Idiopathic hyperostosis of the calvaria in five young bullmastiffs

A new calvarial hyperostotic syndrome (CHS) in young bullmastiffs is described. Calvarial hyperostotic syndrome clinically resembles canine craniomandibular osteopathy (CMO) and human infantile cortical hyperostosis (ICH), but it is unique in that there is progressive and often asymmetric skull bone involvement, and the population affected appears to be only young, male bullmastiff dogs. Characteristic radiographic findings consist of cortical thickening of the calvaria with irregular, bony proliferation over the frontal, temporal, and occipital bones. Histopathological examination shows that the trabeculae of the calvarial diplo? are thickened and contiguous with a sunburst-like pattern of subperiosteal trabeculae composed of woven and lamellar bone tissue, accompanied by loose fibrovascular tissue and a variable inflammatory response comprised predominantly of neutrophils. In 80% of the cases presented, the lesion was self-limiting. The etiology remains unknown; however, traumatic, neoplastic, and degenerative conditions do not appear to be primary factors in the etiopathogenesis of the syndrome. It may be that this syndrome has a familial component, similar to that described for CMO and ICH.     

Unilateral exophthalmos and strabismus due to cranio-mandibular osteopathy

A nine-month-old male West Highland white terrier puppy presented because of non-painful exophthalmos and strabismus of the left eye. Ultrasonographic examination of the globe and retrobulbar space showed abnormal prominence of the dorsal and medial bony wall of the orbit resulting in compression of the retrobulbar structures and indentation of the globe. A similar but less dramatic finding was present in the clinically unaffected right eye. Radiographic examination demonstrated the presence of extensive, active new bone on the frontal and parietal bones, with almost total occlusion of the frontal sinuses. In view of the dog's breed and age a tentative diagnosis of craniomandibular osteopathy was made. Although the dog was clinically well at the time of the initial presentation he sub-sequently suffered an acute episode of severe pain, pyrexia and depression with marked swelling of the periocular tissues and conjunctival oedema. This episode responded well to symptomatic treatment with corticosteroids and analgesics and the dog has continued to progress well with a reduction in the degree of deviation of the eye.     

Exophthalmos Caused by Chronic Sinusitis in a Horse: A Case of Exophthalmos Caused by Sinusitis

A 12-year-old Thoroughbred gelding exhibited a unilateral exophthalmos on the left side. There had been no other clinical symptoms, such as rhinorrhea, before the first consultation. Clinical, hematologic, plasma biochemical, cytologic, and computed tomography (CT) examinations and complete necropsy were performed. These examinations did not reveal neoplastic lesions. CT images suggested that maxillary and frontal sinuses may have been filled with fluid. Cytologic and pathologic examinations revealed that the maxillary and orbital bones were pushed up with a large amount of the inflammatory fluid effused by chronic sinusitis. The CT and cytologic examinations were of great use for differential diagnosis in this case. This was an unusual case of exophthalmos induced by deformation of the orbital bones resulting from chronic sinusitis.     

CALVARIAL hYPEROSTOSIS SYNDROME IN TWO bULLMASTIFFS

Two bullmastiffs with calvarial hyperostosis syndrome are described and are the first documented examples in females. The clinical and radiologic features were similar to those previously reported in males. Magnetic resonance (MR) imaging findings have not previously been reported. One dog underwent MR imaging and abnormalities included thickening of the frontal bones with loss of normal fat signal and changes in the overlying soft tissues. In one of the dogs, long bone changes were seen in the femora and resembled those seen with craniomandibular osteopathy.     

Orbital multilobular tumour of bone in a dog

A multilobular tumour of bone with left orbital involvement was diagnosed at post mortem examination in an eight-year-old German shepherd cross dog. The tumour resulted in progressive exophthalmos with lateral deviation of the left eye. Radiographs revealed that the mass was mineralised and originated from the left frontal bone with invasion of the left frontal sinus and destruction of the cribriform plate. This is the third reported case of this type of tumour involving the orbit of the dog and thus multilobular tumour of bone should be considered as a differentia] diagnosis of exophthalmos.     

Squamous cell carcinoma causing blindness and ophthalmoplegia in a cat

Ophthalmoplegia and blindness caused by squamous cell carcinoma were reported in a cat. Unilateral functional deficits of cranial nerves II, III, IV, and VI and of the sympathetic nerve supply caused blindness, complete ophthalmoplegia, and Horner syndrome. Radiography and computed tomography revealed a proliferating bony lesion associated with the right tympanic bulla, right temporal bone, right side of the mandible, and left frontal bone. A focal area of bony destruction involved the right sphenoid bone. The cat was euthanatized and necropsied. Squamous cell carcinoma was identified invading the bones and rostral part of the right side of the skull. The tumor had extended through the sphenoid bones into the region of the cavernous sinus and had surrounded the cranial nerves passing through this region. It also had invested connective tissue surrounding the optic nerves and had invaded the right globe through the lamina cribrosa. This represents an unusual distribution for ocular cranial squamous cell carcinoma in a cat.     

