Case 130874: Challenging Cases Challenging Cases.pdf8/16/2017 1 Challenging Cases Dr. Russell Tucker, DACVR Photography by Yann Arthus-Bertrand Case 130874: 8 yr QH Gelding History:

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


History: Acute swelling & lameness RF

Swelling at elbow & distal

= Extra-capsular swelling

No fractures or osseous rxn


Diagnosis?: Acute swelling & lameness RF


US exam: abnormal RF vs normal LF radius

Normal side


US exam: abnormal RF vs normal LF radius

Normal side

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US Dx: muscle tear & edematous swelling

Swollen & disrupted

digital flexor muscles &

superficial hematoma


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


Left front foot


Surgery: bilateral pastern osteoarthrodesis


30 dayspost operative

L

RL

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platescrews

reactive periostealresponse





platescrews

reactive periostealresponse





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



STScentered over TT joint

DIRT fragmentremoved

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Axial slice at medial trochlear ridge

Axial scan



US DX = marked intra-articulartissue proliferation & synovitis



marked intra-articulartissue proliferation*non-weight bearing

weight bearing imaging



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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ICL thickened?Origin of suspensory ligament



Suspensory ligament normal, ICL thickened?, small fluid surrounding ICL



Suspensory ligament origin MCIII endosteal fracture & edema

STIR axSPIR sag



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


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MR exam

Axial STIR Axial Proton Density


Sagittal STIR Axial SPIR

MR: Fat-suppressed sequences


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


L

L

L

Metal probe in draining tract

Soft tissue window

proximal to

navicular

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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


Oblique views = dorsal, palmar & lateral


US = lateral collateral ligament origin


US = lateral collateral ligament mid level


US = lateral collateral ligament insertion to P1

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US = wound over palmar distal MC3


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



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Ventral surface Dorsal surface


SX: non-ossifying fibroma


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



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 !!!!!!



Scintigraphy 13 days after presentation



3rd set of rads



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



Orlov-Rostopchine Horse

Questions or Comments?

Documents

Case 130874: Challenging Cases Challenging Cases.pdf8/16/2017 1 Challenging Cases Dr. Russell Tucker, DACVR Photography by Yann Arthus-Bertrand Case 130874: 8 yr QH Gelding History: