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Han dbook of Small A n i mal Rad i ology a n d

Ultrasou n d
Commissioning Editor: Robert Edwards
Development Editor: Louisa Welch
Project Manager: Vijayakumar Sekar
Designer: Kirsteen Wright
Illustration Manager: Gillian Richards
Handbook of Small
Animal Radiology
and Ultrasound
Techniques and Differential Diagnoses

Ruth Dennis MA, VetMB, DVR, DipECVDI, MRCVS
Animal Health Trust, Newmarket, UK

Robert M. Kirberger BVSc, MMedVet(Rad), DipECVDI
Onderstepoort Veterinary Academic Hospital, University of Pretoria, South Africa

Frances Barr MA. VetMB, PhD, DVR, DipECVDI, MRCVS
School of Veterinary Science, University of Bristol, Bristol, UK

Robert H. Wrigley BVSc, MS, DVR, DipACVR, DipECVDI, MRCVS
University Veterinary Teaching Hospital, University of Sydney, Australia

Foreword by Donald E. Thrall DVM, PhD

SECOND EDITION

Illustrations by Debbie Maizels and lonathan Clayton-lanes

ELSEVIER Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2010
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UVINGSTONE
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First edition © Harcourl Publishers Limited 2001
Second edition © Elsevier Limited 2010.

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vii

Foreword

I am honoured to introduce the second edition of imaging abnormalities have been identifiedf lists
the Handbook of Small Animal Radiology and Ultra­ of considerations are provided for each sign. These
sound: Techniques and Differential Diagnosesf written considerations can then be compared to the his­
by Ruth Dennisf Robert Kirbergerf Frances Barr tOryf signalment and physical and clinical findings
and Robert Wrigley. Each of these highly qualified allowing rational prioritization of real diseases.
radiologists is a seasoned expertf having taught the This prioritization can then be used to tailor further
principles of imaging to veterinary students and diagnostic tests or therapeutic interventions. One
residents for many years. Their experience in trans­ fact about imaging is that if one has never heard
mitting knowledge about how to interpret diagnos­ of a diseasef it cannot be diagnosed. Consultation
tic imagesf coupled with collective decades of with this resource will increase ones familiarity
clinical acumenf provides a level of credibility with possibilities that need to be considered.
matched by few other textbooks focused on facili­ As beforef this book is not an all-inclusive imag­
tating the image interpretation process. ing textf nor will it be useful without some pre­
PersonallYf for nearly 40 yearsf I have struggled existing experience in imaging interpretation.
with determining how to best instruct people effi­ Howeverf this does not detract from the value of
ciently in image interpretation. I have come to the this work - on the contraryf this resourceful publi­
conclusion that everyone learns a bit differently and cation fills a much-needed gap by enhancing the
at a different rate. The effectiveness of different maturation of the image interpreter. The most com­
instructional methodologies also varies between stu­ petent radiologists are not just readers of roentgen
dents. Most radiologic imaging instruction is based signs. They are consultants to animal ownersf prac­
on actual patient materiat i.e. images of sick animals titioners and other specialists. Effective consulta­
that have been produced in the clinic. In this work the tion requires making sense of the observed
message is based on drawings where the pathologic roentgen signs. Information contained herein facil­
alteration of tissue is demarcated clearly. Though itates taking imaging abnormalities from the
not identical to the clinical images of patientsf these descriptive to the interpretive and formulating that
drawings make it crystal clear exactly what is hap­ information into an effective consultation.
pening in the patient that leads to the appearance of
various tissue alterations in real radiographic and
sonographic images. Understanding tissue altera­
tions at this basic level will be an asset to many who Donald E. Thrall, DVM, PhD
struggle with image interpretation in the clinic. Diplomate ACVR (Radiology, Radiation
The main function of this book is unchanged; OncologY)f Professorf Department of Molecular
that being the intent to order one's thought process Biomedical Sciencesf College of Veterinary
after the radiographic or sonographic abnormal­ Medicinef North Carolina State UniversitYf
ities have been categorized. In other wordsf once Raleigh, NC, USA
ix

Preface

Body systems can only respond to disease or injury diseases listed may occur in cats as well as in dogs.
in a limited number of ways and therefore it is Infectious and parasitic diseases which are not
often impossible to make a specific diagnosis based ubiquitous but which are confined to certain parts
on a single testf such as radiography. Successful of the world are indicated by an asterisk *f and
interpretation of radiographs and ultrasonograms the reader should consult the Table of Geographic
depends on the recognition of abnormalitiesf the Distribution of Diseases in the Appendix for fur­
formulation of lists of possible causes for those ther information. Details of radiographic technique
abnormalities and a plan for further diagnostic (including contrast studies) are included and guid­
testsf if appropriate. This handbook is intended as ance on ultrasonographic technique and a descrip­
an aide menwire of differential diagnoses and other tion of the normal ultrasonographic appearance of
useful information in small animal radiology and organs is given. This second edition of our book
ultrasoundf in order to assist the radiologist to has been expanded considerably with much extra
compile as complete a list of differential diagnoses information about techniques and normal anatomYf
as possible. Schematic line drawings of many of the many new differential diagnosesf more detailed
conditions as well as normal anatomy and variants description of many of the diseases includedf up­
are includedf to complement the text. dating of the Table of Geographic Distribution of
The authors hope that this book will prove use­ Diseases and expanded Further Reading sections.
ful to all users of small animal diagnostic imagingf An addition to the Appendix is a section on digital
from specialist radiologists through general practi­ radiographic film faultsf which is reproduced with
tioners to veterinary students. However it is kind permission from the journal Veterinary Radiol­
intended to supplementf rather than replacef the ogy and Ultrasound. New illustrations by our artist
many excellent standard textbooks available and Debbie Maizels are includedf to add to those from
a certain degree of experience in the interpretation the first edition drawn by Jonathan Clayton-Jonesf
of images is presupposed. and we are indebted to them both for their excellent
The book is divided into sections representing diagrammatic reproduction of the radiographs and
body systemsf and for various radiographic and ultrasonograms.
ultrasonographic abnormalities possible diagnoses A book such as this can never hope to be com­
are listed in approximate order of likelihoodf pletef as new conditions are constantly being
including those due to normal anatomical variation recognized and described. The authors apologise
and technical or iatrogenic causes. Conditions for any omissions there may be and would wel­
which principally or exclusively occur in cats are come comments from readers for possible future
indicated as suchf although many of the other editions.
xi

Acknowledgements

Our thanks go to Professor Don Thrall for kindly Chapter 32 'Abdominal Masses' by Charles R. Root
agreeing to write the foreword to this second in Textbook of Veterinary Diagnostic Radiology 2nd
edition. We also wish to acknowledge assistance edition, edited by Donald E. Thrall and published
and advice from Dr. Gerhard Steenkamp (dental by Saunders. Finally, we would like to thank the
radiology)f Dr. Nerissa Stander (gastrointestinal many people at Elsevier who have supported us
ultrasonography) and Professor Banie Penzhom throughout this project.
(geographic distribution of diseases)f all from
the Faculty of Veterinary Sciencef University of Ruth Dennis
Pretoria. Figures 9.6, 9.14, 9.15, 9.17, 9.18, and 9.19 Newmarketf UK
have been reproducedf with permissionf from November 2009
Chapter 1

Skeletal system: ge n eral

1 .20 Mixed osteolytic-osteogenic
CHAPTER CONTENTS lesions 25
General 1 .2 1 Multifocal diseases 28
1 . 1 Radiographic technique for the skeletal system 1 .22 Lesions affecting epiphyses 29
1 1 .23 Lesions affecting physes 30
1 .2 Anatomy of bone: general principles 2 1 .24 Lesions affecting metaphyses 31
1 .3 Ossification and growth plate 1 .25 Lesions affecting diaphyses 33
closures 3
1 .4 Response of bone to disease or
injury 3
1 . 5 Patterns of focal bone loss GEN ERAL
(osteolysis) 4
1 . 6 Patterns of osteogenesis: periosteal reactions 1 .1 RADIOGRAPHIC TECHNIQUE FOR THE
6 SKE LETAL SYSTEM
1 . 7 Principles of interpretation of skeletal The skeletal system lends itself well to radiographYf
radiographs 7 but it must be remembered that only the mineralized
1 .8 Features of aggressive versus components of bone are visible. The osteoid matrix
non-aggressive bone lesions 8 of bone is of soft tissue radiopacity and cannot be
1 .9 Fractures: radiography, classification assessed radiographically; this makes up 30-35%
and assessment of healing 9
of adult bone. Articular cartilage is also of soft tissue
Bones 1 4 opacity and is not seen on survey radiographs (see
1 . 1 0 Altered shape of long bones 1 4 arthrographYf 2.1). Lesions in the skeletal system
1 . 1 1 Dwarfism 1 5 may be radiographically subtlef and so attention to
1 . 1 2 Delayed ossification or growth plate good radiographic technique is essential.
closure 15 1. Highest definition fihn-screen combination
1 . 1 3 Increased radiopacity within bone 1 6 consistent with the thickness of the area or
1 . 1 4 Periosteal reactions 1 8 appropriate digital radiography algorithm.
1 . 1 5 Bony masses 1 9 2. No grid is necessary except for the proximal
1 . 1 6 Osteopenia 2 1 limbs and spine in larger dogs; in smaller
1 . 1 7 Coarse trabecular pattern 22 jointsf insufficient scattered radiation is
1 . 1 8 Osteolytic lesions 22 produced to warrant the use of a gridf and
1 . 1 9 Expansile osteolytic lesions 24 the presence of grid lines may obscure fine
detail.