COMPARISON OF RADIOGRAPHY AND COMPUTED TOMOGRAPHY FOR THE DIAGNOSIS OF CANINE NASAL ASPERGILLOSIS

To compare the radiographic and computed tomographic (CT) findings and to evaluate the sensitivity of radiography and CT for diagnosis of nasal aspergillosis in dogs, the radiographic and CT studies of 48 dogs with chronic nasal disease were reviewed separately. The radiographic and CT findings were recorded, and a diagnosis was made. The results obtained in the dogs with nasal aspergillosis (n = 25) were used. Based on definite aspergillosis as diagnosis, CT had a sensitivity of 88% and radiography of 72%. Considering definite and probable aspergillosis as equivalent, CT had a sensitivity of 92% and radiography of 84%. The sensitivity was higher in dogs with lesions affecting the entire nasal cavity and frontal sinus on at least one side (n = 20) with a sensitivity of 100% for CT and 90-95% for radiography than in dogs with lesions restricted to the nasal cavities (n = 5) where CT had a sensitivity of 60-80% and radiography of 0-40%. CT was superior to radiography for evaluation of the nasal cavities (mucosal thickening along the nasal bones, surrounding bone hyperostosis/lysis), frontal sinuses (mucosal thickening along the frontal bone, fluid/soft tissue, frontal bone hyperostosis/lysis), and differentiation between a cavitated-like or a mass-like process. This study suggests that CT is more sensitive than radiography for diagnosis of nasal aspergillosis in the dog because of a better demonstration of some changes suggestive of nasal aspergillosis. A diagnosis of a nasal aspergillosis restricted to the nasal cavities or associated with an FB is challenging, even with the use of CT.     

COMPUTED TOMOGRAPHIC FEATURES OF SKULL OSTEOMYELITIS IN FOUR YOUNG DOGS

Computed tomography (CT) features of four immature to young adult dogs with osteomyelitis of the skull are described. Trauma or bite wounds were the cause of infection and Staphylococcus aureus was the most common pathogen. CT features were a combination of soft tissue thickening, bone lysis, and bone proliferation. Bone lysis was extensive in some dogs with a moth-eaten appearance and involved the calvarium, base of the skull, the frontal sinuses, and the temporomandibular joint. In other dogs it was more focal with thinning of the bone rather than complete lysis. Bone proliferation also varied in appearance from irregular palisading or spiculated to expansion and septation of the frontal bone. Sequestrum formation was seen in one dog. Widespread infection in one dog involved the tympanic bullae and the temporomandibular joint. Lysis of the calvarium resulted in bacterial meningitis in two dogs. One dog was euthanized and three were treated with surgical curettage of the affected bone and antibiotic therapy which resulted in resolution of the clinical signs in one dog whereas two dogs had recurrent disease. CT was very helpful for characterizing extent and localization of the infection. Despite the aggressive CT features, osteomyelitis should be considered especially in young animals with a history of trauma or bite wounds. The pathophysiology of skull bone infections is discussed.     

CASE REPORT: Unilateral eyelid lesion and ophthalmologic findings in an aardvark (Orycteropus afer): case report and literature review

Objective To summarize the medical knowledge surrounding aardvarks to date, to describe the ophthalmic examination of a specimen with a chronic history of an upper eyelid lesion, of an assumed blind left eye, and to detail the anesthesia procedure performed. Procedure A 23‐year‐old aardvark was examined under general anesthesia and multiple ocular abnormalities were detected in the left eye (globe deviation, corneal opacities, iridodonesis, and aphakia). A thickening of the palpebral conjunctiva affecting the medial upper eyelid with erosion of the normal eyelid margin anatomy was identified. The adnexal lesion was resected by a wedge resection and histopathology was performed. Suture breakdown 3 days postoperatively required a second surgery, where buried sutures were used. The surgical techniques and postoperative care are discussed. Results The histopathology revealed mucosal hyperplasia and moderate neutrophilic and lymphoplasmacytic blepharitis. No causal organisms were identified. Following initial wound dehiscence and a modified surgical technique, the upper eyelid healed without complication and retained complete function. Conclusions The eyelid lesion involved a benign inflammatory and hyperplastic pathology of unknown etiology. Adjusting routine ophthalmic surgical techniques to wildlife and zoo animals can be challenging and complicated. It is important to understand the nature of the animals being managed, their circadian cycle, and habitat, to adjust and individualize the surgical approach, instrumentation, suture material, and perioperative treatment.     

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.     

