Radiology Package 27

Tumors etc.

8-year old DSH“Tom”

• Hx: Lameness of the right hind limb for ~2 weeks. There is a palpable mass on the distal femur. The patient is FIV+.

8-year old DSH“Tom”

• RF– Right femur

• There is a proliferative mass arising from the medial cortex of the distal femur.• At the origin of the mass the endosteal surface of the femoral cortex is thickened and irregular in

appearance.• The mass causes protrusion of the soft tissues on the medial aspect of the limb.

– Thorax• The cardiac silhouette is within normal limits for size.• The pulmonary vessels are of normal diameter.• There is a mild diffuse interstitial lung pattern present that is consistent with normal aging

change.• Multiple nodules of soft tissue to mineral opacity are present in the lung fields.

• RD– Proliferative bone lesion of the distal medial femur– Lung metastasis

• R/O– Parosteal osteosarcoma

10-year old Doberman“Kelsa”

• Hx: The dog is presented for evaluation of swelling of the right distal radial region. The swelling has progressed rapidly in the last 3-4 weeks. The dog has been non-weight bearing on the limb for the past 2 weeks.

10-year old Doberman“Kelsa”

• RF– There is a large lytic lesion in the distal radius.– The lesion involves the metaphyseal region and extends proximally into the distal diaphysis.– There is no clear demarcation between the abnormal lytic bone and normal bone.– The cortices are thin in the lytic area, especially on the cranial and medial aspects of the bone.– A pronounced sunburst periosteal reaction is present on the cranial aspect of the bone. The periosteal

reaction continues onto the medial surface of the bone.– There is marked thickening of the soft tissues in the region of the lytic lesion.– There is osteoarthritis of the carpal joint seen as proliferation of the bone on the distal margin of the

accessory carpal bone.

• RD– Aggressive bone lesion of the right distal radius

• R/O– Osteosarcoma– Chondrosarcoma– Fibrosarcoma

• Next– Thoracic radiographs

5-year old Akbash“Yaman”

• Hx: Three week history of weight-bearing lameness. Swelling on the left forelimb proximal to the carpus.

5-year old Akbash“Yaman”

• RF– There is patchy appearance of the distal radius. This is due to a small area of lysis

interspersed with areas of bony reaction.– The lesion involves the metaphyseal region and extends proximally into the distal diaphysis.– A short spiculated periosteal reaction is present on the cranial, caudal and medial aspects of

the distal radius.– The periosteal reaction continues onto the media surface of the bone.– There is thickening of the soft tissues in the region of the radial lesion.

• RD– Aggressive bone lesion of the left distal radius consistent with a osteogenic primary tumor

• R/O– Osteosarcoma– Chondrosarcoma– Fibrosarcoma

• Next– Thoracic radiographs

9-year old Rottweiler“Roxanne”

• Hx: 6 years ago this patient had surgery to repair a cranial cruciate ligament rupture of the left stifle. Roxanne is presented for evaluation of an acute onset of non-weight bearing lameness of the left hind limb of 1 days duration.

9-year old Rottweiler“Roxanne”

• RF– Examination shows a large soft tissue mass caudal to the joint.– In the bones there are several sites of lysis including areas on the femoral condyles, caudal

aspect of the distal femur and the caudal aspect of the tibia.– Lysis of the patella is also evident.– Osteophyte formation is present on the femoral condyles, in the region of the extensor

process fossa, on the intercondylar eminences, on the lateral femoral condyle and at the margin of the tibial plateau.

– A large enthesiophyte is present on the tibial tuberosity in the area of attachment of the patellar ligament.

• RD– Osteoarthritis– Multifocal lytic bone change in both the femur and the tibia– Large soft tissue mass centered at the joint

• R/O– Synovial cell carcinoma– Fibrosarcoma– Chondrosarcoma

Chesapeake bay retriever “Becky”

• Hx: In 2004 “Becky” was presented for evaluation of an acute onset of non-weight bearing lameness of the right hind limb. She had jumped off the deck (height of 1.5 feet) that morning and was immediately lame. In 2006 “Becky” was presented for evaluation of lameness of the right forelimb.

Chesapeake bay retriever “Becky”

• RF– 2004

• There is a spiral fracture of the mid-shaft of the right tibia.• There is increased lucency of the entire medullary cavity of the tibia.• Multifocal opaque areas of variable size are scattered throughout the

medullary cavity creating a patchy appearance.• Smooth periosteal response is present on the cranial and medial aspects of

the tibia at approximately the junction of the metaphysis and distal diaphysis.

– 2006• A subtle focal area of lucency is present at the junction of the proximal

humeral metaphysis and the diaphysis. • The area of lucency is poorly defined.• A focal lucency is present within the caudal cortex of the bone at the level of

the medullary lesion.