© 2010 Els�yi�r Ltd.
2 Handbook of Small Animal Radiology and U ltrasound

3. Accurate positioning and centring with a small Uniformly radiopaque. Thickest where the circum­
object-fihn distance to minimize geometric ference of the bone is smallestf where attached soft
distortion and blurring due to the penumbra tissues exert stress or on the concave side of a
effect. curved bone and taper to nothing in the metaphy­
4. Close collimation to enhance radiographic seal region.
definition by minimizing scatterf and for Diaphysis - The shaft of a long bone; a tube of cor­
radiation safety. tical bone surrounding medullary cavity and can­
5. Correct exposure factors to allow examination cellous bone.
of soft tissues as well as bone. Endosteum - Similar to periosteum but thinnerf
and lines large medullary cavities; it may produce
6. Beware of hair coat debris creating artefactual
bone in some circumstances (e.g. fractures).
shadows.
Epiphysis - The end of a long bone bearing the
7. Radiograph the opposite limb for comparison
articular surfacef which forms from a separate cen­
if necessary.
tre of ossification; cancellous bone with a denser
8. Use wedge filtration techniques if a whole limb subchondral layer.
view is required (e.g. for angular limb Medullary cavity - Fatty bone marrow space in the
deformity); use a special wedge filter or mid-diaphysis; radiolucent and homogeneous.
intravenous fluid bags. Metaphysis - Between the physis and diaphysis;
9. Optimum viewing conditions - dry filmsf cancellous bone. In the young animat it remodels
darkened roomf bright light and dimmer bone from the growth plate into the diaphyseal
facilitYf glare around periphery of fihn masked cortexf hence its external surface may be irregularf
off. especially in large dogs; this is known as the
10. Use a magnifying glass for fine detail; use bone cut-back zone and should not be mistaken for a
specimensf a fihn library and radiographic periosteal reaction or pathological osteolysis
atlases. (Fig. l.1A).
11. For analogue filmf ensure good processing Nutrient foramen - Seen as a radiolucent line run­
technique to optimize contrast and definition. ning obliquely through the cortex and carrying
12. With digital radiography, manipulation of major blood vessels; its consistent location in long
image size and greyscale is readily performed. bones reflects relative growth in length from the
two ends of the bone (it originates centrally in the
fetus). Occasionally it may be in an aberrant
1 .2 ANATOMY OF BO N E : GENERAL
location.
PRINCIPLES (Fig. 1 . l A and B)
Periosteum - Fibroelastic connective tissue sur­
Apophysis - Non-articular bony protuberance for rounding bone except at articular surfaces and
attachment of tendons and ligaments; a separate where muscle fibres and tendons insert; its inner
centre of ossification. layer produces bone by intramembranous ossifica­
Articular cartilage - Soft tissue opacityf therefore tion causing increase in bone diameter.
appears radiolucent compared with bones (unless Physis - Cartilaginous growth plate present in
mineralizing through disease). Provides longitudi­ young animals and seen radiographically as a
nal growth of epiphyses. radiolucent band. Endochondral ossification at the
Cancellous bone - Spongy bone consisting of a physis results in increased length of the bone. Its
meshwork of bony trabeculae; found in epiphysesf width reduces with progressing ossification; after
metaphyses and small bones. A coarse trabecular skeletal maturityf it may be seen as a sclerotic line
pattern is seen where forces are constant and a fine or physeal scar. It provides longitudinal growth
trabecular pattern where they are variable. The of metaphyses and diaphyses.
greater surface area compared with cortical bone Sesamoids - Small bony structures lacking perios­
results in a 40 times greater rate of remodelling in teum that form in tendons near joints; thought to
response to disease or injury. The cancellous bone reduce friction at sites of direction changes.
of skull is called diploe. Subchondral bone - Thinf dense layer of bone
Cortex - Compact lamellar bone formed by intra­ beneath articular cartilage; appears more radi­
membranous ossification from periosteum. opaque than adjacent bone.
Chapter 1 Skeletal system: general 3

Diaphysis ApJphysis
Medullary
cavity
Nutrient
foramen
Cortex
Cut-back
wne
Physeal
Physis scar
(growth (variable)
�ate)
Articular cartilage OIerlying
subchondral OOne
®
Figure 1 . 1 (A) Anatomical features of an immature long bone; (8) anatomical features of a mature long bone.

1 .3 OSSIFICATION AND GROWTH PLATE 1 .4 RESPONSE OF BONE TO DISEASE OR INJURY
CLOSURES
Regardless of causef the pathology of bone
• Skeletal mineralization in dogs and cats begins response is essentially the same. There are only
about two-thirds of the way through pregnancy. two mechanisms: bone loss (focat osteolysis; dif­
fusef osteopenia) and bone production (osteogene­
• This occurs in a preformed cartilage matrix for
sis). A combination of both processes may also
most of the skeleton by endochondral
ossification; the skull forms within membranes occur. Bone is laid down and remodels according
by intramembranous ossification. to Wolffs law - bone is deposited at sites where
it is required and resorbed where it is not; this also
• At birthf ossification is seen radiographically
explains the orientation of trabeculae.
only in diaphyses and skull bones; joints appear
wide because epiphyses are still cartilaginous 1 . Bone loss (see 1 .5 and 1 .1 6)
and therefore radiolucent.
• SubsequentlYf ossification centres appear in • Recognized radiographically after
epiphysesf apophyses and small bones. approximately 7-10 days.
• These secondary ossification centres show • Only the mineralized component of bone is
ragged margination as ossification progresses. visible radiographicallYf and 30-60% of mineral
content must be lost before being detected
• As skeletal maturity approachesf secondary
radiographically.
ossification centres enlarge and become
• Radiography is therefore not a sensitive tool for
smoother in outlinef and physes and the
detecting minor bone loss.
apparent joint spaces therefore become
• Focal bone loss is easier to see than diffuse bone
narrower.
lossf by comparison with adjacent normal bone.
• Some terminology: acJwndroplasiaf absence of
• Bone loss is easier to see in cortical bone than in
cartilage development; cJwndrodysplasiaf
cancellous bonef as cortical bone is more
disordered cartilage development; skeletal
radiopaque.
dysplasiaf disordered skeletal development.
• Osteopenia is a radiological term describing a
generalized reduction in bone radiopacity. It is
Growth plate closure times (dog) due to two different pathological processes:
Radiographic growth plate closure times are vari­ - osteomalacia - insufficient or abnormal
ablef and so a general range is given for each site. mineralization of organic osteoid
In an individual animat closure times will normally - osteoporosis - normal proportions of osteoid and
be the same in right and left limbs (see Table 1.1). mineral componentf but reduced amOilllts.
4 Handbook of Small Animal Radiology and U ltrasound

• Technical factors such as radiographic exposure 2. Bone production (see 1 .6)
and processing must be taken into account when
diagnosing osteopenia - compare the radiopacity • Sclerosis or osteosclerosis used as a radiological
of bone with the radiopacity of the soft tissues. term describes increased bone radiopacity. It can
be due to two different pathological processes:
increased density of bone (e.g. sequestrumf
Table 1 . 1 Growth plate closure times i n dogsa subchondral compactionf enlargement of
trabeculae)
G ROWTH PLATE Superimposed periosteal or endosteal reaction.
CLOSURE TIME
• Apparent sclerosis may also be caused by
Scapular tubt":rosity 4 7 months superimposition of bones (e.g. overlapping
Proximal humerus fracture fragments).
Greatt":r tuberclt": to humeral 4 months • Sclerosis is also a pathological term meaning
ht":ad
literally 'hardening of tissue' and refers to
Proximal t":piphysis 10 13 months
Distal humerus organs becoming hard and useless due to an
Medial to lateral condyle 8 12 wet":ks excess of connective tissue; it is often applied to
Medial epicondylt": 6 months the central nervous system. Caution should
Condyle to diaphysis 5 8 months therefore be exercised when using this word in a
Proximal radius 5 1 1 months radiological sense in order that the meaning is
Distal radius 6 12 months
clear.
Proximal ulna
Olecranon 5 10 months
Anconeal process 3 5 months 3 . Mixed reactions
Distal ulna 6 12 months
Acct":ssory carpal bone physis 10 weeks 5 months • Many lesions combine osteolysis and new bone
Proximal metacarpal I (dewclaw) 6 months production to variable degrees.
Distal mt":tacarpal 11 V 5 7 months
• New bone may predominate and obscure
Phalanges (proximal P 1 , 4 6 months
proximal P2 only) underlying minor osteolysis.
Pelvis • ConverselYf superimposition of irregular new
Acetabulum 4 6 months bone may create areas of relative radiolucency
Iliac crest 1 2 years (or may remain that mimic osteolysis.
open pt":rmanently)
• Consider also the possibility of two pathological
Tuber ischii 8 10 months
Proximal femur processes being present simultaneously (e.g.
Ft":moral head 6 1 1 months synovial cell sarcoma in a joint with pre-existing
Greater trochanter 6 10 months osteoarthrosis ).
Lt":sst":r trochantt":r 8 13 months
Distal femur 6 1 1 months
Proximal tibia 1 .5 PATTERNS OF FOCAL BONE LOSS
Medial to lateral condyle 6 weeks
Tibial tuberosity to condylt":s 6 8 months
(OSTEOLYSIS)
Tuberosity and condyles to 6 12 months Bone loss may be recognized 7-10 days after an
diaphysis
insult. It is easier to recognize in cortical than in
Distal tibia
Main physis 5 1 1 months
trabecular bone and is more obvious if focal. Cate­
Medial malleolus of distal tibia 5 months gorizing the type of osteolysis helps in differential
Proximal fibula 6 12 months diagnosis by suggesting the aggressiveness or
Distal fibula 5 12 months activity of the disease process (see 1.8).
Tuber calcis 1 1 weeks 8 months
Vt":rtebral t":ndplatt":s 6 9 months
1 . Geographic osteolysis (Fig. 1 .2)
°In tht": cat, growth platt":s fust": later, especially in nt":utt":rt":d animals.
Sources: Sumner Smith, G. (1 966) Observations on epiphyst":al • A single large area or confluence of several
fusion of tht": canint": appendicular skt":lt":ton. Journal of Small smaller areasf usually more than 10 mm in
Animal Practice 7, 303 3 1 2. diameter.
Tict":r, J.W. (1 975) Radiographic Technique in Small Animal
• Clearly marginatedf i.e. there is a narrow zone of
Practice. Philadelphia: Saunders.
transition to normal bone.
Chapter 1 Skeletal system: general 5

