Diagnostic value of whole body bone scan in horses

Scintigraphy is widely used in the assessment of musculoskeletal disorders and often it is considered as a screening tool in lame or poor performing horses. It is proved that nuclear scintigraphy is useful in highlighting the presence of lesions undetectable by clinical examination, in horses that do not respond to local analgesic blocks or with intermittent lameness[1]. Despite the usefulness of bone scan is proven, in a recent report, Quiney et al. observed that false-negative results predominate and may lead to missed diagnosis[2]. The aim of this study is to analyze the diagnostic usefulness of whole body bone scan in horses referred for lameness or poor performance. For this retrospective study, bone scans acquired at the Ospedale Veterinario Universitario di Lodi between July 2014 and February 2019 were reviewed. In the study have been included only horses that had a whole body bone scan. On the basis of the history, horses were classified as poor performing, for localized lameness or non-localized lameness. Scintigraphic findings were organized in five categories: definitive diagnosis, localization of the lameness, no findings related to the present clinical signs, findings of unlikely clinical significance and findings that need further investigations. A contingency table and a chi-squared test were used for the statistical analysis. One hundred and eighty horses underwent scintigraphy and 102 were included in the study; twenty-one horses were referred for lameness localized using diagnostic analgesia while in 44 horses the source of lameness was not identified. Thirty-seven horses had an history of poor performance. Statistical analysis highlighted that the only correlation between clinical history and scintigraphic findings was between horse referred for poor performance and findings of unlikely clinical significance (59,5% of horses with a poor performance diagnosis). A final diagnosis or localization of the source of pain were observed respectively in the 5.9% and in the 29.4% of horses. In 11 subjects (10.8%) were found increased radiopharmaceutical uptakes (IRU) of uncertain clinical significant that needed further investigations using analgesic blocks. In the 20% of cases, all referred for lameness, no findings related to the present clinical signs were found. In order to increase the capability of bone scintigraphy, it is mandatory to consider that the sensitivity and specificity are higher in specific regions[2] and the interpretation of the relevance of IRU must be based on detailed clinical examination. In conclusion, we confirm that whole body bone scintigraphy should not be considered a diagnostic screening especially in poor performing horses and that localization of lameness can improve the possibility of a positive result. [1] Dyson S.J. Musculoskeletal scintigraphy of the equine athlete. Semin Nucl Med, 44:4-14, 2014. [2] Quiney L., Ireland J., Dyson S.J. Evaluation of the diagnostic accuracy of skeletal scintigraphy in lame and poorly performing sports horses. Vet Radiol Ultrasound, 59:477-489, 2018

Peribulbar block in equine isolated heads : development of a single needle technique and tomographic evaluation

Peribulbar block (PPB) has been used in humans as a safer alternative to retrobulbar block (RBB). PBB, depends on the diffusion of anaesthetic solution into the muscle across the connective tissue and it is performed introducing the needle within the extraconal space. The advantages are fewer complications and palpebral akinesia. In Veterinary Medicine few studies describe this technique in dogs and cats (Shilo- Benjamini et al., 2013). The aim of the study is to determinate, in equine specimens, feasibility of inferior PBB with single needle injection, by using contrast medium (CM), and to evaluate thought Computed Tomography (CT) the distribution of the injected volume and regional anaesthesia likelihood. PBB was performed in 10 orbits. The mixture injected consisted of 20 ml of physiological solution and iodinated CM at 25%. Each periorbital area underwent three CT scans. A basal acquisition to assess the needle position before the injection, a second and third scan were performed immediately after injection, and after application of pressure on the periorbital surface area to promote CM diffusion. The injectate distribution at the base and within the extraocular muscle cone (EOMC) and around the optic nerve was evaluated and scored based on Shilo-Benjamini\u2019s work of 2017. The mean minimum distance between the tip of the needle and the optic was 2,23 mm \ub10,2. The mean volume distribution before pressure application was 23.56 cm3 \ub1 2.58 and after pressure application was 27.56 cm3 \ub1 4.8. The CM median distribution around the optic nerve at the base of the EOMC was of 117\ub0 prior pressure and 189\ub0 after pressure. The CM distribution within the EOMC was present in 1 orbit prior pressure and in 3 orbits after pressure. The CM distribution at the base of EOMC was considered unlikely to provide regional anaesthesia in 2 orbits, possible in 3 orbits and likely in 5. In the present study, intraconal distribution was not consistent. For this reason, the likelihood of achieving regional anaesthesia was evaluated at the EOMC base where through the optic foramen the oculomotor, trochlear nerve, ophthalmic branch of the trigeminal nerve, and the abducens travel to reach the orbit together with the optic nerve. Whereas the maxillary branch of the trigeminal nerve passes through the foramen rotundum (Carastro 2004). Therefore, despite the lack of intraconal distribution if the EOMC base had good distribution then it was considered likely to provide regional anaesthesia. This approach needs to be evaluated in clinical trials to assess its feasibility and effectiveness in locoregional anaesthesia; moreover, further investigations on equine PBB are mandatory with higher volumes of injectate and different approaches

