Angel 12 year old F Airedale Terrier

Transcription

1 December 2014 Dr. Norman Ackerman served the University of Florida, College of Veterinary Medicine with distinction as Professor of Radiology from 1979 to A concerned teacher of veterinary students and residents of all disciplines, Dr. Ackerman also reached the veterinary scientific community through his writing. His numerous clinically pertinent publications are still today a vital part of the veterinary literature; therefore, it is appropriate this site perpetuates Dr. Ackerman s dedication to teaching. This site is presented in recognition of Dr. Norman Ackerman and his contributions to the field of veterinary diagnostic imaging. Sponsorship of the display supports the Dr. Norman Ackerman Memorial Fund, dedicated to the teaching of diagnostic imaging residents at the University of Florida College of Veterinary Medicine.

2 Angel 12 year old F Airedale Terrier 2

3 History and case presenta6on Angel presents to your clinic for further evalua6on of her le; limb lameness of 1 week dura6on. The owner also noted a discolored vulvar discharge which began today. At presenta6on Angel is very weak and unable to walk. On physical examina6on, Angel has pink mucous membranes, CRT >3 sec, RR 35 bpm, HR 100 bpm, F, no murmur and strong synchronous pulse. Angel is severely painful and cries whenever any manipula6on or palpa6on is tried. Your plan includes radiographs of the abdomen. 3

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10 Findings There is a tubular so; 6ssue opaque structure in the mid caudal abdomen, ventral to the colon and dorsal to the urinary bladder, measuring approximately 25 mm in diameter. 10

11 Addi6onally, there is a large, ill- defined, so; 6ssue opaque structure, with smooth margins, in the mid- cranial ventral abdomen, caudal to the liver. This structure is best seen on the right lateral projec6on and it is thought to represent the splenic tail. 11

12 The serosal abdominal detail is adequate. 12

13 Moreover, narrowing of the disc spaces at T13- L4, the lumbosacral space and throughout the caudal thoracic spine is noted. In addi6on there is moth- eaten end plate lysis at T8-10 and T13- L4. Associated ventral spondylosis deformans is seen throughout this region. 13

14 Par6cularly, the L7- S1 intervertebral disc space is severely narrowed with sclerosis of the vertebral end plates and moderate spondylosis deformans. 14

15 There is also the presence of mild, smoothly marginated osseous prolifera6on on all the lumbar ar6cular facets. 15

16 There is moderate, unstructured inters66al pulmonary paxern in the ventral periphery of the right middle and caudal lung lobes included in the study. 16

17 Conclusion You have found a tubular so; 6ssue opaque structure in the mid caudal abdomen, ventral to the colon and dorsal to the urinary bladder, measuring approximately 25 mm in diameter. In addi6on you noted a large, ill- defined, so; 6ssue opaque structure, with smooth margins, in the mid- cranial ventral abdomen, caudal to the liver, most likely represen6ng the splenic tail. Furthermore, you recognized narrowing of the disc spaces at T13- L4, the lumbosacral space and throughout the caudal thoracic spine. In addi6on moth- eaten end plate lysis at T8-10 and T13- L4 was noted. Associated ventral spondylosis deformans was seen throughout this region. Also, you found a moderate, unstructured inters66al pulmonary paxern in the ventral periphery of the right middle and caudal lung lobes included in the study. These radiographic abnormali6es are consistent with: uteromegaly (differen6als include: pyometra, hydrometra, mucometra or hemometra); mul$focal thoracic and lumbar discospondyli$s with severe lumbosacral spinal degenera6ve changes, mild osteoarthrosis of the ar6cular facets of the lumbar spine and mul6focal thoracic and lumbar intervertebral disc narrowing sugges6ve of intervertebral disc disease; moderate, ventrally distributed, right sided unstructured inters66al pulmonary paxern (primary differen6al is aspira6on pneumonia with poten6al fibrosis). 17

18 ... your pa6ent has DISCOSPONDYLITIS! Discospondyli6s is an inflamma6on of the intervertebral disk, associated end plates, and adjacent vertebral bodies, causing destruc6on and prolifera6on of bone. The most common cause is bacterial infec6on with coagulase posi6ve Staphylococci (S. aureus or S. intermedius) being the most frequent isolate. Other frequently iden6fied bacteria include Streptococcus, Escherichia coli, and Brucella canis. Fungal infec6ons have also been reported. Discospondyli6s most commonly arises from hematogenous spread of organism to the disc space, subsequently extending to the adjacent vertebrae. Infec6on may originate from bacteriemia associated with urogenital tract infec6ons, skin or dental disease, and valvular endocardi6s. The diagnosis is ul6mately based upon demonstra6ng the bony lysis of the vertebral end plates with vertebral body osteolysis, shortening of the vertebral bodies and prolifera6ve sclerosis and osseous bridging and narrowing of disc spaces in later stages. However development of the radiographic abnormali6es may take 2 to 6 weeks a;er infec6on. Unremarkable findings cannot rule out the existence of discospondyli$s as it can take $me for radiographic changes to develop. Pyometra is an infec6on of the uterus which occurs under the control of hormones produced by the intact female dog. The most common pathogen causing pyometra is E.coli. Angel uterine and blood culture resulted posi$ve for E.Coli During surgery, Angel s spleen was found to be abnormal and folded in on itself, so it was removed prophylac6cally in order to avoid post- op splenic torsion. Pathology report revealed a par6al splenic torsion. 18

19 DISCOSPONDYLITIS Inflammatory Diseases of the Spine in Small Animals. Tipold A, Stein VM. Vet Clin Small Anim (40) Discospondyli6s is defined as an inflamma6on or infec6on of the intervertebral disk and osteomyeli6s in adjacent vertebral end plates and bodies. Discospondyli6s most commonly arises from hematogenous spread of organism to the disc space. Primary source can be the urogenital tract, skin or dental disease, valvular endocardi6s, migra6ng foreign bodies (such as grass awns), extending body organ abscesses, iatrogenic trauma (such as spinal surgery or fenestra6on) and epidural injec6ons. Discospondyli6s typically affects young to middle aged dogs. Purebread, large- breed and male dogs are more o;en affected. It is very rare in cats. Clinical signs are variable. They range from systemic depression, anorexia, fever and weight loss to s6ffness and reluctance to walk and jump. Spinal or paraspinal hyperesthesia is the most characteris6c sign. Extension of inflamma6on can lead to neurologic signs due to extradural compression and to meningi6s and meningomyeli6s. The course of the disease is usually slowly progressive but vertebral pathologic fractures or intervertebral disc protrusion can lead to acute deteriora6on of clinical signs. The sites most commonly affected are L7- S1, caudal cervical, midthoracic, and thoracolumbar spine. The diagnosis is sugges6ve from pa6ent history and physical and neurological examina6ons. A defini6ve diagnosis is made on the basis of characteris6c findings on radiographs. Blood and urine cultures should be obtained before star6ng an6bio6c therapy. An aggressive long- term an6bio6c therapy for at least 2-4 months is mandatory. Analgesics may be necessary. Prognosis is usually favorable if neurological signs are mild, unless mul6ple lesion, vertebral fracture, instability or disloca6on occurs. Prognosis may be guarded in dogs with fungal infec6ons or infec6on with Brucella canis (!!! zoonosis!!!). 19