Use of computed tomography to evaluate a fracture associated with a subchondral pedal bone cyst in a horse

The radiological examination of bone lesions can be challenging, considering the complex superimposition of the 3D anatomy of a region on to a 2D image. This report describes the findings achievable with different diagnostic imaging modalities (radiography, arthrography, spiral computed tomography) and the correlation with the post mortem and histopathological findings in a horse with a fracture associated with an osseous cyst‐like lesion in the third phalanx. CT was highly superior to radiography to evaluate the spatial configuration and completeness of the fracture, relationship between the fracture and osseous cyst‐like lesion, architecture of the cyst, presence of its communication with the joint and secondary degenerative joint disease. In conclusion, CT represents an asset in these cases for an accurate prognosis and therapy.     

Aortic rupture and aorto‐pulmonary fistulation in the Friesian horse: Characterisation of the clinical and gross post mortem findings in 24 cases

Reasons for performing study: In horses, aortic sinus of Valsalva aneurysms or tears in the aortic root are well‐recognised conditions in breeding stallions, often leading to sudden death. A more uncommon form of aortic rupture, located proximal to the ligamentum arteriosum has been reported in 3 Friesian horses. Objectives: The purpose of this study was to phenotypically characterise aortic rupture and aorto‐pulmonary fistulation in Friesian horses in terms of clinical and post mortem data based on 24 cases. Methods: Friesian horses that were diagnosed with aortic rupture and aorto‐pulmonary fistulation over a period of 13 years (1997–2010) at the Department of Equine Sciences of Utrecht University (n = 15) and Wolvega Equine Hospital (n = 9), were included in this study. Case history, results of clinical examination and gross post mortem findings were screened and analysed. Results: Some cases were found dead without prior symptoms, but in several cases signs such as recurrent colic, peripheral oedema and sustained tachycardia were present for several weeks prior to cardiac failure. Clinical examination during hospitalisation revealed increased rectal temperature, peripheral oedema and increased jugular pulse with a bounding arterial pulse. In the majority of horses an aortic rupture of the aortic arch near the ligamentum arteriosum, concurrent with a circumferential cuff of perivascular haemorrhage and aorto‐pulmonary fistulation, was found at post mortem examination. Conclusions: Aorto‐pulmonary fistulation in conjunction with aortic rupture is more common in Friesians than previously estimated. In some cases findings demonstrate a progressive pathology rather than acute cardiac failure and sudden death. An appropriate approach is necessary during post mortem examination of the heart in order not to overlook the diagnosis. Potential relevance: Equine practitioners should realise that in Friesian horses presented with a history of recurrent false colic, coughing, sustained tachycardia and/or peripheral oedema, aortic rupture and aorto‐pulmonary fistulation should be included in the differential diagnosis.     

Post mortem survey of peripheral dental caries in 510 Swedish horses

Reasons for performing study: Peripheral caries (PC) of equine teeth is a poorly described disorder that can cause serious clinical problems if it progresses. Objectives: To assess the prevalence, sites and severity of PC in a population of Swedish horses. Methods: A post mortem study of 510 equine skulls was performed in 2 Swedish equine abattoirs. Results: PC only affected the cheek teeth (CT) and was present in 6.1% (31/510) of skulls. It affected mainly the peripheral cementum, and 87% of PC in the 29 affected mature horses occurred in the 3 caudal CT (Triadan 09‐11). Concurrent infundibular caries involving most maxillary CT (mean 9.7/skull) was present in 32% of skulls affected with PC. Trotting horses (mean age 8.1 years) believed to be on a high concentrate and silage diet were preferentially affected with PC in this population. Food was usually tightly adherent to the PC lesions and this feature may have promoted the progression of the disease. Significantly increased levels of diastemata were present in PC‐affected horses, and periodontal disease was present in areas adjacent to some PC lesions. Conclusions: PC is a relatively common disorder of horses under certain management conditions that can progress to cause serious dental disorders, especially if concurrent, widespread infundibular caries is present. Potential relevance: Equine clinicians should be aware of this significant dental disorder and research into its aetiopathogenesis, possible prevention and treatment are required.     

