Haematogenous septic arthritis in foals: Short‐ and long‐term outcome and analysis of factors affecting prognosis

Synovial sepsis represents a major cause of morbidity and mortality in foals; however, there are no studies focusing on foals particularly at risk during the first 2 months of life. Our objective was to analyse outcome in foals aged <2 months with haematogenous septic arthritis and to identify prognostic factors and compare the effects of two different lavage procedures on outcome. Sixty foals with synovial sepsis were used for our retrospective study in which medical records, online data and telephone interviews were utilised to analyse prognostic factors, and determine short‐ and long‐term survival and athletic performance of foals treated at Evidensia Equine Specialist Hospital, Helsingborg, between 2008 and 2014. Overall survival to discharge was 80% (48/60). Time to long‐term follow‐up ranged from 6 months to 6.5 years. Forty/60 (67%) horses survived long‐term. Four/8 (50%) of the nonsurvivors at long‐term follow‐up had been subjected to euthanasia due to sequelae of joint sepsis. Of the long‐term survivors, 37/40 (92.5%) achieved athletic soundness. Overall long‐term outcome for athletic soundness was 37/60 (62%). Prognostic factors based on historical, clinical or laboratory data, or the use of through‐and‐through needle lavage compared to endoscopic lavage as the first procedure, could not be identified. The present study demonstrates a more favourable prognosis than previously reported, with 80% of foals with synovial sepsis surviving to discharge, and approximately 60% achieving athletic soundness. However, the study was limited by a small population size, which may account for the failure to verify statistically significant prognostic factors.     

Short‐ and long‐term results following standing fracture repair in 34 horses

Reasons for performing study: Standing fracture repair in the horse is a recently described surgical procedure and currently there are few follow‐up data. This case series contains 2 novel aspects in the standing horse: repair of incomplete sagittal fractures of the proximal phalanx and medial condylar repair from a lateral aspect. Objectives: To describe outcome in a case series of horses that had lower limb fractures repaired under standing sedation at Rossdales Equine Hospital. Method: Case records for all horses that had a fracture surgically repaired, by one surgeon at Rossdales Equine Hospital, under standing sedation and local anaesthesia up until June 2011, were retrieved. Hospital records, owner/trainer telephone questionnaire and the Racing Post website were used to evaluate follow‐up. Results: Thirty‐four horses satisfied the inclusion criteria. Fracture sites included the proximal phalanx (incomplete sagittal fracture, n = 14); the third metacarpal bone (lateral condyle, n = 12, and medial condyle, n = 7); and the third metatarsal bone (lateral condyle, n = 1). One horse required euthanasia due to caecal rupture 10 days post operatively. Twenty horses (66.7% of those with available follow‐up) have returned to racing. Where available, mean time from operation to return to racing was 226 days (range 143–433 days). Conclusions: Standing fracture repair produced similar results to fracture repair under general anaesthesia in terms of both the number of horses that returned to racing and the time between surgery and race. Potential relevance: Repair of lower limb fracture in the horse under standing sedation is a procedure that has the potential for tangible benefits, including avoidance of the inherent risks of general anaesthesia. The preliminary findings in this series of horses are encouraging and informative when discussing options available prior to fracture repair.     

Medication‐related osteonecrosis of the jaw after long‐term bisphosphonate treatment in a cat

A 12‐year‐old, neutered female, domestic medium hair cat was evaluated for a nonhealing, oral mucosal ulceration. The cat had a history of idiopathic hypercalcemia that had been treated with a bisphosphonate for 41 months. Oral examination identified exposed maxillary bone adjacent to a previous extraction site. Histopathology of the exposed bone and associated mucosa was most consistent with medication‐related osteonecrosis of the jaw. Treatment involved both medical and surgical interventions. Oral mucosal healing occurred after 6 months of treatment.     

Canine spinal meningiomas and nerve sheath tumours in 34 dogs (2008‐2016): Distribution and long‐term outcome based upon histopathology and treatment modality

The purpose of this retrospective, multicentre case series was to describe the outcome following surgery and/or radiation of spinal meningiomas and nerve sheath tumours (NSTs) based upon treatment modality, with a specific aim to evaluate the survival times and time to recurrence following treatment for each histopathological diagnosis. Our hypothesis was that the addition of radiation therapy modalities to treatment will yield longer time to recurrence of clinical signs and survival time. Thirty‐four dogs met the inclusion criteria of histopathologically diagnosed extramedullary spinal meningioma or NST. Sixteen extramedullary spinal meningiomas and 18 NSTs were diagnosed. A diagnosis of meningioma was associated with a significantly longer survival time compared with NSTs, with median survival times (MST) of 508 days (95% confidence interval [CI]: 66‐881) vs 187 days (95% CI: 76‐433; P = .02). Dogs (seven) treated with stereotactic radiation therapy (SRT) for recurrence after surgery alone or SRT alone as their initial treatment gained an additional 125 to 346 days survival time.     

