Presumed cholesterinic granulomas detected on CT in horses are associated with increased lateral ventricle height and age

Cholesterinic granulomas are mass‐like lesions that form at the choroid plexus of the ventricular system. Large cholesterinic granulomas within the lateral ventricles have been reported to cause severe neurological signs. However, little data are available about their prevalence or appearance in the overall population. The objective was to report the prevalence of presumed cholesterinic granulomas on CT in a population of horses, and investigate associations between presumed cholesterinic granuloma presence, lateral ventricle size, age, and neurological signs. The study was cross sectional, CT scans of the head were assessed for presumed cholesterinic granuloma presence and size, and lateral ventricle height. Computed tomography findings and clinical information were compared using nonparametric testing. Computed tomography scans of 139 horses were included. Presumed cholesterinic granulomas were found in 22 horses (15.8%), nine were unilateral and 13 bilateral. A significant increase in prevalence was observed with age (P < .0001), with 38% of horses over 15 years old affected. The median volume of presumed cholesterinic granulomas was 242 mm³ with a range from 51 to 2420 mm³. The mean lateral ventricle height was significantly increased in horses with presumed cholesterinic granulomas present (P = .004), with a median of 7.3 mm compared to 4.9 mm without. Neurological signs were not associated with presumed cholesterinic granuloma presence or lateral ventricle height. Fourth ventricle mineralizations were found in seven horses, which may represent cholesterinic granulomas. In conclusion, presumed cholesterinic granulomas occurred in a large proportion of the examined population and are associated with increased lateral ventricle dilation and advanced age.     

Episodic blindness and ataxia in a horse with cholesterinic granulomas

An 11‐year‐old Oldenburg mare presented following three episodes of acute, transient blindness, ataxia, and disorientation within the preceding 7 months. Clinical improvement, including return of vision, occurred within 1 week of initiating corticosteroid therapy for each of the three episodes. However, mild right‐sided miosis was a consistent finding on ophthalmic examinations. Routine clinicopathologic testing revealed no significant abnormalities, and testing of cerebral spinal fluid for selected infectious diseases was unrewarding. Computed tomography of the brain demonstrated a hyperattenuating mass with peripheral mineralization in the rostroventral aspect of each lateral ventricle. The mare was euthanized due to a guarded to poor prognosis. On histopathology, the masses consisted of clusters of cholesterol clefts admixed with leukocytes, mineral deposits, and connective tissue. Cholesterinic granulomas of the lateral ventricles and hydrocephaly were diagnosed. Cholesterinic granulomas should be considered a differential diagnosis in horses presenting for intermittent blindness.     

Diagnostic utility of computed tomography imaging in equine intracranial conditions

Reasons for performing study: The use of computer tomography (CT) and contrast‐enhanced CT (CCT) to image the head is common. However, the validity of CT as a neurodiagnostic indicator of intracranial diseases in horses is unknown. Objective: To define the validity of CT and CCT in horses with suspected intracranial disorders. Methods: The validity of CT imaging was estimated by comparing clinical, clinicopathological and histopathological findings to CT findings in 15 horses presented for intracranial disorders, for which pre‐ and post contrast CT images and post mortem examination of the brain and skull were reviewed. Post mortem examination (gross and histopathological examination) was considered as the gold standard; and sensitivity, specificity, predictive values, likelihood ratios, and pre‐ and post test probabilities were calculated. Results: All horses had abnormal neurological examinations on admission. Computer tomography imaging identified intracranial lesions in 8 horses, and included masses (oligodendroglioma, adenocarcinoma and cholesterinic granulomas), acute haemorrhage and skull fractures. Computer tomography imaging failed to identify intracranial lesions in 6 cases, which included meningitis, meningoencephalitis and nonacute haemorrhage. Lesions not recognised by CT were also not evident on gross examination but were identified by histopathological examination of the brain. Post mortem examination of the brain and skull was unremarkable in one horse, for which cranial CT imaging was normal (specificity, 100%). Therefore, the odds of having an intracranial lesion after an abnormal CT were very high. In contrast, there was a moderate sensitivity (57.1%, 95% confidence interval: 29.6–81.2). Conclusions and potential relevance: CT was an excellent neurodiagnostic tool in identifying skull fractures, intracranial space‐occupying lesions (e.g. neoplasia) and acute haemorrhage and allows to rule in intracranial disorders. However, CT showed limited sensitivity in identifying inflammatory disorders and small parenchymal lesions in the equine brain, which was not further detectable after contrast administration.     