Sudden death in racing Thoroughbred horses: an international multicentre study of post mortem findings

Reasons for performing study: To improve the understanding of exercise related sudden death in Thoroughbred racehorses. Objectives: To describe the post mortem findings in cases of sudden death associated with exercise in 268 Thoroughbred racehorses. Methods: Gross and histological post mortem findings of 268 cases of sudden death were collated and reviewed. Cases originated from 6 racing jurisdictions around the world. Sudden death was defined as acute collapse and death in a closely observed and previously apparently healthy Thoroughbred racehorse, during, or within one hour after, exercise. Cause of death as determined by the attending pathologist was categorised as definitive, presumptive or unexplained and compared between the different populations. Cardiopulmonary lesions recorded at post mortem examination were compared between different populations. Results: Pathologists recorded a definitive cause of death in 53% (143/268) of cases. Major definitive causes of sudden death included cardiac failure, apparent pulmonary failure, pulmonary haemorrhage, haemorrhage associated with pelvic fractures or with idiopathic blood vessel rupture, and spinal cord injury. A presumptive cause of death was made in 25% (67/268) of cases and death remained unexplained in 22% (58/268) of cases. There were several statistically significant inter‐population differences in the cause of death and in reporting of cardiopulmonary lesions. Conclusions: Sudden death can be attributed to a variety of causes. Causes of sudden death and the lesions found in cases of exercise‐related sudden death are similar in different racing jurisdictions. However, the lesions are often not specific for the cause of death and determination of the cause of death is therefore affected by interpretation by the individual pathologist.     

Disseminated alimentary mycobacteriosis in the horse: a retrospective study of nine cases

This paper summarises the clinical findings of 9 cases of disseminated alimentary mycobacteriosis in horses presented at a Finnish referral equine hospital 2009–2014. Four of 9 horses were Standardbreds and 8/9 horses were male. The median age was 2 years, ranging from 6 months to 15 years. The duration of clinical signs before admission ranged from 2 weeks to 6 months. All horses demonstrated deterioration of the clinical signs after a protracted period of the disease and were finally subjected to euthanasia after poor response to multiple medical therapies. The most common complaints on admission were weight loss and diarrhoea (9/9), pyrexia (7/9), ventral oedema (7/9), lethargy (7/9) and inappetance (6/9). The most common clinicopathological abnormalities were hypoalbuminaemia and hyperfibrinogenaemia, which were present in all horses. Rectal biopsy specimens were examined from 5/9 horses and specimens were stained with Ziehl‐Nielsen (ZN). At rectal biopsy, mild multifocal neutrophilic or mild granulomatous proctitis was recognised in all 5 horses, but the ZN stain for mycobacteria was positive in only one biopsy. A liver biopsy was taken from one horse in which hepatomegaly was observed clinically and revealed marked granulomatous hepatitis with the presence of mycobacteria. The rectal biopsy from this horse was ZN negative. At post mortem examination, chronic, multifocal to coalescing granulomatous typhlocolitis and lymphadenitis were found in all horses with the small intestine less frequently involved. At histopathological examination of post mortem samples, a ZN stain was performed and intracellular acid‐fast bacilli were identified in macrophages and multinucleated giant cells in the large intestine, liver and lymph nodes in 9/9 horses and in the small intestine in 5/9 horses. Mycobacterium avium ssp. hominissuis was isolated in 5/9 horses from post mortem samples.     

Imaging diagnosis and clinical presentation of a Chiari malformation in a Thoroughbred foal

A newborn Thoroughbred foal was presented to the clinic with ambiguous neurological deficits, spinal anomalies and a soft tissue swelling dorsal to the lumbar vertebral column. The foal was alert but unable to rise and stand. With radiography, ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) a lumbar dysraphic anomaly, cerebellar herniation and coincidental skeletal abnormalities were documented. Finally, a meningomyelocele was defined and, in context with the cerebellar herniation through the foramen magnum, the foal was diagnosed to have a Chiari malformation. The MRI examination corresponded best with the post mortem findings. Although 3‐dimensional imaging methods have been considered superior regarding full and detailed assessment of the congenital malformation, radiography and ultrasonography also provide essential information to diagnose dysraphic lesions at reduced costs and efforts. A Chiari malformation should be considered as a differential diagnosis in foals with neurological deficits.     

Can distal border fragments of the navicular bone be a primary cause of lameness?

A horse with unilateral forelimb lameness and pain localised to the palmar aspect of the foot was evaluated using radiography and low field magnetic resonance (MR) imaging. A distal border fragment of the navicular bone, an osseous cyst‐like lesion (OCLL) in the distal third of the navicular bone and focal distal sesamoidean impar desmitis were identified as the most likely causes of pain and lameness. No other lesions likely to contribute to pain and lameness were identified on MR images or gross post mortem examination. The OCLL was characterised histologically by enlarged bone lacunae containing proliferative fibrovascular tissue. Focal lesions of the distal aspect of the navicular bone are rarely found in isolation but can be causes of pain and lameness in horses.     

