IMAGING DIAGNOSIS: MAGNETIC RESONANCE IMAGING OF A CERVICAL WOODEN FOREIGN BODY IN A DOG

This article describes the discovery of a chronic cervical wooden foreign body ventral to the left transverse processes of the cranial cervical spine using magnetic resonance imaging (MRI) in a dog that presented with chronic neck pain and lameness. The dog did not exhibit dysphagia or chronic draining tracts, the most common signs of the presumed cause, that of a penetrating oropharyngeal foreign body. The foreign body itself was represented on MR images as an oval straight-edged core within an inflammatory tissue reaction. The wood was slightly hyperintense on T2- and isointense on T1-weighted images relative to muscle. Surrounding this was a more conspicuous contrast-enhancing reactive tissue rim that was hyperintense on all pulse sequences. Adjacent musculature also exhibited diffuse edema and contrast enhancement that extended around the left cervical vertebral transverse processes and local intervertebral nerve roots. The foreign body was found to be a wooden stick upon surgical removal. MRI is an excellent method for visualizing the inflammatory tissue reactions associated with soft-tissue foreign bodies because of its contrast resolution and depiction of anatomy in multiple imaging planes.     

Imaging characteristics and treatment of a penetrating brain injury caused by an oropharyngeal foreign body in a dog

A 4‐year‐old Border collie was presented with one episode of collapse, altered mentation, and a suspected pharyngeal stick injury. Magnetic resonance imaging (MRI) and computed tomography showed a linear foreign body penetrating the right oropharynx, through the foramen ovale and the brain parenchyma. The foreign body was surgically removed and medical treatment initiated. Complete resolution of clinical signs was noted at recheck 8 weeks later. Repeat MRI showed chronic secondary changes in the brain parenchyma. To the authors' knowledge, this is the first report of the advanced imaging findings and successful treatment of a penetrating oropharyngeal intracranial foreign body in a dog.     

Chronic bronchocutaneous fistula caused by toothpick foreign body in a Maltese dog

A 7-year-old, 1.76 kg Maltese dog presented with a 4-year history of a chronic pustular lesion and a wet cough. Erosive lesions were seen at the left thoracic wall. Radiology and computed tomography (CT) revealed a bronchocutaneous fistula connecting from the left cranial bronchus to the skin. On definitive surgery, a long wooden toothpick was observed within this tract, and clinical signs resolved after retrieval of the foreign body. Three-dimensional CT was useful to identify the characteristics of the bronchocutaneous fistula. However, the wooden foreign body was not apparent on CT. Here, we report the clinical, clinicopathological and diagnostic imaging findings of a chronic bronchocutaneous fistula caused by a foreign body in a dog.     

Comparison of ultrasound, computed tomography, and magnetic resonance imaging in detection of acute wooden foreign bodies in the canine manus

We evaluated the diagnostic sensitivity of ultrasound, nonenhanced computed tomography (CT) and nonenhanced magnetic resonance (MR) imaging in detecting wooden foreign bodies in the canine manus. Identical wooden splinters were manually inserted into 30 cadaver canine manus, and the limbs were evaluated using ultrasound, CT, and MR imaging by independent observers. All sites were rated as positive or negative for the presence of a foreign body, and observer certainty was scored on a 1-10 scale. Using receiver operating characteristic analysis, CT was the most accurate modality for detection of wooden foreign bodies overall and within each of the three individual regions, followed by ultrasound and MR imaging, respectively. Ultrasound evaluations were most limited in the metacarpal pad, where distal acoustic shadowing from the pad surface hindered evaluation of the tissues in some specimens.     

The use of magnetic resonance imaging in the management of pharyngeal penetration injuries in dogs

Objectives: To investigate the correlation between the magnetic resonance imaging findings and subsequent surgical findings for a series of dogs presenting with suspected pharyngeal stick injuries to the Animal Health Trust, Newmarket, between 1995 and 2004. Methods: Magnetic resonance imaging findings were reviewed for patients undergoing a scan of the pharyngeal or cervical area for suspected foreign bodies during the years 1995 to 2004. Results: Case signalment, history and clinical signs were similar to those reported in previous studies. Magnetic resonance imaging demonstrated foreign material in six of seven cases where this was present. There was good correlation between diagnosis of a foreign body at magnetic resonance imaging and subsequent surgical identification. Clinical Significance: Compared with other imaging modalities, magnetic resonance imaging is very helpful for this type of injury, especially in chronic cases where radiographic evidence of a foreign body is unlikely. It is a valuable aid in the diagnosis of pharyngeal penetration injury and in surgical planning.     

