Radiology Packet 43

1
Radiology Packet 43

• Equine Phalanges

2
3 yr old STDB Gelding

• HX presented for an acute onset of lameness in
  the left fore that occurred immediately after
  racing, the horse is sensitive to hoof testers in
  the left fore foot

3
3 yr old STDB Gelding
4
3 yr old STDB Gelding

• RF
• In the DP view there is a linear lucency in the
  lateral aspect of P3, this line is approximately
  parallel to midline and is oriented in a
  different direction than the normal vascular
  channels.
• The DLPMO view provides better visualization of
  the lucent line.
• This line can be seen extending into the distal
  inter-phalangeal joint.
• The opaque material seen along the medial surface
  in the DP and DLPMO views is debris on the
  surface of the hoof.
• RD
• Articular fracture of the lateral aspect of P3
  (Type II)

5
13 yr old Appaloosa GeldingJoker

• HX history of right forelimb lameness and a
  noticeably large pastern

6
13 yr old Appaloosa GeldingJoker
7
13 yr old Appaloosa GeldingJoker

• RF
• Marked narrowing of the proximal interphalangeal
  joint.
• Marked osteophyte formation around the dorsal,
  medial, and lateral margins of P1-2, involving
  the distal periarticular margins of P1 and the
  proximal margins of P2.
• The osteophytes extend well beyond the articular
  margins, to include the distal half of P1 and the
  proximal half of P2.
• Enthesophytes are noted along the palmar surface
  of mid P1, the site of distal suspensory
  ligamentous attachment.
• On the DP radiograph note the very mottled bone
  opacity of distal P1 due to the large amount of
  new bone.
• RD
• Severe degenerative joint disease of the right
  front proximal interphalangeal joint, known as
  high ringbone
• Since the bony reaction extends well beyond the
  articular margins and includes mid P2,
  non-articular ringbone is also present

8
2 yr old STDB Colt

• HX grade 3 of 4 lame in the right hindlimb

9
2 yr old STDB Colt

• RF
• There is a subchondral lucency in the
  proximomedial aspect of the middle phalanx.
• The lucent area is irregularly marginated and
  surrounded by sclerotic bone.
• In the lateral view the lucent area is not seen
  as a distinct structure but there is an
  appearance of mixed opacity in the dorsoproximal
  middle phalanx.
• Careful evaluation (hotlight) shows an irregular
  periosteal response on the dorsal aspect of the
  second phalanx which seems to be located at the
  distal margin of the lucent lesion.
• RD
• Subchondral bone cyst of the proximal middle
  phalanx
• Next
• Surgical curettage could be considered, however
  with a cyst in this location, secondary
  osteoarthritis will likely occur and the
  prognosis for soundness is fairly poor.

10
4 yr old Grade GeldingBobby

• HX presented for evaluation of bilateral
  forelimb lameness

11
4 yr old Grade GeldingBobby

• RF
• The osseous structures of the right forelimb
  (left film) are normal in appearance.
• In the left forelimb there is osteophyte
  formation at the extensor process of the third
  phalanx (right film).
• RD
• Degenerative joint disease (osteoarthritis) of
  the distal interphalangeal joint of the left
  forelimb (low ringbone)

12
3 yr old Arabian Colt

• HX presented for evaluation of a left forefoot
  lameness that has been going on for three weeks

13
3 yr old Arabian Colt

• RF
• There is a large round lucency located centrally
  within the distal phalanx.
• A sclerotic margin surrounds the area of lucency.
• In the lateral view remodeling of the
  dorsoproximal third phalanx is evident.
• This has resulted in change in shape of the
  extensor process and narrowing of the distal
  interphalangeal joint dorsally.
• RD
• Subchondral bone cyst of the third phalanx
• Next
• Surgical curettage

14
1 yr old Belgian FillyCandy

• HX the filly is grade 4 of 5 lame in the left
  hindlimb and has been for one month

15
1 yr old Belgian FillyCandy

• RF
• There is a sibchondral lucency in the distomedial
  aspect of the proximal phalanx.
• A rim of sclerotic bone surrounds the lucency.
• In the DP view the lucency appears to extend to
  the articular surface of the bone.
• RD
• Subchondral bone cyst of the distal proximal
  phalanx
• Next
• Surgical curretage, however with a cyst in this
  location, secondary osteoarthritis will likely
  occur and the prognosis for soundness is fairly
  poor.