COMPUTED TOMOGRAPHIC CHARACTERISTICS OF EOSINOPHILIC PULMONARY GRANULOMATOSIS IN FIVE DOGS

Canine pulmonary eosinophilic granulomatosis is a rare inflammatory pulmonary disease characterized by formation of eosinophilic granulomas that tend to obliterate the normal pulmonary architecture. The purpose of this retrospective study was to describe the CT characteristics of confirmed idiopathic pulmonary eosinophilic granulomatosis in a group of dogs. Five dogs met inclusion criteria. All patients were young adult dogs of variable breeds. No dog had concurrent occult heartworm disease. Computed tomographic characteristics most commonly included pulmonary masses and nodules of variable size, and lesions were most commonly located in the caudal lung lobes. Four dogs had large pulmonary masses with or without additional nodules and one dog had nodular lesions disseminated throughout the entire lung parenchyma. All large eosinophilic granulomas were smoothly margined, heterogeneous pulmonary masses displaying heterogeneous contrast enhancement. A honeycomb‐like enhancement pattern was observed in all but one mass and consisted of multiple hyperattenuating rims delineating central hypoattenuating areas, suggestive of bronchiectatic lung with peripheral enhancing airway walls and fluid‐filled, necrotic bronchial lumen. One dog had evidence of tracheobronchial lymphadenopathy. Findings indicated that canine eosinophilic pulmonary granulomatosis should be included as a differential diagnosis for dogs with CT characteristics of multiple pulmonary masses and/or nodules in caudal lung lobes, and a honeycomb‐like enhancement pattern in masses after intravenous administration of iodinated contrast medium.     

Staining abnormalities of dermal collagen in eosinophil- or neutrophil-rich inflammatory dermatoses of horses and cats as demonstrated with Masson's trichrome stain

A retrospective study was performed on skin biopsy specimens from horses and cats having eosinophilic granulomas with 'collagen degeneration', eosinophilic skin diseases without 'collagen degeneration' and pyogranulomas without 'collagen degeneration'. Neither the appearance of collagen fibres nor the dominant polymorphonuclear cells, as seen in H & E-stained sections, were predictive of Masson's trichrome findings. Hence, a Masson's trichrome staining abnormality of collagen fibres was no more likely to be present in lesions with 'collagen degeneration' than in those lesions without 'collagen degeneration'. In addition, evaluation of trichrome-stained specimens suggested that there is no collagen degeneration in equine and feline eosinophilic granulomas and that the areas previously referred to as collagen degeneration are more appropriately called flame figures.     

INCIDENCE AND DEVELOPMENT OF UNUNITED PROXIMOPLANTAR TUBEROSITY OF THE PROXIMAL PHALANX IN STANDARDBRED TROTTERS

Radiographic examination of all four metatarso- and metacarpophalangeal joints was performed on 753 Standardbred yearlings. Ununited proximoplantar tuberosity of the proximal phalanx was seen in 18 (2.4%) of the horses. All ununited tuberosities were in the pelvic limb. The condition was seen laterally in 16 horses while one horse had the medial and lateral tuberosities affected and another only the medial tuberosity. Upon follow-up examination it was apparent that 12 ununited proximoplantar tuberosities in 11 horses had united to the proximal phalanx after 6–12 months. A worsening of the condition was seen in 4 horses, and one horse had unchanged radiographic findings after 7 months. Lameness had not been observed in any horse prior to the first examination.     

