Portfolio X-ray

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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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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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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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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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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Crossbreed dog Pack, 8 years

Crossbreed dog Pack, 8 years

Heart murmour and coughing

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

Diagnosis

Description

Normal body condition with a body condition score (BCS) of 4/9. Deeply inspiratory view; cranial diaphragmatic crus level with T13. Mild rotation of the lateral radiograph, left and right costo-chondral junctions not at the same level. Bony structures are normal. The diaphragm is intact. The liver is of homogenous soft tissue opacity.

The caudo-ventral liver margin extends beyond the costal arch (due to the deep inspiration) but is pointed.

The stomach contains food material and gas.

The trachea runs parallel to the spine. The carina is elevated. Mild splitting of the main stem bronchi on the lateral view.

On the dorsoventral (DV) radiograph the main stem bronchi are laterally displaced ; the left main stem bronchus and its continuation into the left lobar bronchus is not visible.
The caudal vena cava (CVC) runs from caudoventral to craniodorsal .

Severe enlargement of the cardiac silhouette is present.
On the lateral view the cardiac silhouette occupies 4,5 intercostal spaces with increased sternal contact; the cardiac silhouette occupies 95% of the thoracic height. The caudal border is straight and there is loss of the caudal waist. Severe tenting/enlargement of the left atrium is present.

On the DV view the cardiac silhouette occupies 90% of the thoracic width. The cardiac silhouette appears almost round . A large bulge is present between 1 to 4 o’clock (point of maximum bulging is at 3 o’clock =region of the left auricle) followed by a slight flattening of the cardiac contour. The caudal aspect of the cardiac silhouette appears rounded. Caudal to the bifurcation the cardiac silhouette shows a centrally increased opacity, with a clear convex border superimposed onto the remaining cardiac silhouette.

The pulmonary vessels are difficult to see. On the lateral radiograph the pulmonary arteries and veins are larger than the proximal third of the third rib and are thus enlarged. On the DV view the caudal lobar vessels are larger than the 9th rib at the intersection of vessels and rib. The veins are slightly larger than the arteries.

The lung shows a generalized increased opacity, esp. in the caudodorsal lung field. Airbronchograms view are visible on the DV.

Radiographic diagnoses

  • Severe, generalized cardiomegaly with a more pronounced left sided enlargement
  • Dilated pulmonary vasculature with the veins slightly larger than the arteries
  • Alveolar lung infiltrate caudal lung lobes

Discussion

The course of the CVC and the elongated cardiac silhouette are due to an enlargement of the left ventricle. Loss of caudal waist, double opacity and bulge between 1-4 o’clock are compatible with an enlargement of left atrium and displacment of the left auricle. That there is only mild splitting of the main stem bronchi on the lateral radiograph is most likely due to the mild rotation of the radiograph obscuring the splitting. The lack of visibility of the left main stem bronchus and its continuation into the left lobar bronchus points toward a displacement and compression due to the enlarged left atrium.

The overall round appearance of the cardiac silhouette on the DV radiograph is most likely related to the deep chested conformation with an upright position of the heart. The round caudal aspect can in addition be due to the enlarged left atrium forming the visible caudal contour.
One common cause for enlargement of the left atrium and auricle in an aged dog is degenerative mitral valve disease. Enlargement of the left ventricle can occur secondary to volume overload, as the increased blood volume in the left atrium enters the ventricle during diastole. The impression of an additional right sided cardiomegaly can be artificial due to displacement of the right side of the heart by the severely enlarged left side or can be due to a concurrent tricuspid valve insufficience (degenerative or congenital (latter being less likely)).

The differential diagnosis is dilated cardiomyopathy which can lead to enlargement of all 4 chambers. However, there is flattening of the cardiac contour at the level of the left ventricle (straightening between 4-5 o’clock on the DV view). The enlargement of the left atrium is more severe than that of the left ventricle. Atrial enlargement occurs secondary to eccentric ventricular enlargement (dilatation) in DCM, thus a more severe enlargement of the left ventricle would be expected.

Another differential diagnosis includes congenital mitral valve dysplasia. The advanced age does not exclude a mild form of congenital disease and the changes could represent a late phase of the disease process. The enlargement of the right side of the cardiac silhouette may be due to similar reasons as discussed for degenerative mitral valve disease.

Dilatation of the pulmonary veins in combination with an alveolar lung pattern is compatible with cardiogenic pulmonary oedema due to left heart backward failure as a result of decompensation.

Outcome

Severe mitral valve insufficiency due to degenerative mitral valve disease with severe enlargement of the left atrium and left ventricle.

Mild tricuspid insufficiency without significant atrial or ventricular enlargement.

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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.

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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.

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Domestic Shorthair Samson, 7 years

Domestic Shorthair Samson, 7 years

Weight loss

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

Diagnosis

Description

Thin body condition.

Collapse of the intervertebral disc space L7/S1 with sclerosis of the adjacent vertebral endplates and associated ventral spondylosis. Moderate ventral spondylosis is also present at L5 to L7. The last rib on the right side shows at its mid portion circular smooth and solid periostal new bone formation, the opacity is slightly reduced compared to the rib. The rib appears sclerotic centrally.

The diaphragm is intact. The visible part of the thorax is unremarkable.

The abdominal serosal detail is reduced centrally.

The liver is visible within the rib cage and is of homogenous soft tissue opacity. The stomach is moderately dilated and contains gas. Two populations of small intestinal loops are present. In the central abdomen a C-shaped, gas containing small intestinal loop is visible. It extends from caudo-dorsally from level L6 to L4, curves ventrally at L4 and terminates caudo-ventrally level with L5. It is approximately 3 times the height of the vertebral body of L5. At close inspection a second dilated intestinal loop is evident parallel to the ventral body wall and immediately caudal to the loop described above. It contains fluid and small gas bubbles. Caudal to the caudo-dorsal end of the gas containing dilated intestinal loop the gas containing descending colon is visible. The colon can be traced cranially, where it contains formed faecal material and is superimposed onto the described dilated intestinal loop. The remaining small intestinal loops are unremarkable containing small amounts of gas and fluid.

The dilated, gas filled intestinal loop is visible as a ring like structure in the central left abdomen. The spleen is visible along the left lateral abdominal wall. Kidneys and urinary bladder are unremarkable.

Radiographic diagnoses

  • Two populations of small intestinal loops are present, one of which shows a focal, severely dilated gas- and fluid content
  • Reduced abdominal serosal detail
  • Solid, smooth periostal reaction 13th rib right side
  • Collapsed intervertebral disc space L7/S1 with sclerosis of the end plates and ventral spondylosis

Discussion

The changes are compatible with a mechanical ileus.
This can be due to an intraluminal foreign body, mural changes, e.g. neoplasia, or extramural changes, e.g. stricture. Differentiation between the different aetiologies is not possible radiographically. The reduced abdominal serosal detail is most likely due to the reduced body condition. A perforation with peritonitis and a mild amount of ascites cannot be excluded though no free abdominal gas is evident.

Changes affecting the last rib are compatible with an old, healed rib fracture.

The collapsed intervertebral disc space L7/S1 with sclerosis of the end plates and ventral spondylosis is most likely related to chronic disc degeneration and herniation.

Outcome

In surgery an intestinal mass was found, which lead to the mechanical ileus. The mass was removed. On patho-histology the mass was confirmed as an intestinal adenocarcinoma. The cat recovered uneventfully and was discharged a couple of days later.

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