Pathology of gastritis and gastric ulceration in the horse. Part 1: Range of lesions present in 21 mature individuals

Reasons for performing study: Gastric ulceration is now widely recognised as an important disease in high performance horses. Little is known about gastric histopathology in healthy or diseased animals; a comprehensive assessment would enhance interpretation of gross findings through assessment of their accuracy and allow for identification of lesion variety and pathogenesis in different anatomical regions of the stomach. Objectives: To investigate the true extent and variety of gastric lesions in a mixed population of mature horses at post mortem. Methods: Stomachs were removed from a mixed population of 21 horses at post mortem. Mucosal abnormalities were recorded in photographic and written form. Representative samples from all gross lesions were taken for histopathology and processed routinely. Special stains including Gram, PAS and Warthin Starry, were used when appropriate. Pathological classification of lesion type using both gross and histological appearances was performed. Results: Classification of lesions within the squamous region included hyperkeratosis, punctate scars, diffuse erosions/ulcerations and margo injuria; and within the glandular region, hyperaemia, focal erosions and ulcerations. Glandular metaplasia was recognised for the first time in the equine stomach. No Helicobacter‐like organisms were detected in association with lesion development. Conclusions and potential relevance: This study used gross and histological examination to highlight the large variety of naturally occurring gastric lesions in a mixed population of horses. Analysis of the pathogenesis of lesion development is now possible. Further research regarding the range of pathology in larger, more diverse groups of horses is required.     

Diagnosis of severe traumatic brain injury using multimodal imaging in a donkey

A 6‐month‐old donkey presented with recumbency after rearing and falling over. A presumptive diagnosis of traumatic brain injury secondary to a skull fracture was made following the clinical examination, although a fracture could not be identified on radiography. To provide a definitive diagnosis, for planning any surgical intervention and to obtain prognostic information, computed tomography and magnetic resonance imaging were performed. An occipital depression skull fracture with secondary haemorrhage and oedema of the cerebellum and brainstem were identified. The imaging findings were confirmed at pathological examination. This report describes the imaging features of a traumatic brain injury in a donkey.     

Computertomographic characteristics of primary brain tumors in dogs and cats

Since computed tomography (CT) was introduced to veterinary medicine in the beginnings of the 80s, the CT of the skull has mainly been used for the diagnosis of brain tumors. The present study includes 18 dogs and five cats, all patients of the Clinic of Small Animals of the School of Veterinary Medicine Hannover. After a CT of their skull was made, a primary intracranial neoplasm was confirmed by a pathomorphological and -histogical examination post mortem. Four of the five cats had a meningioma, one cat an astrocytoma. With five cases the meningioma also predominated in the dogs, followed by primary lymphoma with four cases. An astrocytoma, an oligodendroglioma and a choroid plexus papilloma were diagnosed respectively in two dogs. A pituitary gland tumor, a germ cell tumor and a medulloblastoma represented individual cases. Based on the pathomorphologically and -histologically confirmed diagnosis, characteristics of these primary brain neoplasms can be found in their CT image. However, changes are not pathognomonic for a certain type of tumor; a definitive diagnosis cannot be made from the CT image.     

Carcinoma of an accessory genital gland in a 23‐year‐old Camargue gelding

This report describes the case management, histopathological and post mortem findings in a 23‐year‐old gelding with a peri‐rectal mass. The mass was debulked surgically and submitted samples revealed it to be a poorly differentiated carcinoma. In the post operative period the horse developed signs of abdominal pain and dysuria and was subjected to euthanasia. Post mortem examination revealed a large infiltrative mass located between the rectum and urethra, consistent with a carcinoma of an accessory genital gland, most likely the seminal vesicle.     

Idiopathic hopping‐like forelimb lameness syndrome in ridden horses: 46 horses (2002–2014)

