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DSH cat Napoleon, 5 years

DSH cat Napoleon, 5 years

R forelimb lameness

With kind permission of the small animal clinic Frankenthal

Diagnosis

Description

A 6 cm long and 4 x 4 mm wide bone fragment is located on the caudo-lateral aspect of the right ulna. The bone fragment begins 2 cm distal to the Tuber olecrani, tapers and ends in a pointed tip. The fragment is sclerotic when compared to the adjacent cortex and is surrounded by a radiolucent rim. A severe brush border periosteal reaction extends from the olecranon along the ulna to end distal of the fragment. The periosteal new bone appears more lucent when compared to the cortical opacity.

An isolated, elongated, smoothly marginated mineral opacity is evident cranial to the humeral condyles.

Radiographic diagnoses

  • Sequestrum right ulna with severe surrounding periostitis
  • Small bony fragment cranial to humeral condyles

Discussion

The changes are suggestive of a traumatic insult which has led to sequestrum formation of the ulna. The small bony fragment cranial to the humeral condyles can also be traumatic in origin and represent for example a chip fracture of the radial head. Differential diagnosis is dystrophic mineralisation of a tendon.

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Labrador Retriever Bella, 9 years

Labrador Retriever Bella, 9 years

Progressive swallowing problems, especially of larger items

Post-contrast sequence

Pre-contrast sequence

With kind permission Dr. G. Viefhues, Small Animal Clinic Ahlen

Diagnosis

Description

The atlanto-occipital and atlanto-axial junctions are surrounded by a cavitating, space occupying lesion which is hypoattenuating to the surrounding soft tissue. The density of the individual cavities is 11-13 HU (density of the neighboring muscles is approx. 80 HU). Another space occupying lesion is located ventral to the M. longus capitis and appears separate from the other masses. It is approx. 3.8cm long, 2.5cm high, 4.1cm wide and results in severe displacement of the pharyngeal roof so that the caudal nasopharynx is completely obliterated. The occipital and temporal bones as well as the atlas (C1) and cranial aspect of the axis (C2) including the dens show a large number of well circumscribed, lytic defects. The space occupying lesion extends into the right caudal cranial fossa which leads to mild displacement and compression of the cerebellar vermis. Brain stem and spinal cord at C1 and C2 are also compressed; mostly from ventral and the sides. Severe, heterogenous and foamy contrast enhancement of the compressing structures in the spinal canal is evident. The space occupying lesions do not contrast enhance.

CT diagnosis

  • Soft tissue neoplasia atlanto-occipital and atlanto-axial junction with bone destruction and compression of cerebellum, pons and spinal cord

Discussion

The changes are suggestive of a myxosarcoma. Differential diagnoses include all other soft tissue tumours; however, the extreme hypodensity of all masses is highly suggestive of a myxosarcoma. The tumor is most likely arising from the atlanto-occipital and atlanto-axial joints, which are continuous which each other. The described masses are therefore most likely connected and part of one tumor mass.

Outcome

Bella was euthanized. The histopathological report confirmed the diagnosis of myxosarcoma.

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DSH cat Lucy, 8 years

DSH cat Lucy, 8 years

Mild cough

With kind permission Dipl.med.vet. TA Hennig

Diagnosis

Description

Body condition score (BCS) 5-6/9. The skeletal structures are physiological. The caudo-ventral liver lobe is rounded and extends just beyond the costal arch. A moderate amount of air is present in the stomach. The gastric axis is parallel to the ribs. A soft tissue structure with a triangular cranial outline is evident ventro-caudal to the stomach; its caudal component is not included in the view (tail of spleen). As far as included in the images, the retroperitoneal and peritoneal detail is good.

The thoracic volume is physiological and the contour of the diaphragm is relatively straight.

The left hemithorax is filled with a soft tissue opaque mass extending from rib 6 to the diaphragm. The contour of the mass is slightly rounded on the cranial, ventral and medial aspects. Silhouette signs exists between mass, heart and left diaphragm. Carina and cardiac shadow have been displaced ventrally and to the right by the mass; the left main stem bronchus is also displaced ventrally. The lobar bronchus for the diaphragmatic lobe (right caudal lobe) can only be appreciated just caudal to the carina.

The cardiac silhouette shows no obvious changes. The pulmonary vessels also appear physiological.

Radiological diagnoses

  • Space occupying lesion left caudal thorax
  • Aerophagia
  • Slightly rounded caudo-ventral liver lobe

Discussion

The most likely cause for the mass is a tumour in the left caudal lobe. Differential diagnoses include granuloma and abscess.

A diaphragmatic rupture can be ruled out due to a physiological position of the stomach. An extra-pleural mass is also unlikely due to the described radiographic appearance.