Figure 1 .2 Geographic osteolysis. Figure 1 .4 Permeative osteolysis.

• Sclerotic margins may be present if the body is 3 . Permeative osteolysis (Fig. 1 .4)
attempting to wall off the lesion.
• Usually affects both the medullary cavity and • Nmnerous small pinpoint areas of osteolysisf
the cortex. 1-2 mm in diameter.
• The overlying cortex may be thinned and • Poorly definedf with a wide zone of transition to
displaced outwards due to a lesion that is normal bone - areas of osteolysis are more
expansile (see 1.19 and Figs 1.25 and 1.26). spread out at the periphery.
• Usually due to a benign or non-aggressivef low­ • Mainly recognized in the cortex (hard to see in
grade lesion such as a bone cystf pressure the medulla because of its trabecular pattern).
atrophy or a benign dental tumour. • The cortex is irregularly eroded from the
endosteal side.
2. Moth-eaten osteolysis (Fig. 1 .3) • Due to a highly aggressive disease process such
as a very active malignant tumour or fuhninant
• Multiple areas of osteolysisf often varying in
(often fungal) osteomyelitis.
size and usually 3-10 mm in diameter.
• May coalesce to form geographic osteolysis in
the centre of the lesion. 4. Mixed pattern of osteolysis (Fig. 1 .5)
• Less well definedf with a wider zone of
Often more than one type of osteolysis is recog­
transition to normal bone.
nized (e.g. central geographic osteolysis sur­
• The cortex is often irregularly eroded. rounded by moth-eaten and permeative zones);
• Due to a more aggressive disease process such the nature of the lesion is denoted by the most
as a malignant tumour or osteomyelitis. aggressive type of osteolysis present.

. , ..
.. ' . :
,

;�",...:
:••
" ,.
. !I
iII
. ' �,.'.
..

Figure 1 .3 Moth-eaten osteolysis. Figure 1 .5 Mixed pattern osteolysis.
6 Handbook of Small Animal Radiology and U ltrasound

5. Osteopenia (diffuse reduction in bone
radiopacity - see also 1 . 1 6) Spicular
• Due to osteomalacia or osteoporosis (see 1.4).
• Differential diagnoses are overexposuref Sunburst
overdevelopmentf other causes of fogging.
• Reduced radiopacity of bone compared with Arrorphous
soft tissues (ghostly bones). (+/-turrour Ixlne and
• Thinf shell-like cortices.
remnants of original
oone)
• Coarse trabecular pattemf as smaller trabeculae
Figure 1.7 Interru pted periosteal reactions.
are resorbed.
• Apparent sclerosis of subchondral bonef
especially in vertebral endplatesf as these are 1 . Continuous periosteal reactions
relatively spared and therefore show high
Often slow disease processes that allow new bone
contrast with the osteopenic bone.
to form in an orderly fashion. Usually represent a
• Double cortical line due to intracortical bone benign or healed process but may also be seen
resorption is occasionally seen. early in a more aggressive disease or at the edge
• If in a limb due to disusef the epiphyses and of an overtly aggressive lesion. Described below
small bones are affected predominantly. in order of increasing aggressiveness.
• Pathological folding fractures may occurf seen • Smooth and solid (e.g. chronic mild traumaf
as sclerotic lines. remodelled more active new bonef panosteitisf
healed subperiosteal haematoma).
• Codman's triangle - solid triangle of new bone
1 .6 PATTERNS OF OSTEOGENESIS:
PERIOSTEAL REACTIONS at the edge of a more active lesionf due to bony
infilling beneath advancing periosteal elevation.
Periosteal new bone is also usually recognized 7-10 Often at the diaphyseal edge of a primary
days after an insult (earlier in young animals). malignant bone tumour.
Identifying its nature helps in differential diagnosis • Rough and solid (e.g. traumaf adjacent soft tissue
by suggesting the aggressiveness of the disease inflammation). May settle to become smooth.
process (see 1.8).
• Lamellar - periosteum elevated by exudate or
There are two main groups of periosteal reac­
haemorrhage and produces a single line of new
tions: continuous and interrupted (Figs 1.6 and
bone parallel to the cortex that fills in with timef
1.7). Howeverf these represent arbitrary division
becoming solidf for example early metaphyseal
of a spectrum of periosteal reactions.
osteopathy (hypertrophic osteodystrophy).
• Lamellated ('onion skin') - late stagef after
a- - - ..... -
recurrent episodes of periosteal elevation due to
..... Smooth and solid
sequential insults creating several layers of new
bonef for example late metaphyseal osteopathy
Ccdman's triangle (hypertrophic osteodystrophy), fungal
osteomyelitis.
• Palisading (thick brush-like) - solid chunks of
Rough and solid
new bone perpendicular to the cortex (e.g.
hypertrophic osteopathYf craniomandibular
Lamellar osteopathy).
• Brush border (thin brush-like, 'hair on end') -
__."",
" ,, ,,,
., ,,, '''
'�'
''' '".
h,,-
' . periosteum lifted fairly rapidly over an extensive
,"
t h!"
,
'

area of cortex with new bone laid down along
the perpendicularly oriented Sharpey's fibres
_-,-�u>..uLL"'-'-'-'=,"",'\M,-,-,_ Palisading
(e.g. adjacent soft tissue inflammationf acute
Figure 1 .6 Continuous periosteal reactions. osteomyelitisf early neoplasia).
Chapter 1 Skeletal system: general 7

2. Interru pted periosteal reactions Features to consider when interpreting skeletal
radiographs include the following:
Represent an aggressive disease process (e.g.
malignant neoplasia or osteomyelitis). 1. Distribution of lesions.
Rapidly changing lesions breaching the cortex a. Generalized or diffuse changes.
and periosteum with no time for orderly repair. - Metabolic or nutritional disease.
Variable in radiopacity and depth and may be in - Neoplasia (e.g. widespread osteolysis -
shortf disconnected segments. Often associated multiple myeloma; widespread sclerosis -
with underlying cortical lysis. lymphoma).
• Spicular - wisps of new bone extending out into b. Whole limb.
soft tissuef roughly perpendicular to the cortex. - Disuse.
• Sunburst - radiating spicular patternf deepest c. Focal lesions.
centrally; indicates a focal lesion erupting - Congenital or developmental.
through the cortex and extending into soft - Trauma.
tissues. - Infection or inflammation.
• Amorphous - not a periosteal reaction as suchf - Neoplasia.
but fragments of new bone that are variable in d. Symmetrical lesions.
sizef shape and orientation; often cannot be
- Metabolic disease.
differentiated from remnants of displaced
- Haematogenous osteomyelitis.
original bone and tumour bone produced by
osteosarcomas. - Metaphyseal osteopathy (hypertrophic
osteodystrophy).
- Hypertrophic osteopathy.
1 .7 PRINCIPLES OF INTE RPRETATION - Bilateral trauma.
OF SKE LETAL RADIOGRAPHS - Metastatic tumours.
Bone has a limited response to disease or insultf 2. Nmnber of lesions.
and so lesions with different aetiologies may look a. Monostotic.
similar radiographicallYf for example neoplasia - Congenital or developmental.
and osteomyelitis. A definitive diagnosis may - Trauma.
not be possible without further tests or biopsy. - Localized infection (traumaf iatrogenic).
The radiologist must examine radiographs method­
- Neoplasia (primary bone tumourf soft
icallYf identify changesf recognize patterns and then
tissue tumour distant from jointf solitary
formulate lists of differential diagnoses. Patient
metastasis).
typef historYf clinical signsf blood parametersf geo­
b. Polyostotic (see 1.21).
graphic location (current or previous)f change of
3. Location of lesions (see 1.22-1.25).
the lesion with time and response to treatment must
be considered. Radiographs should be oriented a. Epiphysis (e.g. various arthritidesf
consistently on the viewer to promote familiarity chondrodysplasiasf osteochondrosisf soft
with the normal appearancef and bone specimens tissue tumours affecting joints).
and radiographic atlases used for reference. b. Physis - mainly young animals (e.g.
A useful rrmemonic for differential diagnosis of haematogenous osteomyelitisf traumaf
aetiology is VITAMIN D: premature closuresf rickets).
c. Metaphysisf e.g. haematogenous
V vascular
osteomyelitisf metaphyseal osteopathy
I inflammatory or infectious (hypertrophic osteodystrophy), primary
T trauma malignant bone tumours.
A anomalous d. diaphysis (e.g. traumaf panosteitisf
M metabolic hypertrophic osteopathYf metastatic
I idiopathic tmnours).
N neoplastic 4. Presence and type of osteolysis (see 1.5 and Figs
D degenerative 1.2-1.5).
8 Handbook of Small Animal Radiology and U ltrasound