Exophthalmos due to sterile neutrophilic dermatosis in a dog

An 8‐year‐old castrated male Bichon Frise was presented to the Kansas State University Veterinary Health Center for evaluation of unilateral right‐sided exophthalmos, suspected secondary to a retrobulbar abscess. The dog had acutely developed right‐sided periorbital swelling, exophthalmos with pain on retropulsion, as well as multiple cutaneous exudative plaques on the feet and tail base. On ophthalmic examination, the dog also exhibited mild left‐sided exophthalmos with decreased, nonpainful retropulsion. Orbital ultrasound and CT were performed to evaluate the extent of bilateral orbital disease. Incisional biopsies were obtained from the affected right periorbital tissues and skin of the feet, and histopathology revealed severe neutrophilic inflammation of the dermis with no organisms detected. Histologic changes were consistent with sterile neutrophilic dermatosis. The dog achieved clinical remission following treatment with initial immunosuppressive doses of corticosteroids and subsequent long‐term maintenance therapy using oral cyclosporine.     

Cavernous sinus syndrome in a holstein bull

A 13‐month‐old Holstein bull was presented for right‐sided exophthalmos. Ophthalmologic examination noted that the animal was visual in both eyes, but that the right pupil was persistently dilated and very sluggish to constrict when stimulated with a bright light and that normal ocular motility was absent. Fundic examination of the right eye was normal as was a complete ophthalmologic examination of the left eye. Radiographs at presentation did not reveal the presence of sinusitis or other skull abnormalities. Initial treatment comprised intravenous antibiotics and anti‐inflammatories for orbital inflammation over a 14‐day period. There was no perceptible change in the appearance or neuro‐ophthalmologic examination of the right eye during hospitalization. The animal was discharged to the owner's care, but 3 weeks later was found recumbent with unilateral strabismus of the left eye and a fixed right pupil. Due to the inability to rise and rapid deterioration, humane euthanasia was performed, and a full postmortem examination, preceded by a MRI, was performed that identified abscesses extending bilaterally through the round foramina obliterating the cavernous sinus region, as well as abscessation of the right mandible, right trigeminal neuritis, right‐sided sinusitis, and right‐sided otitis media. Cavernous sinus syndrome should be considered in cattle with a combination of exophthalmos and neuro‐ophthalmologic abnormalities involving cranial nerves III, IV, V, and VI, whose branches are located within the cavernous sinus.     

Feline intracranial meningioma with skull erosion and tumour extension into an area of skull hyperostosis

Skull hyperostosis is a frequently recognised feature of meningioma in feline and human patients, occurring at a frequency of around 4.5% of human cases. Evidence of osteolysis with extension of meningioma into, and in some cases through, the region of skull hyperostosis is much less commonly described in human patients. Here we present a 12-year-old cat with marked skull hyperostosis secondary to an intracranial meningioma, with magnetic resonance imaging and computed tomography evidence of tumour extension into the skull, centrally within the region of hyperostosis. Only a thin layer of bone was remaining between the mass and the extracranial region. Surgical resection of the region of skull demonstrating tumour invasion and the underlying mass resulted in good resolution of clinical signs and no post-surgical recurrence of meningioma within the 5 months follow-up period. Histopathological examination confirmed the mass to be fibroblastic meningioma.     

Fixation of chronic suture exostosis in a mature horse

This case report describes the clinical findings, diagnosis and treatment of a 14‐year‐old Warmblood gelding with suture exostosis. The horse was referred to our clinic because of bilateral swelling in the region of the frontal and nasal bone junction and bilateral epiphora. Epiphora was the main concern for the owner and the reason for further investigation and treatment. Radiographic examination showed extensive bone proliferation on the dorsal frontal and nasal bones. Computed tomographic (CT) images further characterised the periosteal proliferation as new bone formation and localised it along the frontonasal and frontolacrimal suture lines. Computed tomographic images also showed pathological changes of both lacrimal ducts. A chronic fracture was suspected to be the cause of the periosteal proliferation, and surgical treatment using 2 small 2.4 Unilock plates was chosen to stabilise the suture between the frontal and nasal bones. The swelling decreased and the epiphora resolved by 6 months post operatively. A CT examination 2 years later showed complete healing.     

CT and MRI evaluation of skull bones and soft tissues in six cats with presumed acromegaly versus 12 unaffected cats

Feline acromegaly is predominantly caused by an adenoma of the pituitary gland, resulting in excessive growth hormone and insulin-like growth factor (IGF-1) secretion. In advanced cases, cats will display prominent facial features and upper airway congestion secondary to bony and soft tissue proliferation. The purpose of this study was to describe CT and MRI characteristics of soft tissues and skull bones in six cats with presumed acromegaly and to compare findings with those observed in 12 unaffected cats. In the five acromegalic cats with CT or MRI evidence of a pituitary tumor, frontal bone thickness was greater than age-matched controls with and without a history of upper airway disease. These five cats also had evidence of soft tissue accumulation in the nasal cavity, sinuses, and pharynx. One cat with insulin-resistant diabetes mellitus, elevated IGF-1, and a normal pituitary size did not have evidence of frontal bone thickening or upper airway congestion.     

