Portfolio landingpage-en

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.

Read More

Maine Coon Lenny, 5 months

Maine Coon Lenny, 5 months

Possible erosive arthritis?

Images courtesy of Tierärztliche Klinik Ahlen. Dr. Gereon Viefhues

Diagnosis

Description

The main pathology is located in the epiphyses.

The proximal and distal epiphysis of both humeri, as well as the proximal epiphysis of both radii and femora are markedly deformed. The epiphyses are reduced in height and even partially absent (shoulder joints); they appear stippled with a heterogeneous opacity. The joint surfaces are markedly irregular incongruent. The underlying bone is sclerotic. Shoulder, elbow and stifle joints show a moderate to severe increase in soft tissue opacity.

Smooth, slightly heterogenous periostal new bone formation is present on the proximal humeral metaphyses resulting in a nose-like caudal protrusion. The underlying bone is sclerotic.

The glenoid cavity of both humeri is shallow. Smooth and solid new bone formation is present on the cranio-lateral aspect of the cranial and caudal acetabular edges.

The right femoral head is collapsed with a flattened cranial aspect. The left femoral head is flattened medially.

The distal epiphyses of both radii, ulnae, both tibial and fibular epiphyses as well as both tibial tuberosities are decreased in height but still result in a smooth articular surface.
The carpal and tarsal bones are of normal size but the bones show a coarse trabecular pattern.
The sacrum consists of only 2 vertebrae. The 3rd sacral vertebra is separate from the second. Otherwise the lumbar spine is unremarkable.

Radiographic diagnosis

  • Epiphyseal dysplasia in the appendicular skeleton with pathological fractures of some of the epiphyses. Associated secondary osteoarthritis

Discussion

Differential diagnoses for epiphyseal dysplasia include mucopolysaccharidosis, mucolipidosis, congenital chondrodysplasia, hypothyroidism and pituitary dwarfism.

In the current case mucopolysaccharidosis is considered the most likely differential diagnosis. Mucolipidosis is possible but very rare and usually lead to less severe epiphyseal changes. A congenital chondrodysplasia is less likely, as this usually leads to delayed of ossification of the small cuboid bone of the carpal and tarsal joint as well, which appear markedly reduced in size. In the case presented here the carpal and tarsal joints are not entirely normal, however the size of the cuboid bones is physiological.

Hypothyroidism is unlikely as changes usually also affect the epiphysis of the spine.
Pituitary dwarfism is unlikely due to the normal appearance of the physes. Pituitary dwarfism leads to delayed physeal closure, epiphyseal changes are also possible but do not represent the main finding.

Read More

Wood pigeon

Wood pigeon

Found, unable to fly

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

Diagnosis

Description

Radius, ulna and tibiotarsal bones show multiple expansile lesions with central osteolysis and thinning of the overlying cortex. Adjacent to the osteolytic areas the bones are sclerotic. A complete fracture through the osteolytic area in the mid diaphysis of the right radius is present. The left ulna shows a fracture at the level of the osteolytic area in the distal metaphysis resulting in severe shortening of the bone and cranial displacement of the radius. Another complete fracture is visible in the distal diaphysis of the right tibiotarsal bone. Soft tissue swelling is present surrounding the fracture sites.

On the lateral radiograph the lung shows a generalised increase in opacity; the liver is enlarged.

Radiographic diagnoses

  • Multifocal, expansile bone lesion
  • Multiple pathological fractures
  • Luxation of the left radius due to a pathologic compression fracture of the left ulna resulting in shortening of the ulna
  • Pulmonopathy
  • Hepatomegaly

Discussion

The changes are compatible with mycobacteriosis. Due to the close bond between the respiratory system and the pneumatised bone, infections often spread between the two organ systems. Pulmonary lesions commonly found in other species are, however, rare in birds.

Osteomyelitis of a different origins will have to be considered as a differential diagnosis.

The hepatomegaly could be caused by hepatic lipidosis, which is common in Wood pigeons. However, a connection between infection and hepatomegaly is also possible. Avian tuberculosis in domestic birds is primarily an intestinal and hepatic disease with dissemination to other organs including the lungs, air sacs, spleen, bone marrow, and skin. In case of infection of liver and spleen enlargement of the organ can occur.

Outcome

The pigeon was euthanized. Histo-pathologic examination confirmed granulomatous osteomyelitis due to mycobacteriosis.