Chesapeake bay retriever “Becky”

• RD– 2004

• Bone destruction and periosteal response of the tibia• Pathologic fracture secondary to neoplasia

– 2006• Subtle lesion present in the right proximal humeral metaphysis

• R/O– 2004

• Non-osteogenic primary bone tumor– Hemangiosarcoma– Lymphosarcoma– Liposarcoma– Giant cell tumor– Myeloma

– 2006• Metastatic lesion to bone

• Next– 2004

• Hind limb amputation

– 2006• Radiographs of other bones

7-year Golden Retriever“Rupert”

• Hx: The dog is presented for evaluation of mild lameness of the right forelimb. He is painful to palpation of the left right carpal region.

7-year Golden Retriever“Rupert”

• RF– There is a lytic lesion in the distal radius.– The lesion involves the metaphyseal region and extends proximally into the dstial diaphysis.– There is no clear demarcation between the abnormal lytic bone and normal bone.– The cortices are thin in the lytic area, especially on the cranial and caudal aspects of the bone.– A subtle periosteal response is visible on the medial, cranial, and caudal aspects of the radius

as the proximal margin of the lytic area.– There is mild thickening of the soft tissues surrounding the bone lesion.

• RD– Aggressive bone lesion of the right distal radius

• R/O– Osteogenic primary tumor– Chondrosarcoma – Fibrosarcoma

• Next– Thoracic radiographs to assess for pulmonary metastatic disease.

6-month old Rough Coated Collie“Tia”

• Hx: Left hind limb lameness, draining tracts in metatarsal area.

6-month old Rough Coated Collie“Tia”

• RF– There is a cuff of smooth periosteal bone surrounding the entire 3rd metatarsal

bone. – In the mid-to-distal 3rd metatarsus there are irregularly shaped areas of lucency.– Some of the lucency is the result of bone lysis in the region.– An absence of the periosteal response also contributes to the lucency.– Smooth periosteal response and bone sclerosis is present along the dorsal aspect

of the metatarsal bones.– There is increased soft tissue volume at the level of the phalanges of the 4th digit.– Smooth periosteal response is seen along the margins of the middle phalanx of the

4th digit.

• RD– Semi-aggressive bone process affecting the 2nd and 3rd metatarsal bnones and

middle phalanx of the 4th digit

• R/O– Osteomyelitis

3-year old Labrador Retriever“Mikey”

• Hx: Presented for evaluation of lameness of the right forelimb. The limb is swollen at the level of the mid-humerus and painful to palpation. The dog is febrile.

3-year old Labrador Retriever“Mikey”

• RF– There is a mixed lytic and proliferative lesion of the diaphysis of the humerus.

– Bone lysis is most prominently seen at the lateral margin of the bone in the CC view and centrally in the laterally view.

– Cortical destruction is visible on the lateral and cranial margin of the bone.

– A fluffy periosteal response is seen circumferentially at the level of the lytic lesion. Superimposition of this periosteal response with the humerus creates the patchy pattern that is visible in the medulla.

– There is soft tissue thickening surrounding the bone lesion.

• RD– Aggressive bone lesion of the diaphysis of the right humerus

• R/O– Osteomyelitis

• Bacterial• Fungal

3-year Akbash“Koleu”

• Hx: The dog is presented for evaluation of pelvic limb weakness and muscle wasting. The patient is painful in the hind-end and is unable to walk on slippery surfaces. There is a history of hypercalcemia.

3-year Akbash“Koleu”

• RF– There is a lytic lesion involving the greater trochanter of the right femur extending into the distal

portion of the femoral neck.– The lytic process has caused destruction of the cortical bone in several areas.– A large lytic area with cortical destruction is present in the left tuber ischii.– Tiny indistinct lytic areas are present in the left ischii axial to the large lytic lesion.– There is an incidental finding of a transitional vertebra at the lumbosacral junction.– The vertebral radiograph is under-exposed to better demonstrate the lytic lesions of the spinous

process of T12.

• RD– Multiple lytic bone lesions of the axial or proximal appendicular skeleton

• R/O– Multiple myeloma– Multifocal osteogenic neoplasia (lymphosarcoma)– Metastatic neoplasia

• Next– Bone biopsy

10-year old DSH

• Hx: The cat is presented for evaluation of lameness of the right hind limb. Swelling is present in the right flank region.

R

10-year old DSH

• RF– There is proliferative and lytic lesion arising from the right ilial body and wing.– The lesion is predominantly proliferative with a large irregular and wispy

mineralized mass projecting from the tissues laterally.– A mass of soft tissue opacity is seen surrounding the proliferative response.– Decreased muscle mass of the right hind limb is apparent.

• RD– Aggressive bone lesion of the right ilium

• R/O– Osteogenic primary tumor

• Osteosarcoma