Hyperostotic bone disease in a wombat (Vombatus ursinus)

Little is known about wombat diseases in general, and about their congenital diseases in particular. In the current study, the skeleton of a common wombat (Vombatus ursinus) that exhibited generalized hyperostosis is analyzed, and possible diagnoses are reviewed. Macromorphological analyses revealed that the diaphyses of the long bones manifested an increased diameter with extensive diaphyseal new-bone formation (periosteal and endosteal). Cross-sections of the diaphyses showed that the cortical–medullary demarcation was indistinct. The calvarial bones were thickened. Radiographs showed uniform sclerosis of the long bones with loss of trabecular pattern. Microradiography showed extensive bone remodeling, a hyper-vascularized lamellated layer of bone and numerous linear formation defects. Possible causes for the lesions, including sclerosing bone dysplasia disorders, acquired syndromes causing hyperostosis, and metabolic diseases typical of animals in captivity, are discussed.     

Exophthalmus secondary to a sinonasal cyst in a horse

CASE DESCRIPTION: A 13-year-old female Miniature Horse was evaluated for progressive unilateral exophthalmia of the left globe of 3 weeks' duration. CLINICAL FINDINGS: Results of a physical examination were unremarkable. Ophthalmic examination identified exophthalmus of the left globe with complete resistance to retropulsion and mild blepharoconjunctivitis. Computed tomography revealed a large, space-occupying mass within the left caudal maxillary and left conchofrontal sinuses. The mass extended into the left retrobulbar space and contacted the cribriform plate. Trephination yielded copious amounts of turbid yellow fluid. The diagnosis was a sinonasal cyst. TREATMENT AND OUTCOME: Subtotal surgical excision of the cyst via a frontonasal osteoplastic flap was curative, with complete resolution of the exophthalmus. Histologic examination confirmed diagnosis of a sinonasal cyst. There was no evidence of cyst recurrence by 4 months after surgery. CLINICAL RELEVANCE: Sinonasal cyst should be a differential diagnosis for retrobulbar disease in horses. Exophthalmia may be the only clinical finding in horses with a sinonasal cyst.     

Orbital Surgery in Two Horses

The case histories of 2 horses that required surgery within the orbit are described. In 1 horse, severely comminuted fractures of the left facial area and orbit were repaired in 2 stages, the first consisting of elevation and wiring of the depressed fractures. In the second stage, an autogenous tendon graft from the lateral digital extensor tendon of the left front leg was used to reconstruct the orbital floor and elevate the globe in the orbit. In the second horse, a retrobulbar tumor causing exophthalmos and prolapse of the nictitans was removed by creating a bone flap of the zygomatic process of the frontal bone for exposure.     

Retrobulbar respiratory epithelial orbital cyst in a dog: A case report

A 10-month-old female, neutered French Bulldog presented with a history of unilateral right-sided intermittent conjunctivitis and exophthalmos. The patient suffered blunt force trauma to the right eye after a tennis ball impact approximately five months prior to presentation. Examination identified the patient was visual with exophthalmos, lateral strabismus, conjunctival hyperaemia, episcleral congestion, and papilloedema. Magnetic resonance imaging and ultrasonography identified an approximately two centimeter diameter fluid-filled structure directly posterior to the globe leading to displacement of the optic nerve and distortion of the posterior globe wall. Centesis of the lesion demonstrated neutrophilic and macrophagic inflammation with evidence of prior hemorrhage. Within four weeks, the structure had re-filled to its original size and was subsequently excised in its entirety, via a lateral orbitotomy. Histopathologic findings indicated a non-keratinising orbital cyst, the lining of which was consistent with a respiratory epithelial cyst. Recurrence had not occurred seven months' post-surgery. To the author's knowledge, previous reports of retrobulbar respiratory epithelial cysts have not been documented in animals.     

IMAGING DIAGNOSIS—THROMBOSED ORBITAL VARIX IN A DOG

A 9‐week‐old female Rhodesian Ridgeback presented with exophthalmos following minor blunt trauma to the left orbital area. Ocular ultrasound showed an extraconal retrobulbar mass ventromedial to the left globe. Magnetic resonance (MR) imaging demonstrated a thrombosed orbital vascular malformation without intracranial extension. Doppler ultrasound features of nonpulsatile slow flow were consistent with an orbital varix. Contrast‐enhanced dynamic time‐resolved and high‐resolution MR angiography demonstrated the varix arose from the anastomotic branch of the dorsal and ventral external ophthalmic veins. Conservative management led to a positive outcome defined as a visual eye and nearly normal cosmetic appearance at 8‐month follow‐up.