5. Presence and type of osteogenesis (see 1.6 and aniInal - active lesions may change within a
Figs 1.6 and 1.7). few daysf and both bone loss and new bone
a. Periosteal. production occur more rapidly in yOilllg aniInals.
b. Endosteal.
c. Trabecular.
1 .8 FEATU RES OF AGGRESSIVE VERSUS
d. Neoplastic - in bone-producing tumours.
NON-AGGRESSIVE BONE LESIONS
e. Heterotopic - ossification in an abnormal
location. An aggressive lesion is one that extends rapidly
f. Dystrophic - ossification in previously into adjacent normal bone with no or miniInal visi­
damaged soft tissue. ble host response attempting to confine the lesion
6. Zone of transition between lesion and normal (Table 1.2 and Figs 1.8 and 1.9). Assessment of this
bone. activity is essential in order to compile a realistic
a. Short - well-demarcated lesionf abrupt list of differential diagnoses. Lesions may change
transition to normal bone; usually benign or their status with time or in response to treatment.
non-aggressive disease. Intermediate grades of aggression exist through a
b. Long - poorly demarcated lesionsf gradual spectnun (e.g. chronic osteomyelitisf low-grade
transition to normal bone; usually aggressive malignancy).
disease.
7. Soft tissue changes.
a. Muscle atrophy.
b. Soft tissue swelling.
c. Joint effusions.
d. Displacement or obliteration of fascial planes
or fat pads.
e. Soft tissue emphysema.
f. Soft tissue mineralization.
g. Radiopaque foreign bodies.
h. Abnormalities in other body systems (e.g.
lung metastases).
8. Rate of change on sequential radiographs and
presence of response to treatment. The tiIne
interval between radiographic studies is arbitrary Figure 1.8 Non-aggressive osteolytic bone lesion, with
and determined by the apparent activity or geographic osteolysis, short zone of transition, intact
aggression of the lesion and the age of the overlying cortex and smooth periosteal reaction.

Table 1 .2 Radiographic features of aggressive versus non-aggressive bone lesionsa

NON AGGRESSIVE AGGRESSIVE

For example uncomplicated trauma, degenerative or resolving For example malignant neoplasia, fulminant osteomyt":litis
lesion, benign neoplasia, bont": cyst
Well demarcatt":d Poorly demarcated
Narrow, distinct zone of transition Wide, indistinct zone of transition
Abst":nt or geographic osteolysis Permeative ostt":olysis
Cortex may be displaced and thinnt":d but rarely broken Cortt":x interru pted
Continuous solid or smooth pt":riosteal reaction Interruptt":d, irregular periostt":al reaction
± surrounding sclt":rosis No surrounding scit":rosis
Static or slow rate of change Rapid rate of change

°If mixed signs are present, tht": lesion should be categorized according to its most aggressive feature.
Chapter 1 Skeletal system: general 9

• In young animalsf examine growth plates for
signs of injury; after trauma to the
antebrachiumf re-radiograph after 3 weeks to
check for signs of premature closure of the distal
ulnar physis.
• Radiograph the opposite leg for assessment of
true bone length if surgery is planned.
• Use a horizontal beam if necessary (e.g. if painf
spinal instability or thoracic trauma prevent
dorsal recumbency).
• Increase exposure factors if soft tissue swelling
is present.
• Thoracic and abdominal studies are often
Figure 1 .9 Aggressive bone lesion, with a mixed pattern
required in cases of road accident or falls from
of osteolysis, long zone of transition, cortical erosion and
interru pted periosteal reaction. high buildings (e.g. to detect pulmonary
contusionf ruptured diaphragmf pneumothorax
or bladder rupture).
1 .9 FRACTU RES: RADIOGRAPHY, • If hairline fractures are suspected but not seenf
CLASSIFICATION AND ASSESSMENT repeat the radiographs 7-10 days later (or use
O F HEALING scintigraphy).
Causes of fractures • Stressed views may be needed to detect fracture
(sub)luxations or collateral ligament damage
1. Trauma (direct or indirectf e.g. avulsion). (see 2.1 and Fig. 2.2).
2. Pathological; spontaneous or following minor • Remember that radiographs give no information
tramna to weakened bone. about damage to articular cartilage or
a. Neoplasia. surrounding soft tissues.
b. Bone cys t.
c. Osteomyelitis.
d. Diffuse osteopenia such as nutritional
Radiographic signs of fractures
secondary hyperparathyroidism (usually
folding fractures). 1. Disruption of the normal shape of bone or of the
e. Brittle or fragile bonesf for example cortex or trabecular pattern.
osteopetrosis (see 1.l3.l5)f osteogenesis 2. Radiolucent fracture lines can be mimicked by:
imperfecta (see 1.16.13). a. nutrient foramen
f. Incomplete ossification of the humeral
b. overlying fascial plane fat
condyle - Spaniels (see 3.4.5. and Fig. 3.4).
c. skin defect or gas in fascial planes - open
g. Empty screw hole.
fracture
3. Stress protection - weakened bone at the end of d. normal growth plate or skull suture
an orthopaedic plate.
e. Mach line - dark lines along edge of
4. Fatigue fracture - due to repeated stress on a
two overlapping bones due to an optical
bonef especially metacarpals and metatarsals in
illusion
racing greyhounds.
f. grid line artefact from damaged grid.
5. Defect in bone due to biopsy or surgeryf or after
NB: hairline or minimally displaced
plate removaL
fractures radiating along the shaft from the
Radiography main fracture site may be seen only if parallel
to X-ray beam; this may require additional
• Obtain at least two radiographsf including views.
views at 90° to one another (orthogonal views). 3. Increased radiopacity of cortex and medulla if
• Include joints above and below to check for joint the fracture is folding or impacted or if
involvement and rotation of fragments. fragments override.
10 Handbook of Small Animal Radiology and U ltrasound

4. Smalt free fragments of variable size can be
mimicked by:
a. unusual centres of ossification
b. inconsistently present sesamoids
c. multipartite sesamoids
d. dirt on the animal's hair coat
e. debris within soft tissues.
(a)-(c) are usually bilatera!, so if in
doubt radiograph the opposite limb for
comparison.
S. Ballisticsf foreign material and gas - compound
fractures.
6. Evidence of fracture healing - see below.
7. Muscle atrophy and disuse osteopenia. v

Reasons for overlooking fractures include incor­ Figure 1 . 1 0 Salter-Harris classification of growth plate
rect exposure or processingf non-displacement of fractures. Type I : separation through the growth plate (e.g.
fracture fragmentsf insufficient number of viewsf proximal femur): also known as slipped epiphysis or
confusion with growth plates and fracture reduced epiphysiolysis. Type 11: a metaphyseal fragment remains
by positioning. attached to the epiphysis (e.g. distal femur). Type I l l : fracture
through the epiphysis into the growth plate (rare). Type IV:
fracture through the epiphysis and metaphysis crossing the
Classification of fractures growth plate (e.g. distal h u merus). Type V: crush injury to the
growth plate (may not be radiographically visible initially but
1. Closedf or open or compound (therefore risk of leads to growth disturbance) (e.g. distal ulna).
infectionf especially if the skin has broken
outside to inside).
2. Simple (single fracture)f comminuted (three or 8. Fatigue or stress fracture - one cortex onlYf
more fragments)f multiple (fracture lines do from repeated minor trauma.
not connect; same bone or different bones) or 9. Impaction or compression fracture -
segmental (two or more separate fracture lines shortening of bone due to stress along its
in a single bone). lengthf or one fragment driven into another;
3. Transversef obliquef spirat longitudinal or especially vertebrae.
irregular. 10. Fracture (sub)luxation - fracture with
4. Complete (entire bone width) or incomplete associated soft tissue injury causing joint
(one cortex only). instability or displacement.
a. Greenstick fracture - convex side cortex; 11. Salter-HaITis fractures (Fig. LlD) - fractures
alternatively defined as a fracture with involving unfused growth plates; may lead to
minimal separation between fragment ends growth disturbances (e.g. shortening or
and periosteum remains intact. angulation of bone). They can occur surprisingly
b. Torus fracture - concave side fracture. late in neutered catsf as the growth plates remain
S. Chip fracture (no or one articular surface open longer than in entire animals.
involved) or slab fracture (two articular
surfaces involved). Assessment of fracture: at the time
6. Articular - within the limits of the joint of injury
capsulef whether or not the fracture line
1. Location - which bonef which anatomical area
crosses the articular surface. Young animals
of the bone?
are over-represented due to the presence of
relatively weak growth plates. AlternativelYf 2. Age of fracture (if not known) - assess
non-articular. sharpness of fracture margins and look for
7. Avulsion (traction by soft tissue attachment) - evidence of healing.
usually at an apophysis. 3. Type of fracture - see above.
Chapter 1 Skeletal system: general 11

Assessment of fracture: immediate
post-operative radiographs
1. Degree of reduction - at least 50% bone contact
on orthogonal views is needed for healing.
2. Alignment.
a. Medial-lateral and cranial-caudal.
b. Rotational alignment - include joints above
and below.
3. Adequacy of implant typef size and placement.
4. Joints - congruencYf lack of entry by implants.
5. Presence of cancellous bone grafts.
6. Soft tissues.
Figure 1 . 1 1 Pathological fracture: diffuse rarefaction of
bone around a tibial fracture site due to metastatic (Useful rrmemonic: ABCDS - alignmentf bonef car­
neoplasia. tilagef devicef soft tissues; altemativelYf consider
the four Afs - appositionf alignmentf angulationf
apparatus).