In birds the lung opacity should always be assessed on the lateral radiograph. On ventrodorsal radiographs pseudo-opacification occurs due to superimposition of the pectoral muscles.

Read More

Irish Setter Thor, 12 years

Irish Setter Thor, 12 years

Epileptic seizures

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

Diagnosis

Description

The following sequences are available:

T2 weighted transverse, T2* weighted transverse, T1 weighted transverse pre and post contrast medium administration, FLAIR dorsal

A focal, approx. 0.5cm large, intraaxial lesion is present in the grey matter of the suprasylvian gyrus of the right temporal lobe. Centrally the lesion is hypointense on T1w, T2w and FLAIR images. Peripherally a thin, hypointense rim is visible. On the T2* weighted images a large signal void due to a susceptibility artefact is present.

There are no signs of a mass effect. No significant contrast medium uptake is present.

MRI diagnosis

  • Focal, intraaxial cortical lesion right suprasylvian gyrus with suceptibility artifact

Discussion

The suceptibility artefact is indicative for the presence of haemorrhage.

The most common cause for primary intraaxial bleeding is an amyloidangiopathy. Amyloidangiopathy represents perivascular accumulation of hemosiderin and generally appears as multiple very small, pin point changes. Another cause for primary intraaxial bleeding is a spontaneous rupture of vessels due to systemic hypertension, e.g in case of chronic renal disease.

Most common cause for secondary bleeding into the brain parenchyma is an infection with angiostrongylus vasorum. Further differential diagnoses for secondary bleeding include coagulopathies, such as occur with Cushing’s disease, trauma associated bleeding, tumour associated bleeding (vascular neoplasia, e.g. hemangioendothelioma, primary CNS neoplasia, metastases) or vascular malformations.

Haemorrhagic infarcts in dogs are rare, compared to humans.

Owing to the fact that in this case a single lesion with a relatively large susceptibility artefact is present, bleeding secondary to an infection with Angiostrongylus vasorum is considered the most likely diagnosis.

Furth differential diagnoses include systemic hypertension and coagulopathy. Vascular neoplasia and malformations are rare and therefore considered less likely but cannot be ruled out completely.

Due to the lack of contrast enhancement and the absence of peripheral oedema a brain metastasis is unlikely. Trauma associated bleeding can be excluded as no trauma was reported in the history and there are no changes in the overlying musculature which indicate previous trauma.

Outcome

Fecal examination proved a severe infection with Angiostrongylus vasorum.

The dog was dewormed.

Under therapy with anticonvulsant drugs seizuring was reduced and eventually ceased.

Read More

Irish Wolfhound Bailey, 1 year

Irish Wolfhound Bailey, 1 year

Initially left sided, purulent nasal discharge, later bilateral nasal discharge

CT images from July 2014. At that time unilateral nasal discharge was present.

CT images from March 2015. This time bilateral nasal discharge was present.

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

Diagnosis

Description

Severe reduction in size and number of the turbinates in both nasal cavities. Between the remaining turbinates a mild to moderate amount of soft tissue dense material is present. Within the left frontal sinus soft tissue dense material with a fluid level is present (images flipped horizontally, patient was placed in dorsal recumbency during image acquisition). The mucosal lining of the left frontal sinus is thickened. Findings are almost identical in both CT studies.

Radiographic diagnoses

  • Bilateral reduction in number and size of nasal turbinates
  • Soft tissue dense material between the turbinates
  • Sinusitis with fluid accumulation left frontal sinus

Discussion

Changes are compatible with rhinitis- bronchopneumonia syndrome of the Irish Wolfhound. The etiology is unclear. Immune mediated or primary ciliary defects are discussed. A hereditary background is assumed. Affected dogs show transient or persistent mucoid to mucopurulent nasal discharge of variable degree from birth . Concurrent bronchopneumonia can occur (most likely due to the ciliar dysfunction leading to an increased susceptibility for infection).

No progression of the changes is seen over the one year period. No granuloma is visible in the frontal sinus. The paranasal bones are unremarkable, showing no permeative osteolysis. Therefore a fungal rhinitis is less likely. In addition the dog is very young making a fungal rhinitis unlikely as well.

Recommendations

None.

Normal CT study nasal cavity

A reduction in the number of turbinates is not always related to a destructive rhinitis. Consider congenital hypoplasia predisposing the nasal cavity to infection, especially in young dogs.