16
6 yr old Hanoverian StallionTwol

• HX acute RF lameness isolated to the foot

17
6 yr old Hanoverian StallionTwol
18
6 yr old Hanoverian StallionTwol

• RF
• A large, wide radiolucent line is present in the
  medial quarter/heel of P3 on the DP view.
• Lucent curvilinear shadow seen on the lateral
  view from the edge of P3 coursing to near the
  navicular bone.
• The DMPLO view nicely shows the linear lucency,
  extending from the solar margin to the very edge
  of the joint.
• A large, ovoid osseous bony structure is present
  associated with the extensor process of P3 on the
  lateral view.
• Mild periarticular osteophyte formation on the
  dorsoproximal surface of P2 is present.
• RD
• Non-articular Type I fracture of the medial wing
  of right front P3
• Type IV P3 fracture, an extensor process fracture
• Mild degenerative joint disease of the P1-2 joint

19
3 yr old STDB Colt

• HX acutely non-weight bearing lame in left
  hindlimb at the end of a race, a cast was applied
  to the limb prior to transporting the horse

20
3 yr old STDB Colt

• RF
• Fracture lines are seen extending from the
  sagittal groove of the proximal phalanx and
  coursing in a disto-lateral direction.
• The fracture exits at the plantaro-lateral aspect
  of the articular surface of the bone.
• The fracture is minimally displaced.
• In the DP view 2 fracture lines are visible in
  the proximal portion of P1, this is actually a
  single fracture line with 2 surfaces (dorsal and
  plantar), because the x-ray beam is not exactly
  aligned with the fracture, both surfaces are
  visible.
• Cast materials surrounds the limb making
  evaluation of the soft tissues difficult.
• RD
• Non-displaced sagittal fracture of the proximal
  phalanx extending from the articular surface of
  the metatarsophalangeal joint to the articular
  surface of the proximal interphalangeal joint

21
9 yr old Canadian Hunter MareJessica

• HX foot abscess

22
9 yr old Canadian Hunter MareJessica

• RF
• There is a discrete well-circumscribed lucent
  defect in the lateral margin of the third
  phalanx.
• The bone adjacent to the defect is slightly
  irregular in appearance.
• The areas of increased opacity associated with
  the soft tissues of the hoof are debris on the
  solar surface.
• RD
• Osteomyelitis of the third phalanx

23
6 mo old Belgian FillyImperial Julie

• HX swollen left hind fetlock

24
6 mo old Belgian FillyImperial Julie
25
6 mo old Belgian FillyImperial Julie

• RF
• Several various sized osteochondral fragments
  associated with the proximal mid-sagittal ridge
  of distal MT3.
• The sagittal ridge is irregular here, indicating
  a bed from which the fragments arose.
• Soft tissue swelling of the fetlock joint is
  noted.
• RD
• OCD of the sagittal ridge of left metatarsal 3
• Next
• Radiographic examination of the remaining
  fetlocks, as well as the tarsi.

26
5 yr old STDB GeldingBlu Meadow Chance

• HX acute RF lameness isolated to the foot, two
  views were taken at the time of injury, plus a DP
  view 6 months later

27
5 yr old STDB GeldingBlu Meadow Chance
28
5 yr old STDB GeldingBlu Meadow Chance

• RF
• The first films show the presence of a linear
  lucency traversing from the solar margin of P3
  laterally toward the corner of the distal
  interphalangeal joint.
• The recheck film shows this lucent line is still
  quite evident.
• RD
• Type II RF P3 fracture
• The follow up films show a fracture line, however
  P3 fractures often heal by fibrous, not osseous
  union, so it may be as healed as it will ever be
  and if the horse is sound nothing further needs
  to be done

29
10 yr old Morgan MareEmma

• HX The horse fell in a ditch on a trail ride,
  after the accident she was non-weight-bearing
  lame on the right hind for 3 days. The lameness
  improved to a grade 4 of 5 but has gotten no
  better.

30
10 yr old Morgan MareEmma

• RF
• There is a fracture extending from the
  dorsomedial margin to the extensor process of the
  third phalanx.
• In the lateral view there is osteophyte formation
  on the extensor process of the third phalanx.
• Irregular periosteal response is present on the
  dorsal margin of the second phalanx.
• RD
• Fracture of the third phalanx (Type III)
• Degenerative joint disease of the distal
  interphalangeal joint