Continuous rate infusion of dexmedetomidine vs subcutaneous administration in anaesthetized horses undergoing MRI examination

Up to 2005, dexmedetomidine use had not been reported in equine. Since then, several experimental and clinical studies have been published. The main reason for this increase relies on its beneficial pharmacological profile, including short half-life and rapid redistribution (1). The aim of the study is to compare the clinical effects and recovery quality after continuous rate infusion (CRI) or subcutaneous administration of dexmedetomidine in horses undergoing general anaesthesia. Fourteen horses scheduled for MRI examination were included. All horses were sedated with acepromazine 0.03 mg kg-1 intravenously (IV) and detomidine 10 \ub5g kg-1 (IV). Anaesthesia was induced with ketamine 3 mg kg-1 (IV) and diazepam 0.04 mg kg-1 (IV) and maintained with isofluorane in 60% oxygen; end-tidal isoflurane concentration was maintained between 1.3-1.4 %. Horses were randomly divided in two groups. Group \u201cDex CRI\u201d received dexmedetomidine intravenously at 1 \ub5g kg-1 hour-1, group \u201cDex SC\u201d received 2 \ub5g kg-1 of dexmedetomidine subcutaneously every 60 minutes. If nystagmus or incessant fighting against ventilator occurred, ketamine rescue at 0.1 mg kg-1 was given. In case of sudden movements, thiopental 0.5-1.0 mg kg-1 IV was given. Ringer\u2019s lactate was given at 3 mL kg-1 hour-1, dobutamine was administered IV and the rate adjusted to maintain MAP>70 mmHg. Controlled mechanical ventilation using intermittent positive pressure ventilation was adjusted to maintain arterial carbon dioxide partial pressure between 38-45 mmHg. Heart rate, invasive arterial blood pressure, arterial blood gases, total dose of dobutamine administered, ketamine rescue needed, urine production were recorded. Time required until extubation and time to attain sternal and standing position were noted. The main anaesthesiologist assessed recovery quality graded on a standard scoring 5-point scale with a score of 1 representing the best recovery (2). Mann-Whitney U test was applied for non-parametric data and T-test for parametric data (p 640.05). There was no statistically differences in physiological intra-anaesthetic parameters, in body weight (kg) (CRI 521\ub153; SC 506\ub176), age (years) (CRI 10.7\ub12.1; SC 10.8\ub14.1), anaesthesia duration (min) (CRI 139\ub19.,7; SC 144\ub116.2), number of ketamine rescue needed (CRI 1\ub11.15; SC 0.5\ub11.13), recovery score (CRI 1.8\ub11,2; SC 1.5\ub10,5). Also time until extubation (min) (CRI 11.5\ub15.0; SC 9.7\ub12.6), time to attain sternal (min) (CRI 41.5\ub112.2; SC 49.7\ub16.0) and standing position (min) (CRI 50.7\ub114.6; SC 57.2\ub16.,0) were not statistically different. There was statistical significance in urine production (L) (CRI 8.0\ub13.5; SC 11.1\ub14.4) and total dobutamine mcg/kg/min (CRI 0.89\ub10.35; SC 0.56\ub10.18). Subcutaneous administration of dexmedetomidine has product similar clinical effects to those achieved with CRI. It has permitted a significative reduction in dobutamine administration and a more stable depth of anaesthesia confirmed by the lower number of rescue ketamine boluses required even if not statistically different. Further studies are required to evaluate different dosages both in CRI and subcutaneous administration