Read More

Crossbreed dog Lucky, 9 years

Crossbreed dog Lucky, 9 years

Swallowing problems, respiratory distress

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

Diagnosis

Description

Good body condition. Inspiratory radiograph.

Mild new bone formation visible ventral to T4/5 and T12/13 (spondylosis). Small osteophyte visible at the infraglenoid tubercles of one scapula. Abdominal detail within normal limits.

There is mild convex bulging of the ventral border of the cranial mediastinum. Overall the opacity at the level of the cranial mediastinum appears increased. The trachea runs almost parallel to the thoracic spine with a mild dorsal buldging at the level of the 3rd to 4th intercostal space. Dorsal to the 2nd sternebra a poorly delineated soft tissue opaque structure is visible.

The lung shows an overall, severely increased opacity. Between the cardiac silhouette and the diaphragm it is of almost soft tissue opacity, however the diaphragmatic outline can still be identified. On close inspection also fine white lines can also be seen in the affected areas; they represent vessels. The remaining lung shows more reticular changes. Throughout the entire lung field multiple, soft tissue nodules are visible.

Radiographic diagnoses

  • Severe interstitial pattern with multiple small soft tissue nodules (reticulonodular)
  • Convexity of the cranial mediastinum
  • Soft tissue dens structure dorsal to the 2nd sternebra
  • Spondylosis
  • Mild osteoarthrosis shoulder

Discussion

The lung changes are highly suspicious for a neoplasia (primary versus secondary).

The changes of the cranial mediastinum are suspicious for a cranial mediastinal mass. Differential diagnoses include enlarged cranial mediastinal lymphnodes, mass arising from the oesophagus (neoplasia, granuloma) as well as mediastinal haemorrhage, abcesses, granuloma or inflammation (for example due to perforation of the oesophagus, nocardiosis).

The soft tissue structure dorsal to the 2nd sternebra is most likely an enlarged sternal lymphnode.

The severe opacification caudodorsal to the cardiac silhouette can be due to superimposition of severely altered lung parenchyma. As only a single lateral radiograph is available a caudal mediastinal mass, for example arising from the oesophagus, a hematoma, an abcess or a granuloma cannot be excluded. A second radiograph would be required to assess this change further.

In combination with the lung changes a neoplasia with metastasis to the sternal and mediastinal lymphnodes appears the most likely differential diagnosis.

Recommendations

  • Left lateral and ventrodorsal radiograph
  • And/or Computed tomography of the lung

Outcome

Computed tomography of the thorax confirmed the severe interstitial lung pattern with multiple soft tissue nodules. The sternal as well as the cranial mediastinal lymphnodes were severely enlarged.

Caudal to the heart no other mass lesions were visible, therefore the radiographic changes are most likely due to superimposition of the lung changes.

Lucky had a carcinoma of the larynx with metastasis to the lung and lymphnodes.

A heavy interstitial lung pattern can mimic an alveolar lung pattern. Don’t get fooled by the first impression. On close inspection there are usually still some vessels visible.

Read More

Kestrel

Kestrel

Found, no history provided

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

Diagnosis

Description

The left scapula shows a fracture line at the level of the scapular neck with craniomedial displacement of the fragment. The left clavicle also shows a fracture line. The coracoid is intact. Soft tissue swelling is present surrounding the left shoulder joint. On the lateral radiographs the fracture lines are not clearly visible due to superimposition.

On both views the silhouette of the liver is severely enlarged. On the ventrodorsal radiograph the thoracic and abdominal air sacs are only partially visible lateral to the enlarged liver. On the lateral radiograph an ovoid, soft tissue opaque structure is visible centrally in the coelomic cavity, representing the dorsally displaced proventriculus.

Radiographic diagnoses

  • Fracture of the left scapula and clavicle
  • Hepatomegaly

Discussion

The most likely cause for hepatomegaly is hepatic lipidosis. Differential diagnoses include infectious hepatitis and neoplasia.

Evaluation of the fracture age is difficult. The fracture ends appear blunted, however there is soft tissue swelling surrounding the left shoulder joint. It can be assumed that these are recent fractures with the soft tissue swelling representing a hematoma. The rounded appearance of the fracture margins can be artificial due to the small size of the object leading to slight blurring of small structures.

Read More
WordPress Cookie Notice by Real Cookie Banner