soft tissue compression and trauma. An essential component is the shock-absorbing digital cushion situated under the distal phalanx. The sound claws of 54 slaughtered cows were dissected. The digital cushion consisted of three parallel pads--axial, middle and abaxial--that ran longitudinally from the heel and underneath the distal phalanx with numerous transverse finger-shaped branches that connected the axial and abaxial pads cranial to the flexor process of the distal phalanx. The middle fat pad frequently ended just at the apical end of the flexor process of the distal phalanx, which may result in an inferior cushioning effect under the distal phalanx and increase the likelihood of ulcers. There were differences in the structure of the digital cushion with age and loose connective tissue in heifers' pads was first replaced by fat which, after the third lactation, was gradually supplanted by collagenous connective tissue.     

Distal metacarpal sequestration in a bison.

A 2-year-old 400-kg female American bison was admitted for evaluation and treatment of an open fracture of the right metacarpal bones 3 and 4. Radiography revealed osteolysis of the distal metaphysis and epiphysis, with extensive bony callus formation along the dorsoproximal and proximomedial aspects extending distally to the proximomedial aspect of the proximal phalanx. Evidence of periosteal or bony proliferation at the fracture site or along the distal segment of the third and fourth metacarpal bones was not visible, suggesting that the distal fracture fragment was becoming a sequestrum. Treatment consisted of soft tissue debridement and placement of the limb in a full-limb cast. The cast was changed every 4 weeks until the sequestrum was removed and the bone healed. It is rare for the distal half of a long bone to sequester following fracture. Additionally, it is remarkable that the sequestrum served as a buttress, which prevented collapse of the bone until the sequestrum was replaced by functional bony callus.     

INTRAOSSEOUS EPIDERMOID CYSTS IN THE DISTAL PHALANX OF TWO DOGS

Two dogs were presented with a history of lameness associated with swelling of one of the digits. Radiographs of the affected digits revealed an irregularly mineralized, smoothly marginated proliferative bone lesion in the distal phalanx of one dog and a destructive bony lesion in the distal phalanx of the second dog. The differential diagnosis included nail bed carcinoma, malignant melanoma, osteomyelitis, and subungual keratoacanthoma. Radiographic findings and no response to medical treatment resulted in amputation and submission of the digits for a histopathologic diagnosis. Histologic examination of the distal phalanx of the digits revealed benign epidermoid cysts associated with either bony proliferation or osteolysis. Excision of the lesions was curative. This report presents the clinical, radiographic, and histopathologic findings associated with intraosseous epidermoid cysts in the distal phalanx of two dogs. Veterinary Radiology & Ultrasound, Vol. 33, No. 3, 1992, pp 133–137 .     

Lag screw fixation of an extensor process fracture in a foal with flexural deformity.

A 4-month-old colt with stage I flexural deformity of the distal interphalangeal joint was diagnosed as having a type IV nondisplaced fracture of the extensor process of the 3rd phalanx. An inferior check ligament desmotomy and internal fixation of the fracture were performed. Favorable long-term results for internal fixation of extensor process fractures are presented.     

Severe supracondylar lysis of the third metatarsal bone due to intra‐articular haemorrhage with similarities to human pigmented villonodular synovitis: A differential diagnosis to intra‐articular neoplasia

This report describes a case of severe supracondylar lysis of the third metatarsal bone of a mature Cob gelding. The gelding presented with moderate to severe lameness and soft tissue swelling in the distal metatarsal region. A mass was present plantar to the third metatarsal bone and dorsal to the suspensory ligament branches. The mass was removed surgically, and was found to be a large blood coagulum within an enlargement of the plantar pouch of the metatarsophalangeal joint. The mass was pedunculated and attached to a region of abnormal synovium. This synovium was identified histologically as being an area of villonodular synovitis. The lesion had similarities with human pigmented villonodular synovitis. Removal of the abnormal tissue resulted in resolution of the lameness and of the lysis of the third metatarsal bone. Haemarthrosis should be considered in the list of differential diagnoses for focally mineralised soft tissue masses found within an articulation, and may be associated with pigmented villonodular synovitis.     

A COMPARISON OF RADIOGRAPHY, COMPUTED TOMOGRAPHY, AND MAGNETIC RESONANCE IMAGING FOR THE DIAGNOSIS OF PALMAR PROCESS FRACTURES IN FOALS

The relative sensitivity of radiography, computed tomography, and magnetic resonance imaging for detecting palmar process fractures of the distal phalanx in foals was determined and the imaging findings were compared with histomorphologic evaluations of the palmar processes. Compared to radiography, computed tomography and magnetic resonance imaging did not improve the sensitivity for detection of palmar process fractures. Statistical agreement for palmar process fracture diagnosis was excellent among the three imaging modalities. Histomorphologic evaluations were more sensitive for diagnosis of palmar process fracture than any of the imaging modalities. Three-dimensional image reconstructions and volume measurements of distal phalanges and palmar process fracture fragments from computed tomography studies provided more complete anatomical information than radiography. Magnetic resonance imaging confirmed that the deep digital flexor tendon insertion on the distal phalanx is immediately axial to the site where palmar process fractures occur, and differentiated cartilage, bone, and soft tissue structures of the hoof.     