Injuries at the articular surface of the proximal phalanx and third metacarpal/metatarsal bone in horses, detected with low-field magnetic resonance imaging: 13 case (2010-2017)

Introduction Injuries to the fetlock region are common in horses used for athletic purposes and Magnetic Resonance Imaging (MRI) is diffusely used to diagnose bone injuries (1-3). Despite the classification used in human medicine (4), in the equine practice the terms \u201cshort incomplete fracture\u201d, \u201cstress fractures\u201d, \u201cfissure, transchondral fracture\u201d and \u201costeochondral fracture\u201d are often used interchangeably. The purpose of the study was to report the case details, diagnostic imaging findings and outcomes in sport horses with a diagnosis of traumatic injuries at the articular surfaces of metacarpophalangeal and metatarsophalangeal joint (MCPJ/MTPJ) and verify if it is possibile to differentiate between subchondral, chondral and osteochondral fracture using a low-field MRI under general anesthesia. Material and methods Magnetic Resonance examination of horses referred for lameness localised to the fetlock region over a 7-year period were reviewed. Horses were selected for inclusion in the study that had MRI findings suggestive of primary bone lesion involving the articular surface of third metacarpal/metatarsal bone (MCIII/MTIII) or proximal phalanx (P1). Signalment, detailed clinical history, athletic use, MRI findings and follow-up informations were recorded. On the basis of MRI patterns, injuries at the articular surface were classified as osteochondral fractures (OF), chondral fractures (CF), or subchondral fractures (SF) (4). Lesions were identified as an OF when defect of cartilaginous lining and/or signal change of the cartilage layer was observed in association with subchondral bone marrow lesion and arcuate or linear irregular signal change in the subchondral bone. In the SF there was no involvement of the cartilaginous lining, while in the CF there is a displaced fragment and no alteration of the subchondral black line. Results Thirteen horses have been included in the study; five horses were used for show jumping, four for flat race, two for monta vaquera and two for eventing and dressage, respectively. The median age was 8.5 years of age, with a range between 2 and 16 yo. All horses had unilateral lameness, seven horses with acute onset, while six had a chronic lameness (>12 weeks). The degree of lameness varied from grades 2/5 to 4/5. In four horses lameness was localised to the hindlimb. In four horses a subtle, radiolucent, ill-defined line was observed in the radiographic views, suggestive of short incomplete fracture. Six horses had MRI findings suggestive of OF (impacted type) involving the sagittal groove of P1 in three cases, the medial aspect of P1 in one horse and the medial condyle of MCIII/MTIII in two horses. Seven horses had SF at the medial condyle of MCIII/MTIII in three cases, at the lateral condyle of MCIII/MTIII in two cases and involving the sagittal goove of the proximal phalanx in the last two cases. No MRI findings suggestive of CF were observed in the present study. In six horses no other abnormalities were detected while in seven cases additional alterations were observed, including mild desmopathy of MCPJ/MTPJ collateral ligaments, desmopathy of the suspensory ligament branches, oblique sesamoidean ligament alteration or adhesions between deep digital flexor tendon and distal sesamoidean impar ligament. All horses were treated with a period of rest; four horses received a therapy with biphosphonates and one horse was treated with intra-articular jaluronic acid. Median time of the final follow up was 32 weeks (range: 12 to 40 weeks). Of the 13 horses included in the study, nine (69%) were sound and returned to thier previous athletic use. Three horses were still lame due to MCPJ/MTPJ pain while another one was lame due to pain localised to the suspensory ligament origin. Conclusion In equine practice, the terms osteochondral fractures, tranchondral fractures, short fracture and incomplete fracture were used interchangeably. Differentiating between osteochondral and subchondral fractures is mandatory for an accurate prognosis (4). Even if low-field MRI has a low sensitivity in detecting articular surface damage (3,5), in the present study was possible to discriminate between OF and SF in all cases. Fat-suppressed images had the capability to enhance occult bone lesions like bone marrow traumatic damage. Fat-suppressed and T1-Weighted sequences allowed to detect defect in the overlying articular surface. Despite the results reported by Gold et al. (2017) in the present study 70% of cases returned to previous athletic levels (1). Considering that all horses with a diagnosis of subchondral fracture were sound at the time of re-check while horses still lame had osteochondral fracture, we can speculate that subchondral fracture has a better prognosis. In our study all horses underwent a period of rest and none received a surgical management. Differentiating between SF and OF could help the surgeon in the treatment choice, conservative in case of subchondral injuries and surgical when cartilage involvement was detected (6,8). In the report of Smith at all. (2017), of 12 cases with a diagnosis of short incomplete fracture or osteochondral fracture, 11 returned to race after surgical repair. Even if radiographic examination can, in some cases, identify short incomplete fractures, magnetic resonance examination allows to evaluate the presence of cartilage involvement, bone marrow lesions and simultaneous soft tissue abnormalities (6). The early diagnosis of these lesions is mandatory to prevent repetiteve loading on damaged bone and possible extension to the cortex (7) that can led to catastrophic injuries In conclusion, MRI has to be considered the best imaging technique in the evaluation of an incomplete fractures, in order to differentiate between osteochondral and subchondral fractures for the elective treatment of a specific pathological entity

