This week’s KCC was hosted by our large animal ultrasonographers, Mary Beth Whitcomb and Betsy Vaughan, and they brought some great cases to challenge the residents with.
Case 1
18 month old Standardbred colt who had both front legs caught in the stall yesterday. Lame on the left front limb. The ultrasound images included lateral and medial aspects of the fetlock. On the medial side, there was enlargement and disruption of the collateral ligament near its insertion. The ligament had mottled hyperechoic and hypoechoic areas in this region. Diagnosis: medial collateral ligament desmitis. Recommendations included stress radiographs of the fetlock to evaluate for instability. There is a long and a short component to the collateral ligament, and the long component was featured in these images. The short component runs slightly transverse so may not be seen in the same image.
Case 2
21 year old retired Thoroughbred gelding, grade 4/5 lame on the left hind limb for 2 days. Images of the left hind pastern were presented. The superficial digital flexor tendon was enlarged on the plantaromedial side with a hypoechoic core lesion that occupied 50% of the tendon cross section. This was clearly visible on the sagittal images as well. The lesion involved the medial branch of the SDF at its insertion. Diagnosis: Moderate insertional tendinitis of the medial branch of the SDF. When looking at the lateral branch, there were also mottled areas at the insertion as the tendon fibers splayed outwards as they attached. These are normal findings in this area.
Case 3
11 year old Thoroughbred gelding with grade 3/5 lameness of the right hind limb, of unknown duration. Local anesthesia: abaxial block 0% improvement, distal intertarsal/tarsometatarsal 0% improvement, proximal metatarsal 75% improvement. Ultrasound images of the plantaromedial aspect of the metatarsus extended from 18-28 cm distal to the point of the hock. There was a hypoechoic lesion involving 50% of the cross sectional area of the suspensory ligament. Some normal hyperechoic fibers remained in the central portion of the ligament. Diagnosis: suspensory ligament desmitis. Interesting anatomy points were that the SDF travels over the point of the hock while the DDF travels over the sustentaculum tali medially. So in the proximal images, only the DDF was visible. As the images moved distally the SDF came into view. Recommendations included radiographs to look for sclerosis or avulsion fractures at the origin of the suspensory ligament.
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