The aerophagia is most likely stress related however, small intestinal loops are not included in the views thus chronicity cannot be ruled out entirely. Aerophagia due to dyspnea is a differential diagnosis.

The rounded appearance of the ventral liver lobe is most likely due to the projection of the gall bladder over the hepatic contour which is a physiological occurrence in the feline species. The prominence can be the result of prolonged inappetence but outflow obstruction is a differential diagnosis.

Outcome

Histo-pathology revealed a carcinomatous process in the lung; most likely a broncho-alveolar carcinoma. Adenocarcinoma is a differential diagnosis.

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DSH cat Charly, 12 years

DSH cat Charly, 12 years

Palpable abdominal masses

With kind permission of Drs. David and Krützfeldt, Small Animal Clinic Frankenthal

Diagnosis

Description

The radiographs are of diagnostic quality; both lateral and VD views are slightly rotated.

Body condition score (BCS) 5/9.

The disc spaces T12-L3 are narrow and the endplates are deformed.

The abdominal detail is good. Both renal shadows are severely enlarged. The right renal shadow is 5.5 and the left 4 x the length of the vertebral body of L2 (normal: 1.9 – 3.2x the length of L2 vertebral body). The renal contours are smooth. Their shape is oval with loss of the characteristic indentation at the level of the renal hilus. The opacity is that of soft tissue. The renal enlargement causes a severe mass effect with displacement of the adjacent organs. The stomach contains a moderate amount of food and is cranially displaced; its caudal contour is concave. The intestinal tract is severely displaced ventrally. The small intestine is mostly empty and the colon contains formed faeces and gas. The other abdominal structures appear physiological.

Radiological diagnoses

  • Severe bilateral renomegaly
  • Degenerative disc disease T12-L3

Discussion

Differential diagnoses in case of bilateral renomegaly with smooth surfaces, physiological shape and opacity include perirenal pseudocyst, diffuse, infiltrative neoplasia such as lymphoma and hydronephrosis.

Outcome

On ultrasound a large amount of anechoic, subcapsular fluid surrounded both kidneys. This is compatible with perirenal pseudocyst (bilateral).

Perirenal pseudocyst describes a peri-renal, mostly subcapsular, fluid accumulation which usually represents a transudate. The cause is unknown. Often chronic renal disease is present though a causative effect has yet to be proven.

US image: with kind permission of the Small Animal Clinic Frankenthal

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Staffordshire terrier Gizmo, 10 years

Staffordshire terrier Gizmo, 10 years

Bilateral toe dragging hind limbs, progressive paraparesis

T2 weighted

T2 weighted

T1 weighted without contrast

T1 weighted with i.v. contrast

With kind permission Dr. O. Lautersack, Tierärztliche Klinik für Chirurgie Ettlingen

Diagnosis

MRI description

In the T2 weighted images all included discs show a varying degree of signal loss of the nucleus pulposus. A moderate to severe degree of spondylosis is located at the TL junction and the first three lumbar vertebrae. An approx. 2cm long mass is present to the L of the spinal cord at the level of L2. At the level of the intervertebral foramen L1/2 it causes compression and displacement of the spinal cord to the right. Centrally over L2 the spinal cord is completely abnormal. The transverse images do not indicate if the spinal cord is completely infiltrated or merely severely displaced and compressed. On the T2 weighted dorsal image a “Golf-T sign”, which represents widening of the subarachnoid space, is present cranial and caudal to the lesion. In the T2 weighted images the mass is of heterogeneous hyperintensity, in the T1 weighted images it is hypointense with strong enhancement. A thin structure without contrast enhancement is evident ventral and to the R of L2; its signal intensity is that of the normal spinal cord.

On the sagittal views only part of the LS junction is included. The LS disc appears to protrude moderately into the spinal canal, replacing the ventral epidural fat so that it comes into contact with the cauda equine.

MRI diagnoses

  • Intradural, mostly extramedullary and partially intramedullary mass level with L2
  • Generalised disc degeneration
  • Spondylosis TL junction and cranial L-spine
  • Cauda equine compression secondary to disc protrusion

Discussion

The list of differential diagnoses includes peripheral nerve sheath tumor, lymphoma, malignant histiocytic sarcoma and meningioma. However, the appearance is not typical for the last three tumor types. Localisation and behavior of the mass also fit the diagnosis of neuroblastoma; however, clinical signs generally begin to show between the first and third year of life. In case the tumor is slow growing, the onset of clinical signs can be delayed until later in life.

Outcome

Photo after durotomy.
With kind permission Dr. O. Lautersack.

Gizmo’s owner elected surgery.

During surgery the tumor was intradurally located and had a greasy, friable consistency. Only a partial resection was possible.

