Use of magnetic resonance imaging to diagnose distal sesamoid bone injury in a horse

CASE DESCRIPTION: A 5-year-old Appaloosa mare was examined for severe left forelimb lameness of 4 months' duration. CLINICAL FINDINGS: Lameness was evident at the walk and trot and was exacerbated when the horse circled to the left. Signs of pain were elicited in response to hoof testers placed over the frog of the left front hoof, and a palmar digital nerve block eliminated the lameness. Radiographs revealed no abnormalities, but magnetic resonance imaging (MRI) revealed increased bone density in the medullary cavity of the distal sesamoid (navicular) bone in the proton density and T2-weighted images and a defect in the fibrocartilage and subchondral bone of the flexor cortex. TREATMENT AND OUTCOME: Because of the absence of improvement after 4 months and the poor prognosis for return to soundness, the mare was euthanatized. An adhesion between the deep digital flexor tendon and the flexor cortex defect on the navicular bone was grossly evident, and histologic evaluation revealed diffuse replacement of marrow trabecular bone with compact lamellar bone. Changes were consistent with blunt traumatic injury to the navicular bone that resulted in bone proliferation in the medullary cavity. CLINICAL RELEVANCE: Use of MRI enabled detection of changes that were not radiographically evident and enabled accurate diagnosis of the cause of lameness. Navicular bone injury may occur without fracture and should be considered as a differential diagnosis in horses with an acute onset of severe unilateral forelimb lameness originating from the heel portion of the foot.     

IMAGING DIAGNOSIS—MEDULLARY TIBIAL INFARCTION IN A HORSE

An Andalusian Stallion with left hind limb lameness had a radiolucent lesion in the medullary cavity of distal tibial metaphysis. After euthanasia for other disease, the tibia was examined with magnetic resonance (MR). The MR imaging sequences were characterized by a double line sign, although showing quite different lesion area intensities. Histologically, the lesion was compatible with medullary infarction being characterized by normal spongy bone, areas of abundant fibrous tissue and numerous necrotic adipocytes in various stages of destruction.     

Scapular Sequestrum in a Horse A Case Report

A 15-year-old Morgan mare presented with a draining tract associated with osteomyelitis and sequestration of the medullary cancellous bone of the right scapula. Moderate lameness and muscle atrophy were present. Partial resection of the lateral cortex allowed exploration and debridement of the medullary cavity of the scapula. The mare returned to soundness, the muscle mass returned, but a small discharging sinus persisted.     

Suspected panosteitis in a camel

CASE DESCRIPTION: A 6-month-old male Bactrian camel was examined because of a 3-week history of lameness of the left hind limb. CLINICAL FINDINGS: Lameness was initially detected in the left hind limb but resolved and was detected in the right hind limb during treatment. Lameness increased during periods of rapid growth. Radiography revealed multiple small opacities of the medullary cavity of several long bones throughout treatment. Core bone biopsies of lesions in the tibiae revealed lamellar bone with areas of loose connective tissue, osteoblasts in the medullary cavity, and periosteal new bone formation, all which were consistent with panosteitis. TREATMENT AND OUTCOME: Palliative treatment was attempted with epidural and transdermal administration of analgesics. Flunixin meglumine was administered PO, which coincided with an abrupt increase in serum creatinine concentration. Performance of multiple diagnostic bone biopsies led to remission of clinical signs of pain. CLINICAL RELEVANCE: Panosteitis should be a differential diagnosis for shifting limb lameness in young camels. Bone biopsies can be useful for diagnosis of panosteitis and possible relief of pain associated with the disease. Bactrian camels may be susceptible to the renal toxicity of flunixin meglumine, especially when dehydrated.     

High intraosseous pressure as a cause of lameness in a horse with a degloving injury of the metatarsus

A 6-year-old Paint mare undergoing treatment for a degloving injury of the right metatarsus developed a non-weight-bearing lameness 19 days after admission. Diagnostic nerve blocks localized the source of pain to the area between the tarsus and the metatarsophalangeal joint. Radiography of the metatarsus and metatarsophalangeal joint, arthrocentesis of the metatarsophalangeal joint, and ultrasonography of the flexor tendons, flexor tendon sheath, and suspensory ligament failed to identify the cause of the lameness. The horse was anesthetized and intraosseous pressure was measured in the left and right third metatarsal bones, using a self-tapping cannulated screw attached to a pressure transducer. Pressure in the affected limb (46 mm Hg) was 3.5 times as high as pressure in the unaffected limb (13 mm Hg). The day after pressures were measured and fenestration was performed, signs of lameness were substantially improved. High intraosseous pressure in the affected limb was most likely secondary to edema, inflammation, and partial venous thrombosis, in combination with bone neovascularization, that impaired intraosseous venous drainage from the medullary cavity. Fenestration of the affected bone relieved the excessive pressure and allowed for resolution of pain.     