CLINICAL AND DIAGNOSTIC IMAGING CHARACTERISTICS OF LATERAL DIGITAL FLEXOR TENDINITIS WITHIN THE TARSAL SHEATH IN FOUR HORSES

Lateral digital flexor tendonitis is a rarely reported cause of hind limb lameness in performance horses. The purpose of this retrospective study was to describe clinical and diagnostic imaging findings for a group of horses with lateral digital flexor tendinitis within the tarsal sheath. Equine cases with a diagnosis of lateral digital flexor tendonitis and magnetic resonance imaging (MRI) studies of the affected region were retrieved from North Carolina University's medical record database. Recorded data for included horses were signalment; findings from history, physical examination, lameness examination, and all diagnostic imaging studies; treatment administered; and outcome. Four horses met inclusion criteria. Lameness was mild/moderate in severity and insidious in onset in all patients. Responses to flexion tests were variable. All horses showed positive improvement (70–90%) in lameness after tarsal sheath analgesia. Radiographic, scintigraphic, and ultrasonographic findings were inconclusive. For all horses, MRI characteristics included increased T2, PD, and STIR signal intensity within the lateral digital flexor tendon in the area of the tarsal sheath. Tarsal sheath effusion was slight in three horses, and mild/moderate in one horse. With medical treatment, two horses were sound at 6‐month followup, one horse was sound at 1‐year followup, and one horse had a slight persistent lameness (grade 1/5) at 9‐month followup. Findings supported the use of MRI for diagnosing lateral digital flexor tendonitis within the tarsal sheath in horses. Affected horses may have a good prognosis for return to athletic performance following appropriate medical treatment.     

Electrosurgical Arthrotomy and Excision of Soft Tissue Masses in the Metacarpophalangeal Joint of the Horse

Electrosurgical arthrotomy and excision of infra-articular soft tissue masses from the metacarpophalangeal joint was performed in 12 horses. In six of the 12 horses, osteochondral fragments from the dorsoproximal aspects of the first phalanx were also removed. The electrosurgical scalpel afforded excellent intraoperative efficacy for arthrotomy and relatively bloodless excision of soft tissue masses without the need for a tourniquet. There were no complications associated with healing in 11 of the 12 horses. A retraction technique that used careful positioning of a Langenbeck periosteal elevator relative to the collateral ligaments provided access to both medial and lateral margins of intra-articular masses. With this technique, all masses could be removed through one central arthrotomy incision.     

Squamous cell carcinoma of the equine stomach: a report of five cases.

Five horses with squamous cell carcinoma of the stomach are described. The clinical findings included anorexia, weight loss, abdominal distension, abnormal chewing and swallowing behaviour and abdominal masses palpable per rectum in four cases. Haematological studies revealed a normocytic anaemia in three horses, and neutrophilia and hypoalbuminaemia in two. Analysis of peritoneal fluid revealed abnormal effusions in all five horses and neoplastic cells were identified in three of them. The tumours originated in the cardia and metastases were present in all the horses. Three of them had many small nodules covering the entire peritoneum.     

The ventricles of the brain in the N. American mink (Mustela vison (Brisson, 1756))

Using anatomical as well as radiographic and tomographic methods, sixty brains of the N. American mink were examined. It was found that the brain consists of four ventricles. Also, it was noted that the posterior horn was missing and that there was the olfactory recess present in the lateral ventricle, a large-size interthalamic connection present in the third ventricle, and a flat, necklace-like bottom in the fourth ventricle. Only recently, the ins and outs of the mink's anatomical structure have begun to absorb anatomists. Apparently, it is related to the fact that furry animals, among them the mink, are being domesticated as if "before our eyes". For this reason and because of the easy access to material, examining of the brain ventricles in the mink was taken up.     

Xeroradiographic evaluation of the equine larynx

The normal radiographic anatomy of the equine larynx was determine by use of xeroradiography and dissection. The body and laminae of the thyroid cartilage, the muscular process of the arytenoid cartilages, and the dorsal lamina and arch of the cricoid cartilage had radiographic evidence of mineralization (calcification) and/or ossification in clinically normal horses. There was a significant (P less than 0.01) increase in the degree of mineralization of the thyroid and arytenoid cartilages with advancing age. Horses with diagnosis of arytenoid chondrosis (arytenoid chondral dysplasia, arytenoid chondropathy) by use of endoscopy had radiographic changes that included: enlargement with increased density of the arytenoid cartilage region, abnormal patterns of mineralization (dystrophic mineralization or osseous metaplasia), abnormal contour of the corniculate process(es) and laryngeal masses, sometimes obliterating part or all of the lateral laryngeal ventricles.     

