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