ENCHONDROMATOSIS IN AN ADULT DOG

A 7‐year‐old crossbreed dog presented for lameness with diffuse soft tissue swelling in the right fore limb. Radiographs identified increased opacity of medullary cavity involving the radius and ulna. Whole‐body computed tomography (CT) revealed mineral attenuation in the medullary cavity of multiple bones. Histopathology of the right distal tibia showed a fibrocartilaginous matrix occupying intertrabecular spaces. The final diagnosis was enchondromatosis. Long‐term favorable progression of the dog's clinical condition further supported the benign histopathologic classification. This is the fifth case of canine enchondromatosis reported so far and the first documentation of further characterization with CT.     

Primary ossifying fibroma of the proximal phalanx in a horse

A primary ossifying fibroma was found at necropsy in a 5-year-old Welsh pony cross mare that was humanely subjected to euthanasia for an intractable severe left hindlimb lameness. Antemortem radiographs of the left hind pastern were characterised by articular, subchondral and cortical areas of lysis. Primary ossifying fibroma is a rare lesion of the distal limb but should be considered when there is extensive lysis extending into the medulla and proximal cortical bone.     

IMAGING DIAGNOSIS—ENOSTOSIS-LIKE LESION IN THE FEMUR OF A HORSE

An enostosis-like lesion was diagnosed in the left femur of a Swedish Warmblood horse that had a left hindlimb lameness of 3 weeks duration. With scintigraphy using technetium 99m-hydroxymethylene diphosphonate (^99m Tc-HDP) a marked regional focal increase in radioactivity was identified in the medullary cavity of the left femur. Radiographically there was a corresponding focal increase in bone opacity in the middiaphysis of the left femur. Histopathologically, a 5 cm area of bone matrix was present in the diaphysis of the left femur and confirmed as an enostosis-like lesion. Enostosis-like lesions should be considered as a source of pain in horses with difficult to localize, moderate to severe chronic lameness.     

Computed Tomography and Magnetic Resonance Imaging of an Epidermoid Cyst in a Foot of a Horse

An 18-year-old Quarter Horse mare was evaluated because of moderate left forelimb lameness of 4 weeks’ duration. The clinical evaluation and diagnostic perineural analgesia localized the lameness to the distal portion of the left forelimb. There was swelling on the dorsal and lateral aspect of the coronary band. Radiography, ultrasound, magnetic resonance imaging, and computed tomography of the foot revealed circumscribed well-capsulated soft tissue mass causing a focal deformation of the dorsolateral border of the middle phalanx. The treatment aimed to remove the mass surgically and stabilized the interphalangeal joint, but the owner elected human euthanasia before treatment attempt. Histopathology diagnosis was an epidermoid cyst, which was characterized by multilayers of keratin surrounded by stratified squamous epithelium. Although rare, an epidermoid cyst should be considered as a differential diagnosis for space-occupying mass in horses’ foot that develops chronic lameness after trauma. This report describes the multimodality appearance of the epidermoid cyst.     

Osteosarcoma in the proximal humerus of a mare

A 15‐year‐old Quarter Horse mare was examined for significant and progressive lameness in the right front limb. On physical examination, muscle atrophy over the scapular and pectoral regions were noted. A pain response was elicited on palpation of the scapulohumeral joint. No other abnormalities were noted on examination of the limb. Diagnostic nerve blocks ruled out a source of lameness in the distal limb. Arthrocentesis of the scapulohumeral joint was performed and results were within normal limits. Radiographs of the right scapulohumeral joint revealed an extensive, aggressive bone lesion in the proximal humerus, suspected to be an osteosarcoma. After a course of nonsteroidal anti‐inflammatory therapy, minimal improvement to the lameness was noted. The owner elected to subject the horse to euthanasia due to the lack of significant response to treatment. Post mortem radiographic and histological examinations determined a definitive diagnosis of an osteosarcoma in the proximal humerus.     