COMPUTED TOMOGRAPHIC ANATOMY OF THE EQUINE TARSUS

The purpose of this study was to provide a detailed computed tomographic (CT) anatomic reference for the equine tarsus. CT examinations of the tarsal regions from four clinically and radiographically normal adult horses, which were euthanized for reasons not related to musculoskeletal disease, were included in the study. Limbs were removed at the level of midtibia, and 3-mm contiguous transverse CT images were obtained, starting at a level proximal to the tuber calcanei and continuing distally into the proximal metatarsus. Soft tissue and bone windows were used to image different anatomic features, including bones, joints, and various soft tissue components of the tarsus. Each transverse slice was compared with bone models and dissected specimens to assist in the accurate identification of specific structures. The results of the study consist of nine CT images of the equine tarsus. Each image incorporates labeled soft tissue and bone-window images, a directional compass indicating cranial (Cr) or dorsal (D) and lateral (L), and a reconstructed scout image indicating the level through which the transverse slice was made.     

Avian mycobacteriosis in three horses

The clinical, bacteriologic and pathologic findings of three adult horses suffering from avian tuberculosis are presented. Chronic weight loss and hypoproteinemia were pertinent clinical abnormalities in all three horses. Gross pathologic lesions were characterized by chronic enterocolitis with mesenteric lymphadenopathy in two horses and hepatic granulomas in the third horse. The microscopic diagnoses were chronic, non-caseating granulomatous enterocolitis, and necrotizing, non-mineralizing granulomatous hepatitis, respectively. All three horses had granulomatous lymphadenitis of mesenteric lymph nodes with varying degrees of non-mineralizing, coagulation necrosis. Various serotypes of the Mycobacterium avium-intracellulare complex were isolated from selected tissues and feces.     

CLINICAL RELEVANCE OF ABNORMAL SCINTIGRAPHIC FINDINGS OF ADULT EQUINE RIBS

Horses with cranial rib abnormalities may exhibit severe acute lameness and may have unusual gait deficits characterized by forelimb abduction during protraction at the walk. Horses with caudal rib abnormalities may resent being saddled and ridden. In a retrospective evaluation of 20 horses with a documented rib lesion, 25 sites of increased radiopharmaceutical uptake were found in one or more ribs. Thirteen (52%) scintigraphic lesions involved the first rib; four were located immediately dorsal to the sternal articulation, eight were near the costochondral junction and one was at the costovertebral junction. Six (24%) scintigraphic rib lesions involved ribs 2–8; one was located immediately dorsal to the sternal articulation, three were at the costovertebral junction and two were near the costochondral junction. Six (24%) scintigraphic rib lesions involved the mid‐portion (five) or costovertebral junction (one) of ribs 9–18. The 20 horses were divided into three groups based on the clinical relevance of the scintigraphic findings. Group 1 (n=3) horses had clinical signs attributed to a rib abnormality; Group 2 (n=6) horses had a rib abnormality that was a plausible explanation for clinical signs; Group 3 (n=11) horses had clinical signs that could not be attributed to a rib abnormality. For horses with cranial rib abnormalities, a modified lateral scintigraphic image with the ipsilateral limb pulled caudally and a left (right) 45° caudal–right (left) radiograph facilitated the diagnosis.     