The histological diagnosis was atypical meningioma (Grade II WHO).

Two weeks post operatively “Gizmo” had improved significantly and could walk without signs of paraparesis.

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GSD Tyson, 2 years

GSD Tyson, 2 years

Lameness of both hind limbs with swelling around both tarsal joints

The radiographic changes affect both tarsal joints. The images shown here are of the L tarsus.

With kind permission Drs. Kessler, Kosfeld, Tassani-Prell, Bessmann, Rupp, Delfs, Schmohl, von Klopmann Tierklinik Hofheim.

Diagnosis

Description

A large amount of bridging new bone is present on the dorsal, plantar and lateral aspects of tibia and especially at the tibio-tarsal joint. The surface of the new bone formation is smoot and the opacity heterogeneous. The bone opacity of the talus is reduced.

Radiological diagnosis

  • Bony mass around tarsus with ankyloses of tibiotarsal- and intertarsal joints
  • Severe osteopenia talus

Discussion

The list of differential diagnoses includes multiple cartilaginous exostoses and changes associated with diffuse, idiopathic hyperostosis (DISH). The bilateral symmetrical nature of the changes would be unusual for a traumatic cause. The radiological findings are not compatible with enthesiophytosis or degenerative joint disease.

Due to Wolff’s law, a lack of bone loading results in bone loss; thus the osteopenia of the talus is the result of disuse due to ankylosis. Due to the traction of the Achilles tendon, which causes some loading and thus stimulation of bone turnover, the calcaneus is affected to a lesser degree. Assessment of the degree of osteopenia of the central tarsal and 1st row of tarsal bones is impossible due to superimpositioning. A small degree of osteopenia affecting the distal tarsal bones could be present and could be explained by a small degree of retained movement in the tarso-metatarsal joints.

Outcome

Due to the absence of vertebral abnormalities such as ossification of the ventral longitudinal ligament, as would be expected in DISH, it is likely that “Tyson” is suffering from a form of multiple cartilaginous exostoses.

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Small Münsterländer Samson, 7 years

Small Münsterländer Samson, 7 years

For 4 weeks: swelling lateral to the L eye, no improvement on antibiotics and pain killers: trauma cannot be ruled out.

With kind permission Dr. G. Viefhues, Small Animal Clinic Ahlen

Diagnosis

Description

An approx. 3cm large, mineral dense mass with a granular appearance extends from the zygomatic process of the left maxilla to the zygomatic arch. The mass protrudes slightly into the orbital cavity and causes mild deformity of the globe. The underlying cortex has a slightly roughened surface and shows small, fine osteolytic regions. An extension of the mass into the bone marrow is not evident.

CT diagnosis

  • Bony mass left zygomatic arch

Discussion

The appearance of the tumor is typical for a multilobular tumor of the bone. Other names are osteochonrosarcoma and chondrosarcoma rodens.

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Domestic Shorthair Max, 5 months

Domestic Shorthair Max, 5 months

Unable to stand, staggering in the hindlegs, tumbling over to the side, feed raw diet

Images courtesy of Dr. Gabriele Walb

Diagnosis

Description

Thin body condition with a body condition score (BCS) of 2/9.

Abdominal detail is within normal limits. The small intestinal loops are mainly empty some contain a small amount of gas. The colon and rectum are empty. The urinary bladder is moderately distended.

The overall bone opacity is markedly reduced and there is an increased contrast between cortex and medulla. The cortices are thin. The ventral outline of the sacrum shows a dorsal convex bulge at the level of sacral vertebra 2. S2 is shortened. On the lateral radiograph an abrupt ventral angulation of the pelvic bones is visible cranial to the acetabula. On the ventrodorsal radiograph both iliac bones show a medial deviation with step formation and folding of the cortex just cranial to the acetabula. Axis deviation is more pronounced on the left side than on the right side. The hip joint spaces appear narrowed cranially. The right tibia and fibula show widening of the proximal metaphysis with mild lateral axis deviation. The fibula shows folding of the lateral cortex.

Radiographic diagnoses

  • Severe generalised osteopenia
  • Pathological fractures of the right and left ilium, with possible involvement of the acetabula, and the right tibia and fibula
  • Suspicion of pathological fracture 2nd sacral vertebrae

Discussion

The changes are compatible with hyperparathyroidism, most likely a secondary, nutritional hyperparathyroidism, especially when considering the diet given in the history. Primary or secondary renal hyperparathyroidism cannot be ruled out, however both are less common and therefore less likely.

Surgical treatment of the pathological fractures is not necessary as they are in various stages of healing.

The changes are compatible with hyperparathyroidism, most likely a secondary, nutritional hyperparathyroidism, especially when considering the diet given in the history. Primary or secondary renal hyperparathyroidism cannot be ruled out, however both are less common and therefore less likely.