Association of spinal cord compression seen on magnetic resonance imaging with clinical outcome in 67 dogs with thoracolumbar intervertebral disc extrusion

OBJECTIVES: To determine whether there is an association between the degree of transverse spinal cord compression detected by magnetic resonance imaging following thoracolumbar Hansen type 1 intervertebral disc disease in dogs and their presenting and postsurgical neurological status. METHODS: Medical records of 67 dogs with surgically confirmed Hansen type 1 intervertebral disc disease (2000 to 2004) were reviewed to obtain the rate of onset of disease, duration of clinical signs and presurgical and postsurgical neurological grade. Percentage of spinal cord compression was determined on transverse T2-weighted magnetic resonance images. Linear regression was used to examine the association between spinal cord compression and each of the above variables. Chi-squared tests were used to examine associations among postsurgical outcome and presurgical variables. RESULTS: Eighty-five per cent (57 of 67) of dogs were chondrodystrophoid. Mean spinal cord compression was 53 per cent (sd=219.7, range 14.3 to 84.9 per cent). There was no association between the degree of spinal cord compression and the neurological grade at presentation, rate of onset of disease, duration of clinical signs or postsurgical outcome, with no difference between chondrodystrophoid and non-chondrodystrophoid dogs. CLINICAL SIGNIFICANCE: The degree of spinal cord compression documented with magnetic resonance imaging in dogs with thoracolumbar Hansen type 1 intervertebral disc disease was not associated with the severity of neurological signs and was not a prognostic indicator in this study.     

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.     

Clinical signs, magnetic resonance imaging features, and outcome after surgical and medical treatment of otogenic intracranial infection in 11 cats and 4 dogs

Brainstem dysfunction resulting from central extension of infection is a life-threatening complication of otitis media/interna (OMI) that has been described infrequently in dogs and cats. We review the clinical signs of disease, diagnostic findings, and results of surgical and medical treatments of brainstem disease attributable to otogenic intracranial infection in cats and dogs. Eleven cats and 4 dogs were examined because of acute, subacute, or chronic clinical signs of brain disease including central vestibular signs, altered mentation, abnormal posture/gait, cranial nerve deficits, and seizures. Results of a minimal database (CBC, serum biochemical panel, urinalysis, thoracic radiographs, and abdominal ultrasonographic images or radiographs) were within reference intervals in all animals. Magnetic resonance (MR) images of the head were acquired for all animals, and cisternal cerebrospinal fluid (CSF) from 9 of 11 cats and 3 of 4 dogs was examined. Surgical exploration and ventral bulla osteotomy were done for 12 of 15 animals, followed by 1–3 months of antibiotic therapy; the remaining animals were euthanized before treatment. In all animals, MR imaging was effective in characterizing the location and extent of the pathologic changes intracranially as well as within middle/inner ear structures. Results of CSF analysis were characteristic of bacterial infection in most of the animals with acute or subacute disease. Since long-term outcome in all treated animals was very good to excellent, it was concluded that dogs and cats with intracranial disease secondary to extension of otitis media/interna have a good-to-excellent prognosis when the condition was diagnosed and was treated by surgical exploration and appropriate antibiotic therapy.     

Intra‐operative imaging of surgical margins of canine soft tissue sarcoma using optical coherence tomography

Optical coherence tomography (OCT) is a rapid non‐invasive imaging technique that has shown high sensitivity for intra‐operative surgical margin assessment in human breast cancer clinical trials. This promising technology has not been evaluated in veterinary medicine. The objective of this study was to correlate normal and abnormal histological features with OCT images for surgical margins from excised canine soft tissue sarcoma (STS) and to establish image evaluation criteria for identifying positive surgical margins. Fourteen client‐owned dogs underwent surgical resection of a STS and OCT imaging of 2 to 4 areas of interest on the resected specimen were performed. Following imaging these areas were marked with surgical ink and trimmed for histopathology evaluation. Results showed that different tissue types had distinct characteristic appearances on OCT imaging. Adipose tissue exhibited a relatively low scattering and a honey‐comb texture pattern. Skeletal muscle and sarcoma tissue were both dense and highly scattering. While sarcoma tissue was highly scattering, it did not have organized recognizable structure in contrast to muscle which showed clear fibre alignment patterns. In this investigation, we showed different tissue types had different and characteristic scattering and image texture appearances on OCT, which closely correlate with low‐power histology images. Given the differentiation between tissue types the results support that OCT could be used to identify positive surgical margins immediately following resection of STS. Further research is needed to assess the diagnostic accuracy of this method for surgical margin assessment.     

Clinical and low field magnetic resonance imaging features of osseous cyst‐like lesions of the proximal sesamoid bones in seven horses

Osseous cyst‐like lesions of the proximal sesamoid bones (PSBs) were diagnosed in 7 horses. The diagnosis was achieved radiographically prior to magnetic resonance imaging (MRI) in only one horse, and in the other 6 horses the diagnosis was made using low field MRI (retrospective evaluation of the radiographs after the MRI revealed ill‐defined radiolucencies of the PSBs in 4 of these horses). The horses ranged in age from 3 to 12 years, and the affected limbs included 3 forelimbs and 4 hindlimbs. The onset of lameness was reported to be sudden in 6 horses and insidious in one, and the duration of lameness at the time of MRI ranged from 0.3 to 11 months. The degree of lameness in the 6 horses with sudden‐onset lameness was moderate to severe. Pain on flexion of the affected metacarpo(tarso)phalangeal (fetlock) joint or exacerbation of the degree of lameness following fetlock flexion was recorded in 4 of the 7 horses. The MRI findings in all cases included a focal high signal intensity lesion (all magnetic resonance sequences) at various locations in one PSB. Both septic and nonseptic aetiologies were identified. Four of the 7 horses were subjected to euthanasia due to persistent lameness, one remained chronically lame and only 2 were able to return to their previous level of exercise.     