Injuries at the articular surface of bone in horses detected with low-field magnetic resonance imaging: 13 cases (2010-2017)

Aim of the study The purpose of the study was to report the case details, diagnostic imaging findings and outcomes in sport horses with a diagnosis of traumatic injuries (osteochondral, chondral and subchondral fractures) at the articular surfaces of metacarpophalangeal and metatarsophalangeal joint (MCPJ/MTPJ). Material and methods Magnetic Resonance (MRI) examination of horses referred for lameness localised to the fetlock region over a 7-year period were reviewed. Horses were selected for inclusion in the study that had MRI findings suggestive of primary bone lesion involving the articular surface of third metacarpal/metatarsal bone (MCIII/MTIII) or proximal phalanx (P1). Signalment, detailed clinical history, athletic use, MRI findings and follow-up informations were recorded. On the basis of MRI patterns, injuries at the articular surface were classified as osteochondral fractures (OF), chondral fractures (CF), or subchondral fractures (SF) (1). Lesions were identified as an OF when defect of cartilaginous lining and/or signal change of the cartilage layer was observed, in association with subchondral bone marrow lesion and arcuate or linear irregular signal change in the subchondral bone. In the SF there was no involvement of the cartilaginous lining, while in the CF there is a displaced fragment and no alteration of the subchondral black line. Results Thirteen horses have been included in the study; five horses were used for show jumping, four for flat race, two for monta vaquera and two for eventing and dressage, respectively. All horses had unilateral lameness, 12 horses with acute onset, while six had a chronic lameness (>12 weeks). The degree of lameness varied from grades 2/5 to 4/5. In four horses lameness was localised to the hindlimb. In four horses radiographic findings suggestive of short incomplete fractures were observed. Six horses had MRI findings suggestive of OF (impacted type) involving the sagittal groove of P1 in three cases, the medial aspect of P1 in one horse and the medial condyle of MCIII/MTIII in 2 horses. Seven horses had SF at the medial condyle of MCIII/MTIII in 3 cases, at the lateral condyle of MCIII/MTIII in 2 cases and involving the sagittal goove of the proximal phalanx in the last two cases. In six horses no other abnormalities were detected while in seven cases additional alterations were observed, including mild desmopathy of MCPJ/MTPJ collateral ligaments, desmopathy of the suspensory ligament branches, oblique sesamoidean ligament alteration or adhesions between deep digital flexor tendon and distal sesamoidean impar ligament. All horses were treated with a period of rest; four horses received a therapy with biphosphonates and one horse was treated with intra-articular jaluronic acid. Median time of the final follow up was 32 weeks (range: 12 to 40 weeks). Of the 13 horses included in the study, nine (69%) were sound and returned to thier previous athletic use. Three horses were still lame due to MCPJ/MTPJ pain while another one was lame due to pain localised to the suspensory ligament origin. Conclusion In equine practice, the terms osteochondral fractures, tranchondral fractures, short fracture and incomplete fracture were used interchangeably. Differentiating between osteochondral and subchondral fractures is mandatory for an accurate prognosis (1). Even if low-field MRI has a low sensitivity in detecting articular surface damage (2, 3), in the present study was possible to discriminate between OF and SF in all cases. Despite the results reported by Gold et al. (2017) in the present study 70% of cases returned to previous athletic levels (4). All horses with a diagnosis of SF were sound at the time of re-check while horses still lame had OF. In our study all horses underwent a period of rest and none received a surgical management. Differentiating between SF and OF could help the surgeon in the treatment choice, conservative in case of subchondral injuries and surgical when cartilage involvement was detected (5). Even if radiographic examination can identify short incomplete fractures, magnetic resonance examination allows to evaluate the presence of cartilage involvement, bone marrow lesions and soft tissue abnormalities (5). In conclusion, MRI has to be considered the best imaging technique in the evaluation of an incomplete fractures, in order to differentiate between OF and SF and opt for the elective treatment of a specific pathological entity