Metastatic granulosa cell tumor in a mare.

A 5-year-old Quarter Horse mare was referred for evaluation of an acute non-weightbearing lameness of the left hind limb in which musculoskeletal abnormalities had not been detected. After admission, the mare had signs of colic. Exploratory laparotomy revealed the left ovary to be large, masses in the left sublumbar space, and diffuse infiltration of the mesentery, omentum, liver, and spleen with variably-sized masses. The mare was euthanatized, and granulosa cell tumor was identified on histologic examination of the left ovary, left sublumbar and cranial thoracic lymph nodes, omentum, mesentery, liver, spleen, and lung.     

An unusual cyst‐like lesion in the metaphysis of the tibia in a horse

A 6‐year‐old Haflinger gelding was presented with a chronic right hindlimb lameness. Scintigraphy, radiography and computed tomography confirmed an active large cyst‐like lesion in the distal metaphysis of the right tibia. A transcortical surgical approach was used to curette the lesion and fill it with an autologous bone graft and a calcium phosphate bone substitute material. Histopathology revealed mild histiocytic inflammatory changes, mild fibrosis and bone necrosis. This case report describes an unusual cyst‐like lesion in the tibial metaphysis of a horse.     

HEMANGIOMA OF THE DISTAL PHALANX IN A COLT

A yearling Thoroughbred colt was admitted to the University of Florida College of Veterinary Medicine with severe, progressive lameness of the left forelimb. A centrally located expansile lytic lesion involving approximately 40% of the distal phalanx with a large associated vascular channel was identified by radiography. Increased vascular phase pooling, increased soft tissue phase uptake, and a photopenic area on bone phase images corresponding to the lytic lesion within the left distal phalanx were identified by vascular, soft tissue, and bone phases of a three phase bone scan, respectively. Contrast medium accumulation and disappearance in dilated vessels within the lesion was apparent angiographically. The colt was euthanized and the histologic diagnosis was hemangioma of the distal phalanx with a pathologic fracture.     

MRI and CT diagnosis of acute desmopathy of the lateral collateral sesmoidean (navicular) ligament and long-term outcome in a horse

Clinical, magnetic resonance imaging (MRI) and computed tomography (CT) findings of acute desmopathy of the lateral collateral sesmoidean (navicular) ligament (CSL) in a 13-year-old Hanoverian mare are presented. On admission to the clinic the horse showed a grade 5/6 left front-limb lameness at the walk, pain on coffin joint manipulation, and coffin joint effusion. Despite a positive palmar digital nerve block, radiographs and ultrasonography did not indicate reasons for the severe clinical signs. However, MRI revealed damage to the CSL and bone marrow oedema of the navicular bone (NB), whereas a focal bone defect of the NB at the CSL insertion zone was demonstrated best by CT. The horse was managed with complete box rest and a fibreglass cast for four weeks followed by a controlled exercise program. Follow-up examination revealed no lameness at the trot three months later and the patient had fully recovered within six months.     

Polyostotic cystic bone lesions in a dog

The clinical, radiological, and pathological features of a polyostotic cystic bone lesion in a 9-month-old Doberman Pinscher are described. The patient was diagnosed as having nutritional secondary hyperparathyroidism at 6 weeks of age and after dietary correction it remained clinically normal until 9 months when there was sudden left hind-limb lameness due to a pathological fracture through a cystic lesion in the distal femur. Radiography revealed additional cystic structures in the metaphyses of the left radius, and left and right tibia. Pseudofractures were associated with two of the cystic lesions.
In some areas the cysts were crossed by trabeculae and in others there were bony ridges on the inner cystic wall. The cavities were lined with flesh-coloured fibrillar material which formed a lacy network extending into cavities. Histologically, multiple small cysts were present adjacent to the larger cavities noted radiographically. The secondary spongiosa and the metaphyseal periosteum were the major abnormal tissue sites. The small cysts appeared to arise in an oedematous and congested metaphyseal spongiosa. The cysts were accompanied by small foci of intense osteoclasis but unattended by compensatory bone production, and the consequent possibility of pseudofractures is an important clinical consideration. Earlier reports demonstrated that resolution of the lesions will follow surgical drainage and curettage of the cystic cavity. Of six cases of polyostotic cystic bone lesions observed in the dog, five were in the Doberman Pinscher breed.     