Spinal cord trauma in a cat caused by ingestion of a splinter

A 5-month-old male Abyssinian presented with right hemiplegia. Cervical radiographs, haematology and serum biochemistry were normal. A foreign body was identified on computed tomography (CT) and magnetic resonance imaging (MRI). Removal of the foreign body was carried out via a dorsal approach between the occipital bone and the C1 vertebral body using intra-operative CT. No complications were encountered. Thirty days after surgery, the cat was ambulatory.     

Wooden orbital foreign body in a Weimaraner

A 2-year-old, male Weimaraner presented with acute-onset nonaxial exophthalmos with dorsal deviation of the left globe. Periorbital swelling, pain and a profuse purulent ocular discharge were present on the left side. A draining sinus tract was present in the left ventral conjunctival fornix and another in the left pterygopalatine fossa. The right eye was normal on complete ophthalmic examination. Orbital ultrasonography revealed large, double, linear, parallel echogenic bands with shadowing present in the ventrolateral aspect of the left orbit suggestive of a foreign body. Deformation of the posterior segment was also present. Removal of the orbital foreign body was attempted under ultrasound guidance via the discharging sinuses in the ventral conjunctival fornix and the pterygopalatine fossa. Neither approach was successful; however, a small amount of organic material was retrieved confirming the diagnosis of orbital foreign body. Magnetic resonance imaging (MRI) revealed a linear foreign body of 8 x 1.5 x 0.8 cm extending from the orbit to the level of the oropharynx. A modified lateral orbitotomy with zygomatic arch resection on the left side allowed removal of the wooden foreign body.     

Standing low‐field magnetic resonance imaging of a comminuted central tarsal bone fracture in a horse

This report describes the use of low‐field standing magnetic resonance imaging (MRI) in the diagnosis and clinical decision making process in a 14‐year‐old Dutch Warmblood mare with a comminuted central tarsal bone fracture. Magnetic resonance imaging in the standing horse was preferred over computed tomography examination under general anaesthesia because the animal had sustained the injury during a poor recovery from a previous general anaesthetic episode. Magnetic resonance imaging examination identified a comminuted central tarsal bone fracture with a configuration that was not identifiable with radiography. Due to extensive comminution of this fracture, conservative management was pursued. Standing low‐field MRI examination enabled safe examination of this animal and provided useful diagnostic information whilst facilitating the clinical decision making process.     

Arthroscopic Removal of Metallic Foreign Body from the Talocrural Joint Using a Magnetic Retriever in a Horse

Objective— To report use of a magnetic retriever for arthroscopic removal of a metallic foreign body from the equine talocrural joint.
Study Design— Clinical report.
Animals— A 2-year-old Warmblood stallion.
Methods— A metallic foreign body was removed from a talocrural joint using a 10-mm magnetic retriever under arthroscopic guidance. Preoperative radiographs were used to locate the intra-articular position of the foreign body.
Results— Six months after surgery, the horse was no longer lame.
Conclusions— A magnetic retriever can be used for arthroscopic removal of metallic foreign bodies from the equine talocrural joint.
Clinical Relevance— A magnetic retriever may be useful for arthroscopic retrieval of metallic foreign bodies from synovial cavities in horses, especially when direct observation is impeded by inflamed synovial villi and fibrin.     

Intracranial botryomycosis in a mature horse

This case report describes an unusual diagnosis of central nervous system botryomycosis in a horse. A 16‐year‐old Welsh Section D gelding was evaluated for acute onset of hypermetric ataxia, leaning to the left and head tilt to the right. Based on the neurological signs, a cerebellar lesion with accompanying vestibular disease was suspected and supportive therapy consisting of antimicrobial and glucocorticosteroid drugs and hypertonic saline was instituted. This resulted in marked clinical improvement over a 48 h period. Computed tomography performed in the standing, sedated horse following initial stabilisation identified extensive sclerosis and lysis of the right temporal and occipital bones, consistent with an infectious or neoplastic process. Based on the grave prognosis for survival despite the clinical improvement, euthanasia was undertaken. Post mortem magnetic resonance imaging identified a mass lesion impinging on the right cerebellar hemisphere, sclerosis of the temporal and occipital bones lateral and ventral to the mass, as well as destruction of the temporal bone between the inner ear and the cerebellum. These changes corresponded to the presence of a mass within the right dorsal temporal bone, extending into the right lateral temporal bone. The mass extended to compress and adhere to the right lateral hemisphere of the cerebellum. A histopathological diagnosis of botryomycosis was made, affecting the temporal and occipital bones and compressing the cerebellum.     