Injuries at the articular surface of the proximal phalanx and third metacarpal/metatarsal bone in horses, detected with low-field magnetic resonance imaging: 13 case (2010-2017)

Introduction Injuries to the fetlock region are common in horses used for athletic purposes and Magnetic Resonance Imaging (MRI) is diffusely used to diagnose bone injuries (1-3). Despite the classification used in human medicine (4), in the equine practice the terms \u201cshort incomplete fracture\u201d, \u201cstress fractures\u201d, \u201cfissure, transchondral fracture\u201d and \u201costeochondral fracture\u201d are often used interchangeably. The purpose of the study was to report the case details, diagnostic imaging findings and outcomes in sport horses with a diagnosis of traumatic injuries at the articular surfaces of metacarpophalangeal and metatarsophalangeal joint (MCPJ/MTPJ) and verify if it is possibile to differentiate between subchondral, chondral and osteochondral fracture using a low-field MRI under general anesthesia. Material and methods Magnetic Resonance examination of horses referred for lameness localised to the fetlock region over a 7-year period were reviewed. Horses were selected for inclusion in the study that had MRI findings suggestive of primary bone lesion involving the articular surface of third metacarpal/metatarsal bone (MCIII/MTIII) or proximal phalanx (P1). Signalment, detailed clinical history, athletic use, MRI findings and follow-up informations were recorded. On the basis of MRI patterns, injuries at the articular surface were classified as osteochondral fractures (OF), chondral fractures (CF), or subchondral fractures (SF) (4). Lesions were identified as an OF when defect of cartilaginous lining and/or signal change of the cartilage layer was observed in association with subchondral bone marrow lesion and arcuate or linear irregular signal change in the subchondral bone. In the SF there was no involvement of the cartilaginous lining, while in the CF there is a displaced fragment and no alteration of the subchondral black line. Results Thirteen horses have been included in the study; five horses were used for show jumping, four for flat race, two for monta vaquera and two for eventing and dressage, respectively. The median age was 8.5 years of age, with a range between 2 and 16 yo. All horses had unilateral lameness, seven horses with acute onset, while six had a chronic lameness (>12 weeks). The degree of lameness varied from grades 2/5 to 4/5. In four horses lameness was localised to the hindlimb. In four horses a subtle, radiolucent, ill-defined line was observed in the radiographic views, suggestive of short incomplete fracture. Six horses had MRI findings suggestive of OF (impacted type) involving the sagittal groove of P1 in three cases, the medial aspect of P1 in one horse and the medial condyle of MCIII/MTIII in two horses. Seven horses had SF at the medial condyle of MCIII/MTIII in three cases, at the lateral condyle of MCIII/MTIII in two cases and involving the sagittal goove of the proximal phalanx in the last two cases. No MRI findings suggestive of CF were observed in the present study. In six horses no other abnormalities were detected while in seven cases additional alterations were observed, including mild desmopathy of MCPJ/MTPJ collateral ligaments, desmopathy of the suspensory ligament branches, oblique sesamoidean ligament alteration or adhesions between deep digital flexor tendon and distal sesamoidean impar ligament. All horses were treated with a period of rest; four horses received a therapy with biphosphonates and one horse was treated with intra-articular jaluronic acid. Median time of the final follow up was 32 weeks (range: 12 to 40 weeks). Of the 13 horses included in the study, nine (69%) were sound and returned to thier previous athletic use. Three horses were still lame due to MCPJ/MTPJ pain while another one was lame due to pain localised to the suspensory ligament origin. Conclusion In equine practice, the terms osteochondral fractures, tranchondral fractures, short fracture and incomplete fracture were used interchangeably. Differentiating between osteochondral and subchondral fractures is mandatory for an accurate prognosis (4). Even if low-field MRI has a low sensitivity in detecting articular surface damage (3,5), in the present study was possible to discriminate between OF and SF in all cases. Fat-suppressed images had the capability to enhance occult bone lesions like bone marrow traumatic damage. Fat-suppressed and T1-Weighted sequences allowed to detect defect in the overlying articular surface. Despite the results reported by Gold et al. (2017) in the present study 70% of cases returned to previous athletic levels (1). Considering that all horses with a diagnosis of subchondral fracture were sound at the time of re-check while horses still lame had osteochondral fracture, we can speculate that subchondral fracture has a better prognosis. In our study all horses underwent a period of rest and none received a surgical management. Differentiating between SF and OF could help the surgeon in the treatment choice, conservative in case of subchondral injuries and surgical when cartilage involvement was detected (6,8). In the report of Smith at all. (2017), of 12 cases with a diagnosis of short incomplete fracture or osteochondral fracture, 11 returned to race after surgical repair. Even if radiographic examination can, in some cases, identify short incomplete fractures, magnetic resonance examination allows to evaluate the presence of cartilage involvement, bone marrow lesions and simultaneous soft tissue abnormalities (6). The early diagnosis of these lesions is mandatory to prevent repetiteve loading on damaged bone and possible extension to the cortex (7) that can led to catastrophic injuries In conclusion, MRI has to be considered the best imaging technique in the evaluation of an incomplete fractures, in order to differentiate between osteochondral and subchondral fractures for the elective treatment of a specific pathological entity

