Post on 21-Mar-2020
transcript
8/16/2017
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Challenging Cases
Dr. Russell Tucker, DACVR
Photography by
Yann Arthus-Bertrand
Case 130874:8 yr QH Gelding
History: Acute swelling & lameness RF
Case 130874:8 yr QH Gelding
History: Acute swelling & lameness RF
Swelling at elbow & distal
= Extra-capsular swelling
No fractures or osseous rxn
Case 130874:8 yr QH Gelding
Diagnosis?: Acute swelling & lameness RF
Case 130874:8 yr QH Gelding
US exam: abnormal RF vs normal LF radius
Normal side
Case 130874:8 yr QH Gelding
US exam: abnormal RF vs normal LF radius
Normal side
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Case 130874:8 yr QH Gelding
US Dx: muscle tear & edematous swelling
Swollen & disrupted
digital flexor muscles &
superficial hematoma
Case 130874:8 yr QH Gelding
US exam: compare sides ~ RF vs normal LF radius
Normal side
Argentine Criollo Alpha RollCase 13321517 yr Mule Gelding
History: bilateral severe pastern osteoarthrosis
lameness bilateral forelimbs, swelling over pasterns
Right front foot
Case 13321517 yr Mule Gelding
History: bilateral severe pastern osteoarthrosis
lameness bilateral forelimbs, swelling over pasterns
Left front foot
Case 13321517 yr Mule Gelding
Surgery: bilateral pastern osteoarthrodesis
lameness bilateral forelimbs, swelling over pasterns
30 dayspost operative
L
RL
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Case 13321517 yr Mule Gelding
Surgery: bilateral pastern osteoarthrodesis
lameness bilateral forelimbs, swelling over pasterns
30 dayspost operative
platescrews
reactive periostealresponse
Case 13321517 yr Mule Gelding
Surgery: bilateral pastern osteoarthrodesis
lameness bilateral forelimbs, swelling over pasterns
30 dayspost operative
platescrews
reactive periostealresponse
Case 13321517 yr Mule Gelding
Surgery: bilateral pastern osteoarthrodesis
lameness bilateral forelimbs, swelling over pasterns
30 dayspost operative
L
left
right
non-septic rxn
US Diagnosis: bilateral pastern cellulitis & periostitis secondary to osteoarthrodesis
Case 1222583 yr Arab StallionHistory: OCD L tarsus DIRT arthroscopic Sx
1 month ~ post operative hock swelling
STScentered over TT joint
DIRT= distal intermediate ridge of the tibia
Case 1222583 yr Arab StallionHistory: OCD L tarsus DIRT arthroscopic Sx
1 month ~ post operative hock swelling
STScentered over TT joint
DIRT fragmentremoved
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Case 1222583 yr Arab StallionHistory: OCD L tarsus DIRT arthroscopic Sx
1 month ~ post operative hock swelling
Axial slice at medial trochlear ridge
Axial scan
Case 1222583 yr Arab StallionHistory: OCD L tarsus DIRT arthroscopic Sx
1 month ~ post operative hock swelling
US DX = marked intra-articulartissue proliferation & synovitis
Case 1222583 yr Arab StallionHistory: OCD L tarsus DIRT arthroscopic Sx
1 month ~ post operative hock swelling
marked intra-articulartissue proliferation*non-weight bearing
weight bearing imaging
Case 1222583 yr Arab StallionHistory: OCD L tarsus DIRT arthroscopic Sx
1 month ~ post operative hock swelling
marked intra-articulartissue proliferation with
hypervascular synovial lining
Color Doppler hypervascularity
Dx =synovial hypertrophy & effusion secondary to septic joint1 month post operative for OCD of intermediate tarsal ridge
Case 133681:11 yr QH mare pole racer
History: acutely RF lame following race, blocks to proximal MCIII
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Case 133681:11 yr QH mare pole racer
History: acutely RF lame following race, blocks to proximal MCIII
ICL thickened?Origin of suspensory ligament
Case 133681:11 yr QH mare pole racer
History: acutely RF lame following race, blocks to proximal MCIII
Suspensory ligament normal, ICL thickened?, small fluid surrounding ICL
Case 133681:11 yr QH mare pole racer
History: acutely RF lame following race, blocks to proximal MCIII
Suspensory ligament origin MCIII endosteal fracture & edema
STIR axSPIR sag
Case 133681:11 yr QH mare pole racer
History: acutely RF lame following race, blocks to proximal MCIII
Suspensory ligament origin MCIII fracture & edema*US negative but MRI positive for acute osseous injury