Computed tomographic and magnetic resonance imaging of a coup contrecoup traumatic brain injury in a horse

A 3-year-old Thoroughbred mare found recumbent in the field was referred for further assessment with suspicion of a skull fracture. Neurological examination identified compulsive tight circling to the left, and hypermetria in all four limbs. The mare was obtunded, with a mild head tilt to the right, absent menace response of the right eye and decreased facial sensation on the right. Standing computed tomographic examination revealed a subtle depression fracture of the dorsal calvarium and moderate intra-axial midline shift consistent with a traumatic brain injury (TBI). Despite supportive treatment, the mare deteriorated and was subjected to euthanasia. Post-mortem high field magnetic resonance imaging revealed findings consistent with a small cerebral contusion adjacent to the fracture site, and moderate to severe ipsilateral cerebral oedema within the caudal cerebrum and rostral brainstem, consistent with a coup contrecoup TBI. Brainstem lesions indicate a poor prognosis and support the decision for euthanasia. This is the first report of the imaging findings of a coup contrecoup TBI in a horse.     

Diagnosis and treatment of carpometacarpal desmopathy in a horse

A 9‐year‐old Warmblood gelding underwent magnetic resonance (MR) imaging of the carpal and proximal metacarpal regions for evaluation of prolonged right forelimb lameness. Magnetic resonance findings were indicative of desmopathy of the right lateral carpometacarpal ligament and the interosseous ligament between the third and fourth metacarpal bones. Based on the MR findings and lack of response to conservative therapy, surgery using a drilling technique was performed to facilitate fusion of the right carpometacarpal joint. After surgery and a 6‐month rest and rehabilitation programme, the horse returned to soundness. This case report describes a unique combination of lateral carpal/proximal metacarpal soft tissue injuries that resulted in prolonged lameness and were treated with facilitated arthrodesis of the carpometacarpal joint. These soft tissue injuries should be considered as a differential diagnosis in horses with lameness localised to the proximal metacarpal/distal carpal region.     

Surgical removal of an intramedullary chopstick fragment penetrating the spinal cord in a cat

A 3-year-old male domestic shorthair cat presented with sudden ataxia. Neurologic examination showed complete loss of proprioception in the thoracic and pelvic limbs. Computed tomography and magnetic resonance imaging revealed a non-metallic foreign body penetrating the spinal cord. The foreign body was removed by the ventral approach to the atlanto-occipital junction. Mild improvement of proprioception was observed the day after surgery. In a follow-up two months after surgery, the owner reported a complete recovery of the patient, showing a normal gait. To the author’s knowledge, this is the first case report describing successful removal of an intramedullary foreign body penetrating cervical spinal cord by ventral approach in a cat.     

Scleral and suprachoroidal foreign body in a dog--a case report

A 2-year-old male castrated Springer Spaniel with a 3-week history of waxing and waning right sided exophthalmos, periorbital swelling, chemosis, and fundic changes was examined. Ophthalmic examination of the right eye revealed slight chemosis and nictitating membrane protrusion. Indirect ophthalmoscopy showed an approximately 8 mm peripapillary hyporeflective tapetal lesion with subretinal edema consistent with a bulbar/retrobulbar disease process. Inflammatory or neoplastic diseases were the main differential diagnoses. Ancillary diagnostics (ocular ultrasound and computed tomography) showed a focal, poorly defined dense tissue involving the caudomedial aspect of the right globe, adjacent to the optic nerve head without apparent orbital involvement. Considering the duration, location, and severity of the clinical findings, enucleation of the right globe was performed. Histopathology revealed focal thickening of the posterior wall with severe pyogranulomatous inflammation, surrounding a foreign body most consistent with plant material embedded between the sclera and the choroid (suprachoroidal). This report describes a rare case of a scleral/suprachoroidal foreign body (plant material), and outlines the difficulty of establishing an etiological diagnosis using standard ocular imaging.     