4. Displacement of fragments - distal relative to Fracture healing
proximal fragment (e.g. distractedf impactedf
overriding). NB: need two orthogonal views to assess healingf
as the fracture may appear bridged on one view
5. Underlying bone radiolucency or loss of normal
and not on another. Healing occurs more rapidly
architecturef for evidence of pathological
in young animals.
fracture (Fig. 1.11).
6. Involvement of joints - subsequent osteoarthritis 1. Primary bone healing - direct bridging of the
may occur. fracture by osseous tissuef re-establishing cortex
and medulla without intermediate callus. Occurs
7. Presence of foreign material.
with a high degree of reduction and stabilization
8. Soft tissue changes.
of the fracture site. Stages 1, 2 and 5 (Fig. 1.12).
9. Injuries elsewhere in body (e.g. with pelvic 2. Secondary bone healing - unstructured bone laid
tramnaf check for bladder or urethral rupture; down in soft tissue as a callus and subsequently
thoracic pathology). remodelled. Stages 1-5 (Fig. 1.12).

2 3 4 5

Figure 1 . 1 2 The five stages of fracture healing. Stage 1 : sharp fragments, hairline fracture lines easily overlooked, marked
soft tissue swelling. Stage 2: fracture margins becoming blurred; hairline fractures more obvious; reduced soft tissue
swelling. Stage 3: unstructured bony callus with partial bridging of fracture line. Stage 4: callus becoming more solid;
early remodelling. Stage 5: continued remodelling results in reduction in callus size.
12 Handbook of Small Animal Radiology and U ltrasound

• Stage 1 (recent injury): sharp fracture ends; amount of callus) or oligotrophic (little callus),
well-defined fragments; soft tissue swelling; whereas inactive fractures show no callus or
disruption to skin and soft tissue emphysema atrophy of bone ends.
if the fracture is compound (open). 8. Evidence of infection - osteolysis especially
• Stage 2 (approximately 1-2 weeks): reducing around implantsf unexpected periosteal
soft tissue swelling; fracture line blurred due reactions (differential diagnosis is periosteal
to hyperaemia and bone resorption; hairline stripping)f sequestrum formationf soft tissue
fractures widened and more obvious; earlYf swelling ± emphysema.
indistinct periosteal reactionf especially in 9. Evidence of secondary joint disease.
young animals.
10. Evidence of disuse - muscle atrophYf
• Stage 3 (approximately 2-3 weeks): abundant,
osteopenia.
unstructured bony callus forming (size
11. The six Afs - appositionf alignmentf angulationf
depends on the type of fracturef locationf use of
apparatusf activity of bone healing and
limbf stability at sitef vascularization); partial
architecture of bone and surroilllding soft tissue.
bridging of fracture line; structurally strong.
• Stage 4 (approximately 3-8 weeks): continued
filling in of the fracture line; early Complications of fracture healing
remodelling of the callus.
• Stage 5 (approximately 8 weeks on): 1. Delayed union - longer than expected time to
continued remodelling and reduction in size heal for the type and location of fracturef but
of callus; restoration of cortices and evidence of bone activity is present.
trabecular pattern; the limb may straighten a. Disuse.
slightly if malunion occurred originally. b. Instability.
c. Poor reduction.
Assessment of fracture: subsequent d. Poor nutrition.
exami nations e. Old age.
f. Infection.
1. The intervals at which follow-up radiographs g. Poor vascularity.
are obtained depend on the age of the patientf
h. Large intramedullary pin.
the severity of the injurYf the nature of the
repair and the condition of the patient. Usually i. Presence of a sequestrum.
2- to 3-week intervals for young animals and j. Undetected underlying pathology
4-6 weeks for mature animals are adequate. (e.g. neoplasia).
2. Use the same radiographic technique as for the 2. Non-union - fracture healing has apparently
original radiographsf for comparison (may need ceased without uniting the fragmentsf usually
to reduce exposure factors if soft tissue is less 10-12 weeks post fracture; bone ends smooth
due to reduction of swelling or muscle atrophy). with sealed medullary cavity. Predisposed to
by movement or infection at the fracture site.
3. Alignment of fragments.
a. Non-viable or biologically inactivef for
4. Position and integrity of implants - migrationf
example atrophic (dying back) (Fig. 1.13) -
bendingf cracking or fracture of implants may
no callusf pointed bone ends; especially the
occur.
radius and ulna in toy breeds of dog that
S. Stability of fracture site - evidence of
have been treated with external co-optation
instability following surgical repair includes or intramedullary pinning; also dystrophic
migration of implantsf radiolucent haloes or necrotic non-union (devitalized
around screws and pins (differential diagnoses intermediate fragment)f defect non-union
are infectionf bone necrosis from high-speed (significant bone defect).
drilt artefactual radiolucent halo around b. Viable or biologically activef for example
metallic implants in some digital images). hypertrophic (,elephant's foot') (Fig. 1.14) -
6. Stage of fracture healing. new bone surrounds bone ends but does not
7. Amount of callusf for example active fractures cross the fracture linef giving a bell-shaped
may be hypertrophic (moderate to large appearance; fragment ends parallel;
Chapter 1 Skeletal system: general 13

t
J/
o

Figure 1 . 1 3 Atrophic non-union of a femoral fracture.
(71
Figure 1 . 1 5 Malu nion of a femoral fracture.

or bucket handle callus often seen on caudal
aspect of femur); not usually a clinical
problem.
6. Osteomyelitis - leads to delayed or non-union;
differential diagnosis is exuberant callus due to
instability at the fracture site.
7. Sequestrum formation - a devitalized piece of
bone that will impede healing and/or lead to
sinus formation. Seen radiographically as a
sharply defined fragment of dense bone with
a surrounding radiolucent space containing
pus. May be surrounded by a sclerotic
involucrum attempting to wall off the
Figure 1 . 1 4 Hypertrophic non-union of a femoral fracture. process.
8. Fracture disease - a clinical syndrome with
joint stiffness and muscle wastage due to
disease; radiographs show osteopenia.
medullary cavity may appear sealed; also 9. Neoplastic transformation - may be years laterf
lesser degrees of callus or absent callus especially if metallic implants are present or
(oligotrophic). healing was complex. The mechanism is not
Both types may form a false joint in which known but is possibly due to chronic
the fragment ends are contoured (e.g. one inflammation. Usually in fractures sustained at
is concave and the other is convex or 1-3 years of age.
pointed). 10. Metallosis - a sterilef chronicf proliferative
3. Malunion (Fig. 1.15) - bones fuse but with osteomyelitis that may result from reaction to
incorrect alignment. Subsequent remodelling metallic implantsf especially if dissimilar
may correct the malunion to some extent. metals have been combined; less common in
Joints proximal and distal to the site may domestic animals than in humans due to their
become arthritic due to altered stresses. shorter lifespan.
4. Excessive callus formation.
a. Movement at fracture site. Ultrasonographic assessment of fracture
b. Infection. healing
c. Periosteal stripping. Ultrasonography can be used to assess soft tissues
d. Incorporation of bone grafts. and bony surfaces of fractures and callusesf both at
5. Ossification of stripped periosteumf the time of injury and during the healing process.
especially in young animals (e.g. rhino horn Ultrasonography permits detection of healing earlier
14 Handbook of Small Animal Radiology and U ltrasound