Surgical treatment of the pathological fractures is not necessary as they are in various stages of healing.

Outcome

Three days after changing to a commercial diet “Max” was already able to walk. The following X-ray, taken 1 months later, shows the increased mineralisation of the skeleton after the dietary change. The axis deviation due to the pathological fractures however remained.

1 month later

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GSD Dexter, 8 weeks

GSD Dexter, 8 weeks

Mucohemorrhagic nasal discharge, painful swelling left maxilla

Images courtesy of Kleintierklinik Greven. Dres. Böhmer, Cordes, Möller and Wienker

Diagnosis

Description

Large expansile, cystic lesions are visible in the right maxilla surrounding the crowns of the unerupted permanent 4th premolar (PM4), as well as of the 1st and 2nd molar (M1 and M2). The oral part of the cortex is partially disrupted at the level of M1 and M2. No connection to the nasal cavity is visible. Large expansile, cystic lesions are also surrounding the unerupted permanent mandibular incisor teeth.

After contrast medium administration moderate, heterogenous contrast uptake is visible within the cystic lesion in the right maxilla and in the incisor part of both mandibles.

A severe reduction in the number of nasal turbinates is present in both nasal cavities. The remaining turbinates appear plump. Material isodense to soft tissue is present between the remaining turbinates. The nasopharyngeal meatus is narrowed and contains a moderate amount of material isodens to soft tissue, which circumferentially occupies approximately 60% of its diameter.

Severe enlargement of the mandibular and the medial retropharyngeal lymph nodes is present bilaterally (left > right).

Radiographic diagnoses

  • Expansile, osteolytic bone lesions associated with the crowns of the unerupted permanent teeth (P4, M1 and M2 right maxilla, incisor teeth both mandibles)
  • Bilateral reduction in nasal turbinates
  • Soft tissue material between remaining nasal turbinates
  • Lympahdenomegaly mandibular and medial retropharyngeal lymphnodes

Discussion

The changes are suggestive of dentigerous cysts. As differential diagnosis odontogenic keratocysts should be considered. However, odontogenic kertocysts are rare in dogs. Differentiation of the various odontogenic cysts required histopathology examination of the wall of the cysts.

The changes in the nasal cavity are suggestive of a congenital hypoplasia of the nasal conchae with secondary bacterial infection. As a differential diagnosis to a simple conchael hypoplasia a ciliary dyskinesia with or with situs inversus (Kartagener Syndrom) should be considered. A chronic bacterial rhinitis with secondary destruction of the nasal conchae is less likely due to the young age of the dog.

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Maltese dog Lizzy, 5 months

Maltese dog Lizzy, 5 months

Cough

Images courtesy of Tierklinik Hofheim. Dres Kessler, Kosfeld, Tassani-Prell, Bessmann, Rupp, Delfs, Schmohl, von Klopmann

Diagnosis

Description

Thin animal with with a body condition score (BCS) of 3/9. Expiratory lateral and inspiratory ventro-dorsal radiographs. The diaphragm is not clearly visible due to silhouetting with the pulmonary changes. The liver is of homogenous soft tissue opacity.

The caudo-ventral liver margin extends beyond the costal arch, the caudal end is not included on the radiograph.

The lung parenchyma is increased in opacity. The periphery of the lung, especially close to the diaphragm, shows a patchy, confluent soft tissue opacity. The lung vessels cannot be identified in these areas and airbronchogramms are present. Centrally the lung is less severely affected. Thick and ill-defined doughnuts and tramlines are present. However, faint airbronchogramms are also evident.

The bronchus for the cranial lung lobe is wide and tapers late, suggestive of dyspnoea.

Ribs 1-8 are parallel with large intercostal spaces compatible with dyspnoea. The lung lobes extend to rib 12 on the lateral and rib 11 on the DV.

Radiographic diagnoses

  • Peripheral alveolar infiltrates with a central broncho-alveolar lung pattern
  • Ribs 1-8 are parallel with large intercostal spaces compatible with dyspnoea. The lung
    lobes extend to rib 12 on the lateral and rib 11 on the DV, also compatible with dyspnea

Discussion

The list of differential diagnoses for peripherally accentuated alveolar infiltrate is short and includes infection with Angiostrongylus vasorum and lung infarcts. Centrally, in the less severe affected areas, peribronchial infiltrate is present. The combination of peripheral alveolar and a central peribronchial infiltrate is highly suspicious for an infection with Angiostrongylus vasorum. Bronchial changes are not expected in a case of lung infarcts.

Outcome

Fine needle aspirate of the lung confirmed infection with lung worms. Lissy was dewormed and showed a full recovery.

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