Standing repair of a proximal,incomplete, articular fracture of the third metatarsal bone

A 5-year-old National Hunt Thoroughbred mare presented with sudden onset left hindlimb lameness after race training on the gallops. Clinical examination revealed a marked painful reaction over the proximal metatarsal region but no other obvious abnormalities were detected. Survey radiographs at the yard did not reveal any abnormalities. Nuclear scintigraphic examination 3 days after injury revealed focal marked increased radiopharmaceutical uptake in the proximal metatarsal region. Subsequent radiography revealed an incomplete, articular fracture of the proximal left third metatarsal bone. Repair of the fracture using 3 × 4.5 mm cortical screws placed in lag fashion was performed under standing sedation following perineural analgesia. Follow-up radiographs demonstrated progressive healing of the fracture. The mare returned to race training 8 months after the fracture was repaired and raced successfully 12 months post injury.     

Delayed diagnosis of fungal osteomyelitis with early scintigraphic lesions in a dog

A 4-year-old neutered male golden retriever was diagnosed with osseous blastomycosis of the distal left forelimb by means of radiographs and histopathology. Presumptive bacterial pneumonia and left forelimb lameness had been diagnosed 2 y previously, at which time bone scintigraphy revealed increased uptake in the distal left forelimb, but radiographs showed no detectable lesion. Though not specific, bone scintigraphy appears more sensitive than radiography in identifying early lesions of fungal osteomyelitis in dogs.     

Diagnosis and treatment of biaxial keratomas in the left fore foot of a 15‐year‐old Clydesdale mare

A 15‐year‐old Clydesdale mare presented for further diagnostics and treatment of waxing and waning lameness and recurrent subsolar abscesses. Radiographs and computed tomography revealed biaxial masses extending from the hoof capsule, causing bone resorption of the distal phalanx. Surgery was performed to remove the masses and post operative care included regional limb perfusions, systemic antibiotics and therapeutic shoeing. Histopathology was consistent with the diagnosis of keratoma for each of the masses; this is the first case of confirmed biaxial keratomas. Two months after surgery the horse is sound at the walk and is expected to return to full function within the next year.     

Cutaneous mucormycosis caused by Absidia corymbifera in a horse

A 5-year-old pregnant Spanish thoroughbred mare was presented with an extensive granulomatous lesion, of four months duration, on the left medial foreleg. On examination, the wound was covered by a large mass of ulcerated granulation tissue exuding thick serosanguinous fluid. The mare had not responded to previous treatment. Physical examination revealed no fever, no lameness and the presence of intense pruritus. A surgical resection was carried out to take samples for histopathology. On histopathologic examination the dermis and subcutaneous tissue showed large multifocal necrotic eosinophilic areas and inside these areas, irregularly ramified fungal hyphae. Microbiological examination showed abundant fungal growth and the strain corresponded to Absidia corymbifera . Treatment with amphotericin B was started but there was no improvement in the lesion. The mare aborted, became anorexic, had febrile episodes, had very poor body condition and was euthanized.     

Medial collateral ligament desmitis of the distal interphalangeal joint in the hindlimb of a horse: treatment with cast immobilisation

A 12‐year‐old show‐jumping mare was presented for investigation of a chronic hindlimb lameness of 16 weeks duration. Perineural anaesthesia and ultrasonography localised the lesion to the medial collateral ligament of the distal interphalangeal joint of the left hindlimb. Treatment consisted of a heavily padded distal limb cast for 6 weeks, strict box rest and a strictly regulated hand walking program. Serial ultrasonographic examinations were performed throughout the rehabilitation period. Collateral ligament desmitis of the distal interphalangeal joint is a commonly diagnosed condition of the forelimb; however, hindlimb collateral ligament desmitis has been rarely reported. Ultrasonographic examination in this case was an invaluable diagnostic and follow‐up tool. Immobilisation of the foot by means of a heavily padded distal limb cast allowed excellent healing of the ligament and is presented as a novel treatment for collateral ligament desmitis. At the time of writing the mare had returned to her previous level of exercise and was showing no signs of lameness.