than with radiography and therefore can prevent
unnecessarily long limb immobilization. Vascularity
of tissues can be assessed with power Doppler.
Stages of fracture healing detected ultrasonogra­
phically roughly correspond to those seen radio­
graphically as follows.
• Stage 1 (recent injury): homogeneous,
hypoechoic soft tissue in the gap between the
fragment ends.
• Stage 2 (1-2 weeks): heterogeneous, hypoechoic
soft tissue in the fracture gap.
• Stage 3 (2-3 weeks; callus formation):
heterogeneousf irregular appearance with
Figure 1 . 1 6 'Normal' radius and ulna of a chondrodystrophic
hyperechoic areas indicating the start of
dog, showing bowing of the long bones, prominence of
mineralization earlier than is seen
apophyses, enthesiopathies and bony proliferation in the
radiographically.
interosseus space.
• Stage 4 (3-8 weeks): heterogeneous callus
becoming continuous and lamellar.
f. Congenital hypothyroidism; bowing of long
• Stage 5 (8 weeks on): a continuousf smoothf
bonesf especially the radius and ulna; seen
hyperechoic line represents the healed cortexf
especially in Boxers (see 1.22.9). Disturbed
and intramedullary implants can no longer be
epiphyseal ossification may also lead to a
identified.
change in shape and subsequent
osteoarthritis.
g. Asymmetric bridging of a growth plate,
BONES resulting in uneven growthf for example
severe periosteal reaction in metaphyseal
1 .1 0 ALTERED SHAPE O F LONG BONES osteopathy (hypertrophic osteodystrophy),
See also section 1.15f Bony masses. surgical staple left in too long.
h. Tension from shortened soft tissues (e.g.
1. Bowing of bone(s). quadriceps contracture).
a. 'Normal' in chondrodystrophic breeds i. Altered stresses due to bone or joint disease
(e.g. Basset Hound, Bulldog and Dachshund); elsewhere in limb.
especially radius and ulna. Long bones in j. Hemimelia (rare) - either radius or ulna
affected breeds often have prominent absent (usually radial agenesis)f putting
apophyses as well (enthesiopathies ­ abnormal stress on the remaining bone.
osteophytes at ligamentar insertions) (Fig. 1.16). 2. Angulation of bone.
b. Growth plate trauma resulting in uneven
a. Traumatic folding (greenstick) fracture.
growth.
b. Pathological fracture.
c. Radius - passive bowing due to shortening of
ulna and secondary bowstring effect (see 3.5.4 - Primaryf secondary or
and Fig. 3.13). pseudohyperparathyroidism (see 1.16.4
d. Chondrodysplasias (dyschondroplasias) are and Fig. 1.20).
recognized in numerous breeds and in the - Neoplasiaf especially if mainly osteolytic
Domestic Short-haired cat (see 1.22.7). Failure (primary, secondary, multiple myeloma)
of normal endochondral ossification leads to (see 1.18.2, 1.19.1, 1.20.1 and Figs 1.21-1.24
bowing of long bonesf especially the radius and 1.27).
and ulnaf and epiphyseal changes result in - Enchondromatosis (see 1.19.1).
arthritis. - Bone cyst (see 1.19.2 and Fig. 1.26).
e. Rickets; bowing of long bonesf especially the - Osteomyelitis (see 1.20.2 and Figs 1.28 and
radius and ulna. 1.29).
Chapter 1 Skeletal system: general 15

- Severe osteopenia (see 1.16). 2. Disproportionate dwarfism.
- Osteogenesis imperfecta (see 1.16.13). a. Chondrodysplasias (see 1.22.7).
c. Malunion. b. Hypothyroidism; mainly Boxer (see 1.22.9).
3. Abnormally straight bone (e.g. radiusf due to c. Rickets or hypovitaminosis D (see 1.23.8 and
premature closure of the distal radial growth Fig. 1.30) .
plate). Long bones are normally very straight in d. Zinc-responsive chondrodysplasia in the
some larger dog breeds. Alaskan Malamute and possibly other
4. Expansion or irregular margination of bone. northern breeds.
a. Osteochondroma (single) or multiple e. Hypervitaminosis D - a massive intake
cartilaginous exostoses (multiple) (see 1.15.2 in a young animal causes retarded
and Fig. 1.19). growthf bone deformity and osteopeniaf
b. Enchondromatosis (see 1.19.1). although death from renal failure is
c. Other expansile tumour (see 1.19.1 and more likely; cats are more sensitive to
Fig. 1.25). toxicity.
d. Bone cyst (see 1.19.2 and Fig. 1.26). f. Cats - mucopolysaccharidosis - especially
cats with Siamese ancestry; rarely occurs in
e. Latef remodelled metaphyseal osteopathy
dogs but mucopolysaccharidosis type VII is
(hypertrophic osteodystrophy; see 1.24.4 and
reported to cause disproportionate dwarfism
Fig. 1.31B).
in dogs (see 5.4.9).
f. Disseminated (diffuse) idiopathic skeletal
g. Cats - mucolipidosis type II (rare).
hyperostosis - mainly spine but also
extremital periarticular new bone and h. Cats - hypervitaminosis A in young cats -
enthesiopathies (see 5.4.5). reduced length of long bones due to
g. Insertion tendonopathies. abnormality of physeal cartilage.
- 'Normar in chondrodystrophic breeds (see
1.10.1 and Fig. 1.16).
- Pathological (see Ch. 3). 1 .1 2 D ELAYED OSSIFICATION OR GROWTH
PLATE CLOSURE
Delayed ossification is mainly recognized in epi­
1 .1 1 DWARFISM physesf carpal and tarsal bones. The various condi­
tions listed here may be difficult to differentiatef
1. Proportionate dwarfism. and chondrodysplasias are often initially misdiag­
a. Pituitary dwarfism; mainly German nosed as rickets. Howeverf rickets does not mani­
Shepherd dogf also reported in the Miniature fest until after weaningf whereas other conditions
Pinscherf Spitz and Covelian Bear dog. May begin to develop before weaning. Table 1.3 sum­
be hypothyroid too (see below). marizes the radiographic changes that may be
b. GMrgangliosidosis - English Springer present in animals with growth disturbancesf but
Spaniels. the subject is complex.

Table 1 .3 Radiographic changes that may be present in animals with growth disturbances

EPIPHYSEAL DYSPLASIA WIDE PHYSES LATE CLOSING PHYSES OSTEOPENIA STUNTING

Chondrodysplasia Yes Yes Some No Yes
Congenital hypothyroidism Yes Yes Yes No Yes
Hypervitaminosis A in No No No Yes Yes
immature cats
Pituitary dwarfism Yes Yes Yes No Yes
M ucopolysaccharidosis Yes Irregular Not reported Yes Possible
Rickets No Yes Yes Yes Yes
16 Handbook of Small Animal Radiology and U ltrasound

1. Chondrodysplasias - effect on growth plate 4. Neoplasia.
closure time is variable (see 1.22.7). a. Primary malignant bone tumour of blastic
2. Congenital hypothyroidism - especially Boxers typef although usually there is some
(see 1.22.9). evidence of osteolysis as well (see 1.20.1).
3. Pituitary dwarfism - especially German b. Bone metastases - may be sclerotic or
Shepherd dogs. osteolytic; often at atypical sites for primary
4. Rickets. tumours (e.g. diaphyses); often multiple in
one bone or polyostotic (see 1.20.1 and
s. Hypervitaminosis D - a massive intake in a
Fig. 1.22).
young animal causes retarded growthf bone
c. Certain myeloproliferative disorders (see
deformity and osteopeniaf although death from
1.13.15).
renal failure is more likely; cats are more
sensitive to toxicity. d. Cats - feline leukaemia-induced medullary
osteosclerosis - rare; likely to be widespread
6. Copper deficiency.
in the skeleton.
7. Cats - mucopolysaccharidosisf especially in e. Cats - feline lymphoma may cause
cats with Siamese ancestry; rarely affects dogs medullary osteosclerosis - rare; likely to be
(see 5.4.9). widespread in the skeleton.
8. Cats - neutering delays growth plate closuref S. Osteomyelitis - more likely to be a mixed
especially in male cats. lesion including osteolysis (see 1.20.2 and
Figs 1.28 and 1.29). If due to haematogenous
spreadf there are likely to be multiplef possibly
1 .1 3 INCREASED RADIOPACITY bilaterally symmetrical lesions.
WITHIN BONE a. Bacterial.
b. Fungal.
It may be difficult to differentiate increased radio­
pacity within a bone from increased radiopacity c. Protozoal - leishmaniasis* - periosteal and
due to superimposition of surrounding new bone. intramedullary bone proliferation in
Both will produce a radiographic increased opacity diaphyses and flat bones, provoked by
often referred to as (osteo)sclerosis. chronic osteomyelitis; mixedf aggressive
bone lesions; also erosive and non-erosive
1. Technical factors causing artefactual increased
joint lesions.
radiopacity.
6. Panosteitis (Fig. 1.17) - usually immature or
a. Underexposure (too Iow a kV or mAs).
young adult (5-18 months old, occasionally
b. Underdevelopment.
older); especially German Shepherd dogs,
c. Intensifying screen marks. although other breeds can be affected; male
2. Normal.
a. Normal metaphyseal condensation in the
metaphysis of skeletally immature animals;
also incorrectly termed 'idiopathic
osteodystrophy'.
b. Subchondral bone.
c. Physeal scar - a fine radiopaque line
persisting for variable lengths of time after
the growth plate has closed; howeverf its
presence is not a reliable indicator of the
animal's age.
3. Artefactual.
a. Superimposition of periosteal new bone -
examine the orthogonal view.
b. Superimposition of soft tissues - look Figure 1 . 1 7 Panosteitis in a hu merus: patches of increased
beyond the bone margins to see if soft tissue medullary radiopacity, coarse trabeculation and smooth
lines continue. periosteal reaction.
Chapter 1 Skeletal system: general 17

preponderance. The aetiology is unknown. 10. Osteopenia (see 1.16) - sparing of subchondral
Clinical signs are of cyclical shifting leg bone and bone along epiphyseal and
lamenessf which may be acute and severe metaphyseal margins of growth plates creates
with pain on bone palpation; also lethargYf apparent sclerotic bandsf which are probably
anorexia and pyrexia. The condition is self­ artefactual and arise from increased contrast
limiting but may have a protracted course. with the osteopenic bone.
Lesions are seen in diaphyses and 11. Lead poisoning - in rare casesf thin sclerotic
metaphyses of long bonesf and several bands are seen in the metaphyses of long bones
patterns of increased radiopacity may and vertebrae of young animals suffering lead
occur. poisoning; also causes os teopenia.
• Ill-defined medullary patches often near the 12. Canine distemper - bands of metaphyseal
nutrient foramen; main differential sclerosis paralleling the physis may been seen;
diagnosis is osteomyelitis. differential diagnosis is metaphyseal
• Coarsef sclerotic trabecular pattern. osteopathy (hypertrophic osteodystrophy;
• Increased radiopacity due to superimposed possible link between this and canine
periosteal reactionf which occurs in a distemper vaccination in Weimaraners).
minority of cases. 13. Hypervitaminosis D - alternating areas of
• Narrow transverse sclerotic lines as recovery sclerosis and bone resorption in metaphyses and
occurs; differential diagnosis is growth diaphysis together with periosteal and endosteal
arrest lines. new bone; howeverf bone changes are raref as the
Radiographic signs may lag behind clinical animal is more likely to show soft tissue miner­
signs and may be absent in early or mild alization and to die from renal failure (see 12.2).
cases; bone scintigraphy may be helpful in 14. Bone infarcts - rare; multiple irregular sclerotic
such cases. patches in medullary cavities of limb bones
7. Growth arrest lines - finef transverse sclerotic and cranial diploe; may be associated withf or
lines due to periods of arrested and increased lead tOf osteosarcoma. Mainly smaller breeds
growthf of no clinical significance; differential (e.g. Shetland Sheepdog, Miniature
diagnosis is panosteitis. Schnauzer). Cause unknownf possibly vascular
8. Metaphyseal osteopathy (hypertrophic disease leading to hypoxia.
osteodystrophy) - young dogs, especially 15. Osteopetrosis (osteosclerosis fragilisf marble
the distal radius and ulna; initially radiolucent bone diseasef chalk bones) - rare disease in
metaphyseal bands ± sclerotic borders; which primary and/or secondary spongiosa
later superimposed periosteal new bone adds persists in marrow cavities due to a defect in
to increased radiopacity (see 1.24.4 and osteoclastic resorption; produces a diffuse
Fig. 1.31). increase in bone radiopacity (osteosclerosis)
9. Fractures - if impaction of bone or overlapping with coarsening of trabeculaef thickening of
of fragments occursf a sclerotic band rather cortices and progressive obliteration of the
than a bone defect may be seen. medullary cavity; the bones are brittlef and
a. Folding fractures. pathological fractures may occur. May cause
- Greenstick fractures (single cortex) in anaemia if medullary cavities are severely
young animals. compromised (myelophthistic anaemia).
- Osteopeniaf especially nutritional a. Congenital.
secondary hyperparathyroidism (see - Autosomal recessive genef usually lethal
1.16.4 and Fig. 1.20). but some animals may survive into
b. Compression or impaction fractures ­ adulthood.
especially vertebrae; predisposed to by - Hereditary anaemia in the Basenji.
osteopenia. - Sclerosing bone dysplasia - an inherited
c. Superimposition of overridden fragments subset of osteochondrodysplasia causing
seen on one radiographic projection but generalized osteosclerosis with
shown to be displaced using orthogonal view. obliteration of nasal turbinates and
d. Healing fracture. nasolacrimal duct obstruction.
18 Handbook of Small Animal Radiology and U ltrasound

b. Acquired (the disease is poorly understoodf reaction. May be multifocal if haematogenous
and it is not known whether all such cases are spread.
truly acquired or whether some represent a b. Fungal - may be multifocal due to
late manifestation of an inherited disease). haematogenous spread; more often mixed
- Chronic dietary excess of calcium. osteolytic-proliferative lesion (see 1.20.2 and
- Chronic vitamin D toxicity. Figs 1.28 and 1.29).
- Myelofibrosis. c. Protozoal.
Idiopathic. - Leishmaniasis* - a spectrum of periosteal
reactions varying from smooth to irregular;
16. Osteoid osteoma has been described in the
also intramedullary sclerosisf mixed bone
hmnerus of a dog and the mandible of a cat and is
lesions and erosive or non-erosive joint
a benign lesion consisting of vascular osteoid
disease.
tissue in the medullary cavity surroilllded by an
- Hepatozoonosis* - chronic myositisf
area of sclerotic bone. These are well described in
debilitation and deathf often with
hmnansf occurring usually in males under 25
periosteal reactions varying from subtle to
years in the femur and tibia.
dramatic. Mainly Hepatozoon americanumf
17. Cats - diffuse osteosclerosis of the skeleton
which produces periosteal new bone on
may be seen as an incidental finding or
long bonesf ilium and vertebraef probably
associated with renal failuref leukaemiaf
via a humoral mechanism. The main
myeloproliferative disease or systemic lupus
differential diagnosis is hypertrophic
erythematosus.
osteopathYf but the distribution of lesions
is differentf usually affecting more
1 .1 4 PERIOSTEAL REACTIONS proximal limb sites and/or the axial
skeleton.
Periosteal reactions forming new bone may be loca­
d. Cats - feline tuberculosis - various
lized or diffuse depending on the aetiology. Localized
Mycobacterium species (rare). Also mixed
periosteal reactions appearing as bony masses are also
lesionsf discospondylitis and arthritis.
described in Section 1.15. In some casesf periosteal
elevation caused by illlderlying pathology may be 3. Neoplasia - early malignancy (primary bonef
metastatic or soft tissue tumours before
visualized ultrasonographicallYf and fine needle aspi­
osteolysis becomes apparent). Follow-up
ration may be performed using ultrasoillld guidance.
radiography may help to distinguish neoplasia
1. Trauma. from infection or trauma.
a. Direct blow to the cortexf producing 4. Panosteitis - severe cases may show a mildf
periosteal stimulation (a single episode or smooth or lamellated periosteal reaction on the
repetitive milder trauma). diaphyses (see 1.13.6 and Fig. 1.17). The
b. Periosteal tearing or elevation associated with diagnosis is usually obvious from the
fractures; especially young animals. signahnent and clinical signs and the presence
c. Subperiosteal haematoma - often caudal skull of typical medullary lesions.
in dogs with prominent nuchal crest; also 5. Metaphyseal osteopathy (hypertrophic
sometimes in dogs with coagulopathies (e.g. osteodystrophy) - advanced cases show
Dobermann Pinschers with von Willebrandfs bilateral collars of periosteal new bone and
disease). paraperiosteal soft tissue mineralization around
d. Reactive (e.g. beneath a lick granuloma). the metaphysesf which may obscure the
2. Infection (more likely to produce a diffuse characteristic mottled metaphyseal band (see
reaction in yOilllg animals in which the 1.24.4 and Fig. 1.31). Subsequent remodelling
periosteum is loosely attached). causes thickening of metaphyses. In severe
a. Bacterial - often solitary and associated with casesf the adjacent physis may become bridgedf
an open wound (traumaf surgery); focal resulting in a subsequent angular limb
anaerobic osteomyelitis occurs following bite deformity.
woundsf with a small central sequestrum 6. Hypertrophic (pulmonary) osteopathy (HPO,
surrounded by a raisedf ring-like periosteal Marie's disease) (Fig. 1.18) - florid periosteal
Chapter 1 Skeletal system: general 19