Magnetic resonance imaging of a brain abscess in a 10-month-old filly

The purpose of this paper was to correlate the magnetic resonance imaging (MRI) characteristics of a mature brain abscess in a horse with histopathologic alterations of brain tissue. Eight months after the onset of clinical signs, MRI of the brain of a 10-month-old filly was performed. A large space-occupying lesion in the right cerebral hemisphere was identified. This space-occupying lesion was delineated by a thick and well-defined capsule that was isointense to brain parenchyma on the T1-weighted images and with a markedly hypointense on the T2-weighted images. The identification of such a capsule is highly diagnostic of a mature brain abscess. The lesion seen on MR images was confirmed at necropsy where a large abscess of the right hemisphere was observed. Streptococcus zooepidemicus and Pseudomonas aeruginosa were isolated from the abscess. Based on histopathologic examination, the signal characteristics of the capsule on T1-weighted and T2-weighted images were found to be due to the presence of numerous hemosiderin-laden macrophages. These results are in agreement with previous studies on human patients. This report confirms the value of MRI in the diagnosis of equine brain diseases.     

Fibrotic myopathy of the iliopsoas muscle in a dog

Fibrotic myopathy of the iliopsoas muscle developed in a dog, following extensive migration of a grass awn within the muscle and adjacent subcutaneous tissue. The dog was initially presented for evaluation of a fluctuant swelling over the right flank region. The clinical and imaging findings were suggestive of iliopsoas fibrotic myopathy and the diagnosis was confirmed by histopathology. This is the third report of iliopsoas fibrotic myopathy in a dog, the first report to describe the postmortem pathologic changes and the first report of iliopsoas fibrotic myopathy subsequent to foreign body migration.     

Standing low-field magnetic resonance imaging as a diagnostic modality for solar keratoma in a horse

A 22-year-old Friesian gelding was presented with a history of chronic, nonresolving lameness localised to the right front foot. Radiographs showed a smoothly marginated circular lucent area with a rim of increased opacity adjacent to the solar canal of the distal phalanx. The magnetic resonance imaging (MRI) revealed a reversed V-shaped smoothly demarcated space-occupying mass causing invagination of the solar laminae towards the solar canal arch and deformity of the adjacent surface of the distal phalanx. The mass was removed surgically and submitted for histopathology, which revealed a keratoma and periosteal fibrosis. Six weeks post-surgery the horse returned to the previous work level and 8 months follow-up showed no recurrence of keratoma. This report highlights the usefulness of MRI as a diagnostic modality for solar keratoma.     

Removal of a fragmented nasogastric tube from the transverse colon of a horse undergoing exploratory celiotomy for colic

This report describes the clinical course and surgical findings of a 5-year-old Warmblood gelding referred for colic with a previous history of intermittent colic episodes, and gastric ulcers diagnosed by gastroscopy in the preceding months. The horse underwent medical treatment but remained painful and surgery was elected. The horse underwent an exploratory laparotomy during which an impaction was identified in the transverse colon that was associated with an approximately 1 metre segment of nasogastric tube. The foreign body was removed via an enterotomy in the left dorsal colon, and the horse recovered well from surgery. No complications were encountered post-operatively.     

Otopathy secondary to trigeminal schwannoma in a Quarter Horse

Otitis media secondary to trigeminal nerve (CN-V) paralysis is described in dogs and humans but not in horses. An 18-month-old Quarter Horse colt was presented with history of mastication difficulties and a nonhealing corneal ulcer. Clinical findings were consistent with paralysis of the right CN-V. Computed tomography imaging showed otopathy media and a mass at the root of the CN-V. The colt was euthanised due to poor prognosis. Post-mortem magnetic resonance imaging showed enlargement of the right CN-V which was slightly hyperintense on T2W. Histopathology of the mass revealed fusiform tumoural cells, positive on vimentin- and S100 immunohistochemistry, consistent with a schwannoma. Otitis media was presumed secondary to CN-V paralysis and denervation of the right tensor veli palatini muscle involved in opening of the Eustachian tube. This is the first case of trigeminal schwannoma and secondary otopathy media described in a horse, which highlights the importance of imaging in investigating trigeminal nerve paralysis.