The majority of this week’s cases have a musculoskeletal theme. They were all on film radiographs so no images this time.
Case 1
2 yr male neutered Border Collie with lethargy and vomiting. On the abdominal images, there is increased soft tissue opacity in the retroperitoneal space with a mass effect displacing the colon ventrally. There are several segments of small intestine that are mildly gas dilated but not pathologic. Differentials for the retroperitoneal space include hemorrhage (coagulopathy, mass), urine, inflammatory (leptospirosis). Diagnosis: Rodenticide toxicity.
Case 2
2 week old colt lame in the right pelvic limb. There is an ill-defined lucency in the distal lateral femoral condyle on the craniocaudal projection. There is also soft tissue opacity within the joint indicating effusion. Request radiographs of the opposite stifle to compare for a bilateral lesion (developmental) or unilateral (infectious). The left stifle is normal. Differentials for this lesion include osteomyelitis and septic arthritis, less likely a developmental lesion such as OCD considering the location in the lateral condyle. Comment – ultrasound of the stifle to evaluate the meniscus would be appropriate for prognostic information.
Case 3
2 year old TB filly. Acute right hind limb lameness for 11 days. Worsened to 5/5 lame in last few days. Ultrasound of right hind limb just proximal to the fetlock. There is peritendinous lacy tissue between the SDFT and skin, and between the two tendons, likely within the digital sheath. There is an expansile area in the straight sesamoidean ligament which can be explained by non-weight bearing and reduced tension. Differentials are SDFT desmitis at the level of the fetlock with tenosynovitis and SSL desmitis. Diagnosis: septic tenosynovitis with communicating external wound. Comment: the proliferative synovium has a typical lacy appearance and does not swirl as an effusion would.
Case 4
Adult female neutered DSH with 1 week history of pelvic limb lameness and lethargy. Distal soft tiissue swelling around digits 3 and 4 with lysis of P3. Differentials include metastatic pulmonary carcinoma, cellullitis and osteomyelitis, soft tissue neoplasia with local invasion, trauma. Diagnosis: metastasis from primary pulmonary adenocarcinoma. Comment: This is a classic! Pulmonary adenocarcinomas have a predisposition to metastasize to digits in the feline.
Case 5
6 month old male Labrador Retriever with progressive swelling of the right mandible. Skull radiographs – there is a productive lesion originating from the caudal 2/3 of the right mandible. The periosteal reaction is several cm thick, dense, and irregular. Differentials include craniomandibular osteopathy although it is not a typical breed or distribution. Given the assymetry of the lesion, differentials should include infectious causes such as osteomyelitis, osteoblastic osteosarcoma. Diagnosis: CMO. It did not recur after surgery 6 months later.
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