There has been no analysis of a hopping‐type forelimb lameness syndrome seen in ridden horses. The objectives of this retrospective study were to describe the clinical features of this syndrome, response to diagnostic analgesia and imaging findings and to document post mortem findings. Clinical records from 2002 to 2014 were reviewed and data concerning signalment, history, lame limb(s), lameness characteristics, response to diagnostic analgesia and diagnostic imaging were recorded. There were 46 horses from 4 to 13 years of age, 6 of which had a history of known or suspected trauma immediately before the onset of reduced performance or lameness. Lameness seen when ridden was characterised by an intermittent shortened cranial phase of the step of the lame forelimb at the trot and marked elevation of the head as the affected limb was protracted, with the horse appearing to ‘hop’ (on the contralateral limb) as if trying to break to canter. When lameness was at its worst horses were unwilling to trot. Three horses showed sporadic severe stumbling. Local analgesia of the affected limb did not improve the lameness and in 16 horses lameness deteriorated. Three of 5 horses showed some improvement (≥2/8 grades) in the hopping‐type lameness after intra‐articular analgesia of the articular process joints of the sixth and seventh cervical vertebrae, ipsilateral to the lame forelimb. Radiographic, ultrasonographic and nuclear scintigraphic examinations were inconclusive. Two of 4 horses responded to treatment with gabapentin. In 3 horses post mortem examination revealed mild lymphocytic inflammation within or around the dorsal root ganglia of the fifth and sixth cervical nerve roots, sixth cervical nerve root or second thoracic nerve root ipsilateral to the lame limb. Idiopathic hopping‐type lameness syndrome in ridden horses may be a pain‐related condition ± a neurological component and currently has a guarded prognosis.     

Haemangiosarcoma in the horse

Neoplasms arising from vascular endothelial cells include benign haemangioma and malignant haemangiosarcoma, both of which are rare in the horse. Haemangiosarcoma can arise as a solitary mass, typically involving the eye or skin, or as disseminated tumours throughout multiple organs. There is no sex, breed or age predilection but most cases are found in middle aged horses. Clinical presentations of haemangiosarcoma in the horse include the presence of a visible mass or reflect dysfunction of the organ involved, thus making it difficult to differentiate from other neoplasms. Ante mortem diagnosis through clinicopathological findings, cytological findings of body cavity effusions or fine needle aspirates are often unrewarding. Biopsy or mass submission for histopathological examination may aid in diagnosis of haemangiosarcoma. A majority of cases are diagnosed post mortem; however, if the mass is poorly differentiated additional diagnostics such as immunohistochemical staining may be needed. Unfortunately, treatment of haemangiosarcoma is often unrewarding and limited based on the location of the mass and the aggressive nature of this neoplasm.     

Pseudo‐polydactyly in a horse

A 14‐month‐old half‐breed horse showed a severe lameness due to a lesion of the right forefoot which appeared completely and asymmetrically cleaved, from the solar margin to the coronary band. The horse was presented to an abattoir for slaughter and both forelimbs were collected for diagnostic investigations. The hoof lesion described herein does not fulfil the diagnostic criteria of equine polydactyly since post mortem imaging and pathological investigations ruled out the presence of supernumerary digits. Based on the clinical signs, diagnostic imaging (computed tomography) and gross examination, a diagnosis of pseudo‐polydactyly was proposed. To the best of our knowledge, the features of the present case report are unique, thus widening the range of lesions observed at the level of the hoof, which is crucial for horse health and activity.     

Gastric impaction associated with displacement and volvulus of the large colon in seven mature horses

Gastric impaction associated with large colon volvulus (LCV) was identified in seven horses. Right dorsal displacement of the large colon and suspected nephrosplenic entrapment was identified in 2 of the 7 horses as well as LCV with concurrent gastric impaction. All horses underwent surgery for LCV and none survived. Five horses died or were subjected to euthanasia intraoperatively or in recovery. One horse was subjected to euthanasia post operatively due to persistent gastric reflux, following resolution of the gastric impaction. One horse was subjected to euthanasia post operatively due to a suspected gastric rupture, which was confirmed on post mortem examination. It is hypothesised that a large mass in the cranial abdomen, such as a gastric impaction may disrupt the normal anatomical large colon alignment or may cause colonic motility or microbiota alterations, and thus increase the risk of large colon displacement and volvulus.     

Concurrent or sequential development of medial meniscal and subchondral cystic lesions within the medial femorotibial joint in horses (1996–2006)

Reasons for performing study: Medial meniscal injuries and subchondral cystic lesions (SCL) are known to occur independently within the medial femorotibial (MFT) joint in horses. However, there are no reports of a potential clinical relationship between these 2 types of lesions. Objectives: To: 1) document the concurrent presence or sequential development of medial meniscal and SCL of the medial femoral condyle within the MFT joint; and 2) determine the prognosis with both types of lesions. Methods: Retrospective case series of horses with both a medial meniscal and SCL of the medial femoral condyle identified concurrently or sequentially by radiography, arthroscopy or post mortem examination. Case records and radiographs were reviewed, and a telephone survey of referring veterinarians, owners and trainers was conducted. Results: Twenty‐one horses (9.1% of all horses undergoing MFT joint arthroscopy) were identified to have both a medial meniscal injury and SCL of the medial femoral condyle. Thirteen horses had both abnormalities identified concurrently, 6 developed a meniscal lesion subsequent to SCL debridement, and 2 developed a SCL subsequent to a medial meniscal injury. Only 4/19 horses were classified as successful and returned to their intended use. The severity of the meniscal injury was significantly associated with the severity of lameness but not with outcome. Conclusions: A low percentage of horses may develop both a meniscal injury and SCL of the medial femoral condyle within the MFT joint and have a poor prognosis. Potential relevance: Trauma to the MFT joint may lead to both meniscal and subchondral bone damage of the medial femoral condyle that may be recognised concurrently or sequentially.     