Cervical cystic lymphangioma in a young dog: CT findings

Lymphangioma is a rare lymphatic disorder; in veterinary medicine it is still considered a benign tumour, while in human medicine has been recently classified as a Lymphatic Malformation (LM), in fact it probably origins from a failure in development of connections between lympatic and venous system. Reported localizations of canine lymphangioma include skin, subcutaneous and fascial tissue of axilla, limbs, inguinal and mammary regions; lymph nodes; retroperitoneal space; nasopharynx. In the present report we describe the computed tomographic (CT) features of a cervical cystic lymphangioma in a young dog. A 1-year-old intact male Italian Shepherd dog was referred to the primary care veterinarian with a 1-month history of left ventrolateral neck swelling. No other clinical signs were present. Ultrasonographic (US) examination revealed a mass with hyperechoic thick wall, hypoechoic content with hyperechoic fluctuating areas. Fine needle aspiration biopsy (FNAB) revealed a cloudy pinkish fluid, citologically referable to serous-hematic fluid with chronic inflamation. For better assessment of the morphology and of the margins of the lesion, the dog was referred for CT examination. Pre- and post-contrast CT scan of head, neck and thorax were made. A mass located between the muscles of the caudal neck and thoracic/axillary regions (from the level of C4 to the level of T2) was found, which partially occupied the left visceral space of the neck and bulged into the thoracic inlet. The mass was ellipsoid-shaped (40x45x140 mm), with well-defined margins and heterogeneous soft tissue attenuation. It was apparently capsulated, with fluid-like content and soft tissue attenuating septa and small areas within the fluid. Adjacent to the mass three areas of soft tissue mineralization, smoothly marginated, were found. It was responsible for mild mass effect, without significant compression on the surrounding structures. Mild left axillary and left medial retropharyngeal lymphadenomegaly was noted, with normal shape and attenuation of the limph nodes. Post-contrast images showed moderate enhancement of the mass wall and the soft-tissue-attenuating areas/septa within it; no enhancement of the fluid was noted. No other abnormalities were found. The mass was completely surgically excised and submitted for histopathologic analysis, with a definitive diagnosis of cystic lymphangioma. In human literature CT features of lymphangioma are widely described, while in veterinary literature there are no reports about its CT appearance; moreover, human lymphangioma is described as preferentially located in the neck and axillary regions, while, to our knowledge, cervical localization has never been reported before for canine lymphangioma