Multiloculated solitary (unicameral) bone cyst in a young dog

A 20‐month‐old female spayed Staffordshire Terrier (22.3 kg) presented to the Orthopedic Surgery Service at North Carolina State University Veterinary Teaching Hospital for evaluation of a 6‐week history of toe‐touching to nonweight‐bearing lameness in the right hind limb. Radiographs of the right stifle revealed a multiloculated lytic lesion of the distal femur, with a large open lytic zone centrally, numerous osseous septations peripherally, and focal areas of cortical thinning and loss. An aspirate of the right distal femoral lesion yielded mildly cloudy serosanguineous fluid. Cytologic examination of the fluid revealed a pleomorphic population of discrete cells that exhibited marked anisocytosis and anisokaryosis and a variable nuclear‐to‐cytoplasmic (N:C) ratio, which were interpreted as probable neoplastic cells, with few macrophages, and evidence of hemorrhage. Given the clinical signs of pain, lesion size, and concern for malignant neoplasia, amputation of the right hind limb was performed. Histologically, the lesion had undulating walls 1‐3 mm thick with a continuous outer layer of dense fibrous tissue and an inner layer composed of reactive cancellous bone with no cortical compacta remaining. Remnants of thin fibrous or fibro‐osseous septa projected from the bony wall into the cyst lumen. The final histologic diagnosis was a benign multiloculated solitary (unicameral) bone cyst of the distal right femur. Based on the histopathologic findings, it was speculated that the cells identified on cytology were a mixture of developing osteoclasts, osteoblasts, endothelial, and stromal cells. This is the first report describing the cytologic examination of a solitary bone cyst in veterinary medicine.     

Osseous cyst‐like lesions in the feet of lame horses: Diagnosis by standing low‐field magnetic resonance imaging

Osseous cyst‐like lesions (OCLLs) were diagnosed by standing low‐field magnetic resonance (MR) imaging in 9 mature horses (age range 6–17 years). All horses had been subjected to a routine lameness evaluation (including standard foot radiographs) with no diagnosis being reached prior to MR imaging. The duration of lameness ranged from one month to one year. OCLLs were diagnosed in 12 feet. The site of the lesions included the distal phalanx in 11 feet (subchondral bone in 4, insertion of collateral ligaments of the distal interphalangeal joint in 4, insertion of the distal sesamoidean impar ligament in 3) and the subchondral bone of the distal aspect of the middle phalanx in one foot. OCLLs were characterised by discrete spherical or elliptical areas of high or intermediate signal in all MR sequences. In most cases the lesion was surrounded by a rim of bone with abnormally low signal.     

Collateral desmitis of the distal interphalangeal joint in conjunction with concurrent ossification of the cartilages of the foot in nine horses

The purpose of this study was to describe the frequency of occurrence of severe ossification of the collateral cartilages (sidebone) coexistent with collateral desmitis of the distal interphalangeal joint (DIPJ) in lame horses. Sidebone was diagnosed and graded on standard radiographs and soft tissue injuries of the foot were diagnosed using standing low‐field magnetic resonance imaging (MRI). Of 15 horses with forelimb lameness and severe sidebone, 9 had evidence of concurrent collateral desmitis of the DIPJ. All 15 horses had damage to other structures (including the deep digital flexor tendon, distal sesamoidean impar ligament, collateral sesamoidean ligament, navicular bone and distal phalanx) within the affected feet as identified on MRI. The clinical and pathophysiological significance of concurrent collateral desmitis of the DIPJ and sidebone is currently uncertain. However, this study shows that injuries to multiple structures within the foot are common and that collateral desmitis of the distal interphalangeal joint is frequently seen in lame horses in conjunction with severe ossification of the collateral cartilages.     

Midsagittal intraarticular fracture of the third phalanx in a colt

A 6-month-old Quarter Horse colt, with severe left foreleg lameness of 6 weeks' duration, had swelling of the distal interphalangeal joint and a smaller-than-normal left front foot. Radiographs revealed a nondisplaced, midsagittal, intraarticular fracture of P3, which was treated with an eggbar shoe with 2 quarter clips, and stall rest for 10 weeks. The colt was sound after 10 weeks.     

Bone abscess in the mandible of a quarter horse gelding

A 4-year-old Quarter horse gelding presented with a swelling in the soft tissues over the junction of the body and ramus of the left mandible. Radiography showed a well circumscribed lytic area within the mandible surrounded by sclerosis unassociated with any tooth. Aspiration of the lesion yielded pus. The abscess cavity was opened, curetted and lavaged. A Penrose drain was placed in the abscess cavity for 10 days. Bacteriological culture of the exudate and soft tissues from the abscess produced a few colonies of Staphylococcus intermedius. Histopathology showed chronic pyogenic infection. The horse recovered well and was normal 1 year after treatment.