dorsal
palmar
6 yr QH gelding reining horse
RF lame 9 mo duration
Hoof testers+
PDN+
Rads “normal” 6 mo ago
Ref DP view
Navicular Radiography
Sclerosis, loss cortical-medullary distinction & cortex erosion
6 yr QH gelding reining horse
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MR exam
Axial STIR Axial Proton Density
6 yr QH gelding reining horse
Sagittal STIR Axial SPIR
MR: Fat-suppressed sequences
6 yr QH gelding reining horse
Flexor Cortex Degeneration & DDF adhesionsHarley, 3 yr Gelding QH3 wks severe LH lameness, ? Heel puncture
? navicular fx
Ref radiography
Harley, 3 yr Gelding QH3 wks severe LH lameness
L
L
L
navicular
lateral Fx
Harley, 3 yr Gelding QH3 wks severe LH lameness
L
L
L
Metal probe in draining tract
Soft tissue window
proximal to
navicular
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Harley, 3 yr Gelding QH3 wks severe LH lameness
L
Abscess + navicular Fx
with cortical erosion,
DDF lesion & fistula tract
Case 133358 10 yr Quarter Horse GeldingHistory: 2 months swollen RF fetlock
Proximal & lateral STS & MC3 osseous proliferation
Case 133358 10 yr Quarter Horse GeldingHistory: 2 months swollen RF fetlock
Oblique views = dorsal, palmar & lateral
Case 133358 10 yr Quarter Horse GeldingHistory: 2 months swollen RF fetlock
US = lateral collateral ligament origin
Case 133358 10 yr Quarter Horse GeldingHistory: 2 months swollen RF fetlock
US = lateral collateral ligament mid level
Case 133358 10 yr Quarter Horse GeldingHistory: 2 months swollen RF fetlock
US = lateral collateral ligament insertion to P1
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Case 133358 10 yr Quarter Horse GeldingHistory: 2 months swollen RF fetlock
US = wound over palmar distal MC3
Case 133358 10 yr Quarter Horse GeldingHistory: 2 months swollen RF fetlock
US = collateral ligament injury
US = ? Adhesions to SDF
Case 133358 10 yr Quarter Horse Gelding
Dynamic imaging
US = No adhesions to SDF
Case 13926212 yr THB MareRF chronic lameness, +/- PDN
Case 13926212 yr THB MareRF chronic lameness, +/- PDN
Case 13926212 yr THB MareRF chronic lameness, +/- PDN
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Case 13926212 yr THB MareRF chronic lameness, +/- PDN
Ventral surface Dorsal surface
Case 13926212 yr THB MareRF chronic lameness, +/- PDN
SX: non-ossifying fibroma
Case 13926212 yr THB MareRF chronic lameness, +/- PDN
DLPMO
DMPLO
3 yr SB filly, acute LF lame & carpal STS 10 d post IA inj corticosteroids
~ intercarpal joint effusion w/suppurative joint fluid tap
Tentative Dx: septic arthritis with….
Systemic ABs
I-A ABs
Arthroscopic assessment (no findings) & lavage
Filly became non-weight-bearing
No growth from synovial fluids & membrane
3 yr SB filly, acute LF lame & carpal STS 10 d post IA inj corticosteroids
~ intercarpal joint effusion w/suppurative joint fluid tap
Recheck rads 6 days after presentation
DLPaMO
*extremely painful & difficult to position correctly for radiographs
L-MD-Pa
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DDX: septic arthritis, still aggressively treated with….
Systemic ABs
I-A ABs
2nd arthroscopic lavage (no findings)
The filly stayed non-weight-bearing
No growth from synovial samples
Stablemate was presented w/ septic fetlock joint !!!!!!
3 yr SB filly, acute LF lame & carpal STS 10 d post IA inj corticosteroids
~ intercarpal joint effusion w/suppurative joint fluid tap
Scintigraphy 13 days after presentation
3 yr SB filly, acute LF lame & carpal STS 10 d post IA inj corticosteroids
~ intercarpal joint effusion w/suppurative joint fluid tap
3rd set of rads
3 yr SB filly, acute LF lame & carpal STS 10 d post IA inj corticosteroids
~ intercarpal joint effusion w/suppurative joint fluid tap
Aspergillus fumigatus isolated from joint fluid of stablemate
Switched to systemic iconazole & regional voraconazole perfusion
And…
Responded almost immediately to anti-fungal therapy
BUT, never isolated a pathogen…
Thanks to Matt Stewart, Univ. of Illinois
3 yr SB filly, acute LF lame & carpal STS 10 d post IA inj corticosteroids
~ intercarpal joint effusion w/suppurative joint fluid tap
Orlov-Rostopchine Horse
Questions or Comments?