Planar bone scintigraphy and CT findings in dogs with forelimb lameness

Scintigraphy has been used for many years in veterinary medicine, due to its high sensitivity, for the localization of lameness of unknown origin in horses and for the assessment of thyroid/skeletal neoplasia in dogs. In the last few years bone scintigraphy (BS) has become increasingly used in dogs for the localization of occult lameness, when clinical examination and radiographic exam are inconclusive [1]. This study describes BS and computed tomographic (CT) findings in dogs referred for monolateral forelimb obscure lameness, for which a precise localization had not been found by clinical examination nor radiographic exam (no abnormalities at all, mild radiological abnormalities which could not be related to the grade of lameness or symmetrical bilateral alterations). Eight dogs matched inclusion criteria: 3 mixed breed, 1 Bernese mountain dog, 1 Amstaff, 1 Labrador retriever, 1 Australian shepherd and 1 Boxer. BS images showed intense IRU (Increased Radiopharmaceutical Uptake) of elbow joint in 6 cases; these findings coincided to CT alterations of proximal ulna in 5 dogs (mostly located in the medial coronoid process - MCP region: bone density alterations, evidence of fragmentation, new bone formation). In one of these cases, an intense IRU was observed in correspondence of the region of the flexors attachment, with no concurrent abnormalities on CT examination. These findings were suggestive of an obscure form of flexor enthesopathy. In one case we observed diffuse and intense IRU of the carpus joint; this coincided with arthrosis and the presence of a subchondral cyst. One dog showed only mild IRU of the elbow joint, not compatible with the degree of lameness. Because of lack of significant IRU, CT and MRI examination were performed and revealed the presence of an expansive lesion in correspondence of the brachial plexus roots compatible with PNST (Peripheral Nerve Sheath Tumor). BS' high sensitivity allowed the localization of the lameness thanks to the assessment of functional bone state, as already stated in literature [2]. However, its low specificity required additional imaging (CT, MRI), targeted on the region identified on scintigraphic examination. In our experience, the combined use of functional and morphologic diagnostic imaging techniques (bone scintigraphy and computed tomography- magnetic resonance) has been helpful to reach a definitive diagnosis. Further studies, with an increased sample size, are needed to evaluate whether there is a correlation between bone density changes and grade of IRU in limbs affected by different pathologies

The Frankenstein horses : clinical and diagnostic imaging findings in horses with suture line periostitis

Swellings of the equine frontal area can be caused by inflammation of the craniofacial sutures. Suture line periostitis (colloquial term \u201csuturitis\u201d) results in a firm, usually non-painful swelling in the nasofrontal, maxillary and zygomatic region accompanying epiphora. Instability of the craniofacial suture lines, facial trauma and surgical sinusotomy could be predisposing factors. A definitive diagnosis can be reached with radiography and computed tomography (CT). This study describes clinical, CT and radiographic findings of craniofacial suture lines periostitis in two horses with facial swelling. Two horses developed craniofacial suturitis and were presented with a moderate painful facial swelling, epiphora and mild hyperthermia. A 10 year old, Italian saddle horse, gelding developed clinical manifestation after sinuscopy and positioning of a Foley catheter in the conco-frontal sinus for local treatment of a micotic sinusitis. A 16 year old, Wielkpolska, stallion, developed symptom after frontal synusotomy for the removal of a cystic mass in the left maxillary sinus. A latero-lateral radiographic view of the head in the first horse allowed to recognize bony proliferation, sclerosis and periosteal new bone formation on both sides of the nasofrontal suture. Computed tomography findings in both horses consisted in an intense, irregular periostal thickened bony wall that affected the frontal, lacrimal, zigomatic and maxillary bone. In one case, there was a necrotic bone sequestrum upon the nasofrontal suture line, not detectable on radiographic views. In the second case, the reaction was more intense near the cerclage wires used to fix the nasofrontal flap associated with osteolysis. In both cases the diagnosis was suture lines periostitis. Horses were treated with surgical removal of the necrotic sequester in the first case and the removal of the cerclage wires of the nasofrontal flap in the second one. Sample materials were submitted in both cases for a microbiologial testing and resulted sterile. Horses were administered anti-inflammatory drugs for one week with improvement of the clinical signs. At the 30 weeks follow-up, the owners reported that the nasofrontal swelling and epiphora were no longer detectable. In conclusion, suture line periositits should be included in the differential diagnosis in case of facial swelling expecially in horses underwent to sinus surgery or after an head trauma. In our cases, CT allowed a more accurate assessement of the bony structure and identification of the underlying causes of inflammation