Supracoronary approach for keratoma removal in horses: Two cases

Two competitive horses were presented for examination of chronic lameness; one associated with a hoof‐wall deformity, the other with a firm mass over the dorsal pastern region. Radiographs revealed moderately radiopaque masses associated with both deformities. The lesions were characterised ultrasonographically as noninvasive, well‐circumscribed heterogeneous masses. Computed tomographic examination of the second case revealed a well‐defined, partially mineralised, bi‐lobed mass with associated bony resorption of the underlying middle phalanx. Both patients were anaesthetised and the keratomas surgically removed via approaches 1–2 cm proximal to the coronary bands. Both horses were stall‐sound 2 days after surgery and returned successfully to an equal level of competition by 8 months. A supracoronary approach is a viable alternative to partial or complete hoof wall resection for the removal of nonsolar keratomas from the foot of a horse.     

Natural Heterobilharzia americana infection in horses in Texas

The schistosome Heterobilharzia americana infects dogs, raccoons, and other mammals in the southeastern United States. Migration of eggs into the liver results in parasitic granulomas with varying degrees of fibrosis and inflammation. Recently, hepatic parasitic granulomas in horses were shown to be caused by H. americana infection. In the present study, samples of liver from 11 of 12 horses with hepatic granulomas identified at necropsy (n = 11) or surgical biopsy (n = 1) were used for DNA extraction, polymerase chain reaction amplification and sequencing using primers specific for a portion of the H. americana small subunit ribosomal RNA gene. A polymerase chain reaction amplicon of the correct size was produced from the extracted DNA in 8 of the 11 horses. Amplicons from 5 of the 8 positive horses were sequenced and had 100% identity with H. americana. In all but 2 of the 12 horses, Heterobilharzia was not responsible for the primary clinical disease, and the hepatic granulomas were considered an incidental finding.     

MAGNETIC RESONANCE IMAGING OF THE LATERAL VENTRICLES IN BEAGLE-TYPE DOGS

Magnetic resonance (MR) imaging was performed on 21 presumed normal Beagle-type dogs. The size and symmetry of their lateral ventricles were evaluated and dogs were categorized on the basis of the percentage of their ventricular height (Vh) to brain height (Bh) and the ratio of the largest to the smallest ventricular area (rVA). Eleven dogs had lateral ventricles classified as normal sized (0–14 %Vh/Bh) while 10 of 21 dogs had moderate enlargement (1525% Vh/Bh) of one or both lateral ventricles. None of the dogs had severe lateral ventricular enlargement. Degree of asymmetry was also arbitrarily categorized on basis of rVA as normal to minimal (rVA < 1S), mild (1.5 < rVA < 2.0), or severe (2.0 < rVA). Of the dogs having normal-sized lateral ventricles, six of eleven had symmetric, three of eleven had mildly asymmetric and two of eleven had severely asymmetric lateral ventricles. Of the dogs having at least one moderately enlarged lateral ventricles, five of ten had symmetric lateral ventricles, and two of ten had mild asymmetry and three of ten had severe asymmetry. Gender and body weight had no statistical relationship to lateral ventricle symmetry. Clinically insignificant ventricular enlargement and asymmetry was common in this group of Beagle dogs.     

STRESS FRACTURES OF THE HUMERUS, RADIUS, AND TIBIA IN HORSES

The medical records, radiographic and nuclear scintigraphic findings of 26 racing horses with 27 stress fracture episodes of the humerus, radius, or tibia were reviewed. The purposes of this study were to describe the radiographic and/or scintigraphic features of stress fractures of the humerus, radius, or tibia, and to evaluate the signalment and history of horses in which stress fracture occurred. Stress fractures of the three long bones examined were primarily seen in 2-and 3-year-old male Thoroughbred horses; commonly, the onset of lameness was immediately following training gallops or racing. There were 13 humeral stress fracture episodes in 12 horses. Ten were in the proximal caudolateral cortex, and three were in the distal craniomedial cortex. Radial stress fractures were seen in three horses, all in the midshaft radius. Tibial stress fractures were diagnosed in 11 horses. They were located in the proximal lateral tibia in six horses, the distal caudolateral tibia in three horses, and the midshaft tibia in three horses. Fifteen stress fractures were diagnosed with radiographs alone, one was diagnosed with scintigraphy alone, nine were diagnosed with radiographs and scintigraphy, and, in two horses, radiographs were negative, but the scintigraphic findings were consistent with stress fracture.