Deep erosions of the palmar aspect of the navicular bone diagnosed by standing magnetic resonance imaging

Reasons for performing study: Erosion of the palmar (flexor) aspect of the navicular bone is difficult to diagnose with conventional imaging techniques. Objectives: To review the clinical, magnetic resonance (MR) and pathological features of deep erosions of the palmar aspect of the navicular bone. Methods: Cases of deep erosions of the palmar aspect of the navicular bone, diagnosed by standing low field MR imaging, were selected. Clinical details, results of diagnostic procedures, MR features and pathological findings were reviewed. Results: Deep erosions of the palmar aspect of the navicular bone were diagnosed in 16 mature horses, 6 of which were bilaterally lame. Sudden onset of lameness was recorded in 63%. Radiography prior to MR imaging showed equivocal changes in 7 horses. The MR features consisted of focal areas of intermediate or high signal intensity on T1‐, T2*‐ and T2‐weighted images and STIR images affecting the dorsal aspect of the deep digital flexor tendon, the fibrocartilage of the palmar aspect, subchondral compact bone and medulla of the navicular bone. On follow‐up, 7/16 horses (44%) had been subjected to euthanasia and only one was being worked at its previous level. Erosions of the palmar aspect of the navicular bone were confirmed post mortem in 2 horses. Histologically, the lesions were characterised by localised degeneration of fibrocartilage with underlying focal osteonecrosis and fibroplasia. The adjacent deep digital flexor tendon showed fibril formation and fibrocartilaginous metaplasia. Conclusions: Deep erosions of the palmar aspect of the navicular bone are more easily diagnosed by standing low field MR imaging than by conventional radiography. The lesions involve degeneration of the palmar fibrocartilage with underlying osteonecrosis and fibroplasia affecting the subchondral compact bone and medulla, and carry a poor prognosis for return to performance. Potential relevance: Diagnosis of shallow erosive lesions of the palmar fibrocartilage may allow therapeutic intervention earlier in the disease process, thereby preventing progression to deep erosive lesions.     

Study of laryngopharyngeal pathology in Thoroughbred horses in southern California

Reasons for performing study: There is increasing anecdotal evidence among horse owners, trainers and equine clinicians of a high prevalence of subepiglottic ulcers, suggested to have a negative effect on racing performance. Objectives: To provide a prevalence study and pathological characterisation of laryngopharyngeal lesions with emphasis in the subepiglottic area and, in particular, subepiglottic ulcers. Methods: The study was carried out on 91 Thoroughbred racehorses received for post mortem examination from 4 major Southern California racetracks. The most common reason for submission was catastrophic musculoskeletal injury, but others include sudden death, laminitis, colic, colitis, neurological disorders, pleuropneumonia and arytenoid chondropathy. Laryngopharyngeal specimens were collected and examined grossly; selected cases were also examined histopathologically. Results: Thirteen horses (14.3%) had at least one type of laryngopharyngeal abnormality, 7 horses (7.7%) had lesions in the subepiglottic soft tissues, including 4 subepiglottic ulcers, 2 soft palate ‘kissing lesions' and one 'subepiglottic scar’. Eight horses (8.8%) had lesions elsewhere in the laryngopharynx, including mucosal ulcerations, arytenoid chondropathy, epiglottic entrapment and partial absence of arytenoid cartilage. Conclusions and potential relevance: Lesions in the subepiglottic area were among the most prevalent in this study, suggesting that an important percentage of laryngopharyngeal abnormalities may be missed during routine endoscopy of the standing horse, which often does not include the examination of subepiglottic tissues. Pathologically, subepiglottic ulcers were chronic‐active with viable hyperplastic epithelial margins, suggesting that proper healing and re‐epithelialisation should occur with appropriate treatment. In most cases, the lesions observed do not necessarily indicate a clinical problem and more extensive prevalence studies and correlation between abnormalities found and performance are needed to assess the clinical relevance of subepiglottic soft tissue lesions accurately.