The collateral ligaments of the distal interphalangeal joint: magnetic resonance imaging and post mortem observations in 25 lame and 12 control horses

Reasons for performing study: Magnetic resonance imaging (MRI) is used with increasing frequency to diagnose injuries of the collateral ligaments (CLs) of the distal interphalangeal (DIP) joint, but the results have not been verified by histology and the mechanism of injury is poorly understood. Hypothesis: Abnormal signal intensity and tissue contour represents change in tissue structure detected on histology. Objectives: To compare results in horses free from and those with chronic lameness and to describe possible progression of lesions. Methods: One or both feet of horses free from lameness (Group N: n = 12) and with foot‐related lameness (Group L: n = 25) were examined using MRI and by gross post mortem examination. The magnetic resonance (MR) images were graded. Sagittal sections from the proximal and distal aspect of each CL were examined histologically and each ligament assigned a score. Scintigraphic images from lame horses were also evaluated. Results: In Group N, 25 CLs were graded normal on both MR images and histology, 2 CLs were grade 1 on MR images, but were histologically normal, and 2 CLs had MR abnormalities verified histologically. However, 2 CLs appeared normal on MR images but were histologically abnormal. In Group L, 18 CLs were deemed normal on both MR images and histology, and 54 CLs had MR abnormalities verified histologically. However, 13 CLs appeared normal on MR images but were graded abnormal histologically. Lesions appeared to be degenerative, characterised by extensive fibrocartilaginous metaplasia and development of multiple, intercommunicating fissures within the degenerate collagen in severe lesions. There was an association between increased radiopharmaceutical uptake and a higher histological score. Conclusions: High‐field MRI is reasonably reliable for detection of lesions of the CLs of the DIP joint, but may underestimate their prevalence. Clinical relevance: Collateral ligament injury appears to be a primary degenerative process, which may explain the poor response to conservative treatment and a need for promotion of regeneration.     

Evaluation of magnetic resonance imaging for the differentiation of inflammatory,neoplastic, and vascular intradural spinal cord diseases in the dog

Magnetic resonance imaging (MRI) is a common test for dogs with suspected intradural spinal cord lesions, however studies on diagnostic performance for this test are lacking. Objectives of this multi‐institutional, retrospective, case‐control study were to estimate sensitivity and specificity of MRI for (1) distinguishing between histopathologically confirmed intradural spinal cord disease versus degenerative myelopathy in dogs, (2) categorizing intradural spinal cord diseases as neoplastic, inflammatory, or vascular; and (3) determining tumor type within the etiologic category of neoplasia. Additional aims were to (1) determine whether knowledge of clinical data affects sensitivity and specificity of MRI diagnoses; and (2) report interrater agreement for MRI classification of intradural spinal lesions. Cases were recruited from participating hospital databases over a 7‐year period. Three reviewers independently evaluated each MRI study prior to and after provision of clinical information. A total of 87 cases were sampled (17 degenerative myelopathy, 53 neoplasia, nine inflammatory, and eight vascular). Magnetic resonance imaging had excellent (>97.6%) sensitivity for diagnosis of intradural spinal cord lesions but specificity varied before and after provision of clinical data (68.6% vs. 82.4%, P = 0.023). Magnetic resonance imaging had good sensitivity (86.8%) and moderate specificity (64.7–72.5%) for diagnosing neoplasia. Sensitivity was lower for classifying inflammatory lesions but improved with provision of clinical data (48.1% vs. 81.5%, P = 0.015). Magnetic resonance imaging was insensitive for diagnosing vascular lesions (25.0%). Interrater agreement was very good for correctly diagnosing dogs with intradural lesions (? = 0.882–0.833), and good (? = 0.726–0.671) for diagnosing dogs with neoplasia.     

Diagnostic imaging,surgical treatment and histopathological findings of a vascular hamartoma in a 2‐year‐old horse

We describe a case of a 2‐year‐old mare that presented with a large firm swelling on the lateral aspect of the right tarsus. Diagnostic ultrasound demonstrated a fluid filled cavernous mass that was not clearly demarcated from the surrounding subcutaneous tissue. Contrast radiography with intralesional injection of contrast medium showed accumulation of the medium in the caverns of the mass and in the saphenous vein. Contrast enhanced computed tomography demonstrated 2 vascular meshes, one deep and one more superficially, closely associated with the mass. Surgical excision of the mass was performed and a vascular hamartoma was diagnosed based on histopathology. The horse showed no signs of recurrence 7 months after surgery.