adjacent to distal ulnar metaphysesf similar to
metaphyseal osteopathy (hypertrophic
osteodystrophY)f are occasionally seen (see
3.5.16 and Fig. 3.14).
8. Cats - hypervitaminosis A - focal periosteal new
bone around vertebrae (mainly cervical or
thoracic), joints (especially elbow and stifle),
stemumf ribs and occipital bone. May lead to
joint ankylosis. Usually yOllllg adult cats on raw
bovine liver diets; differential diagnosis is
mucopolysaccharidosis.
9. Cats - mucopolysaccharidosis - mainly spinal
changes similar to hypervitaminosis A (see
2.5.14 and 5.4.9). Differential diagnosis is
Figure 1 . 1 8 Hypertrophic pulmonary osteopathy: palisading hypervitaminosis A. Rare in dogs.
periosteal new bone mainly on abaxial surfaces of bones,
with overlying diffuse soft tissue swelling.
1 . 1 5 BONY MASSES
See also Sections 1.10, Altered shape of long bones,
new bone on the diaphyses of long bonesf and 1.14f Periosteal reactions.
usually beginning distally in the limb, although
Differential diagnoses for bony masses include
can extend proximally to scapula or pelvis;
mixed osteoproductive--osteolytic lesions in which
bilaterally symmetricat with overlying soft
new bone predominates and obscures underlying
tissue swelling due to oedema. In the digitsf it is lysisf and soft tissue mineralization that is close to
most severe on the abaxial margins of digits 11 or superimposed over bonef for example calcinosis
and V. The new bone may appear in several circumscripta (see 12.2.2 and Fig. 12.1).
patterns: palisadingf irregularf brush borderf
lamellated or smooth and solid depending on 1. Trauma.
the stage of the disease. The thorax and a. Exuberantf localized periosteal reaction
abdomen should be imaged to look for an following direct injury.
llllderlying lesion. This is usually primary or b. Large fracture callus - due to movementf
secondary pulmonary neoplasiaf but a variety of infectionf periosteal stripping.
other causes have been implicatedf including c. Hypertrophic non-llllion - bone defect at the
non-neoplastic puhnonary diseasef other fracture line should be evident.
intrathoracic massesf oesophageal disease d. Rhino horn callus from periosteal stripping
(especially neoplastic transformation of caudal to the femurf associated with femoral
Spirocerca lupi granulomas)f infective fracture.
endocarditis and bladder neoplasia. Theories as 2. Neoplasia.
to cause include puhnonary shuntingf vagal a. Osteochondroma (when single) or
nerve stimulationf humoral substances osteochondromatosis or multiple
produced by neoplastic cells and megakaryocyte cartilaginous exostoses (when multiple)
or platelet chunping. The diagnosis is usually (Fig. 1.19). Rare: a skeletal dysplasia rather
obvious from the nature and distribution of the than a true neoplastic process. In dogsf seen
periosteal reaction and detection of a primary when skeletally immature at osteochondral
lesion. HPO is rare in cats. The main differential junctionsf for example long bone metaphyses
diagnosis is hepatozoonosis* (see 1.14.2). (often bilateral)f ribs and costochondral
7. Craniomandibular osteopathy (mainly Terriersf junctionsf pelvis and vertebrae. Hereditary
especially West Highland White Terrierf but tendency for multiple lesions; especially
seen sporadically in other breeds) - florid Terriers. Generally smoothf cauliflower-like
periosteal new bone on the skult particularly or nodular projections with cortex and
the mandible and tympanic bullae (see 4.11.1 medulla continuous with underlying bonef
and Fig. 4.6). Masses of paraperiosteal new bone but may appear more granular and
20 Handbook of Small Animal Radiology and U ltrasound

e. Predominantly osteoblastic primary
malignant bone tumour - mainly metaphyses
of long bones; also skull.
f. Parosteal or juxtacortical osteosarcoma (see
3.11.12 and Fig. 3.29) - rare; radiographically
and pathologically distinct from other
osteosarcomata. Slow-growingf scleroticf
smooth or lobulatedf non-aggressive or low­
grade malignant bony mass arising from
periosteal connective tissue with little or no
underlying osteolysis; seen especially around
the stifle on the caudal aspect of the distal
femur but also reported affecting other long
Figure 1 . 1 9 Multiple cartilaginous exostoses (dog): bonesf skult vertebrae and ribs. Periosteal
expansile masses arising from a rib and the wing of the ilium. and high-grade surface osteosarcomas also
occur on the outside of bones but are more
aggressive during the active growth phase. aggressive in appearance and behaviour.
Lesions in long bones may be more irregular 3. Enthesiopathies (osteophytes forming within
than those elsewheref and those arising at ligamentar insertions).
growth plates may cause limb shortening or a. Normal prominence of apophyses in
angular limb deformities. While still chondrodystrophic breeds; bilaterally
ossifyingf they may appear not to be attached symmetrical (see 1.10.1 and Fig. 1.16).
to underlying bone and may mimic calcinosis b. Enthesiopathies in individuals of other
circumscripta (see 12.2.2 and Fig. 12.1). breeds suffering from chondrodysplasias;
Osteochondromata in ribs may mimic healing bilaterally symmetricaL
rib fractures. Growth of osteochondromata c. Enthesiopathies in specific tendon and
ceases at skeletal maturitYf but malignant ligament attachments (see Ch. 3).
transformation to osteosarcoma or d. Disseminated or diffuse idiopathic skeletal
chondrosarcoma has been reported. In catsf hyperostosis (DISH) - spurs of new bone mainly
seen in youngf mature animalsf usually 2-4 on the spine but also periarticular new bone and
years old at diagnosis; possibly with a viral enthesiopathies in the limbs (see 5.4.5).
aetiology (test for feline leukaemia virus). 4. Proliferative joint diseases may result in bony
Lesions are similar to those in dogs. They masses associated with joints (see also 2.5).
arise from the perichondrium of flat or a. Severe osteoarthritis.
irregular bones such as the skult ribs and b. Disseminated idiopathic skeletal
pelvis and may continue to growf becoming hyperostosis.
more aggressive; as in dogsf malignant c. Synovial osteochondromatosis (see 2.S.1S and
transformation may occur. Also reported as Fig. 2.7).
amorphous and linear opacities in the d. Cats - osteochondromata or osteocartilaginous
surrounding soft tissues. In older catsf exostoses - especially the elbows.
osteocartilaginous exostosesf often around the e. Cats - hypervitaminosis A; especially the
elbowsf may represent the same condition. elbow and stiflef although spinal changes
b. Osteoma (benign) - rare, usually skull; often predominate (see 5.4.8).
younger dogs; especially Mastiff types. f. Cats - mucopolysaccharidosis (see 2.5.14 and
Densef bony mass without underlying 5.4.9).
osteolysis. 5. Craniomandibular osteopathy - masses of
c. Ossifying fibroma - skull. periosteal new bone on the skult mainly
d. Multilobular tumour of bone (syn. mandibles and tympanic bullae; occasionally
osteochondrosarcomaf chondroma rodens) - see limb changes (see 3.5.16, 4.10.1 and Figs 3.14
skull (see 4.6.3 and Fig. 4.3); often have a and 4.6).
characteristic stippled appearance. 6. Calvarial hyperostosis in Bullmastiffs (see 4.6.2) .
Chapter 1 Skeletal system: general 21

1 . 1 6 OSTEOPENIA limb with chronic disuse) - compare with
the opposite limb if possible.
Osteopenia is a radiographic term meaning reduc­
b. Increase in surrounding soft tissue in obese
tion in radiographic bone radiopacity. This may
dogsf especially affecting spinal
be due to osteoporosis (reduced bone mass but nor­
radiographs; the increased kV required
mal ratio of organic matrix and inorganic salts) or
produces more Compton scatterf resulting in
osteomalacia (organic matrix present in excess due
loss of visualization of trabeculae and
to failure of mineralization)f and these cannot be
apparent osteopenia.
differentiated radiographically. This section lists
3. Disuse (limb) - paralysisf fracture or severe
differential diagnoses for diffuse osteopenia usu­
lameness; often most severe distal to a fracture
ally affecting the whole skeletonf or in the case of
and affecting particularly epiphyses and the
disusef a whole limb. More localized areas of osteo­
cuboidal bones of the carpus and tarsus.
penia are described in Section 1.18f Osteolytic
4. Hyperparathyroidism (osteitis fibrosa cysticaf
lesions. Focal osteopenia is more easily recognized
fibrous osteodystrophy). Metastatic
than diffuse osteopeniaf due to contrast with sur­
calcification may occur secondarily in soft
rounding normal bone. Howeverf radiography is
tissues such as the kidneysf gastric rugae and
relatively insensitive for bone lossf because approx­
major blood vessels (see 12.2).
imately 30-60% of the mineral content of bone
a. Nutritional secondary hyperparathyroidism
must be lost before being radiographically evident.
Guvenile osteoporosisf butcherfs dog disease)
Osteopenia is most readily apparent in parts of
(Fig. 1.20) - especially seen in young animals
the skeleton with high bone turnoverf such as tra­
due to high skeletal activity. Seen after
beculated bone in the metaphyses and epiphyses
weaning when on a high-meat diet that is low
of long bonesf vertebrae and the skull. The radio­
in calcimn and high in phosphorus. Clinical
graphic signs of osteopenia are:
signs of lamenessf lordosis and para- or
• a reduction in bone radiopacity compared with tetraplegia due to folding fractures occur.
soft tissues More common in cats than in dogs.
• thinning of corticesf sometimes with a double b. Renal secondary hyperparathyroidism (renal
cortical line ricketsf renal osteodystrophy) - chronic renal
• relative sparing of subchondral bone leading to failure in young animals with renal dysplasia
apparent sclerosisf especially in the endplates of or in older animals with chronic renal disease;
the vertebrae and adjacent to physes mainly affects the skult causing rubber jaw
• coarse trabeculation due to resorption of smaller (see 4.9.5 and Fig. 4.5), but other skeletal
trabeculae changes may also be seen as above.
• pathological folding or compression fracturesf c. Primary hyperparathyroidism - rare;
which are seen as distortion of the contour of the parathyroid gland hyperplasia or neoplasia.
bone and bands of increased opacity. d. Pseudohyperparathyroidism;
hypercalcaemia of malignancy - various
Most causes of osteopenia are metabolic diseasesf neoplastic causesf especially lymphoma and
and the aetiology may be complex. The condition
is reversible if the cause is corrected. Osteopenia

;.,�.•. �>�.
"�
may also be mimicked by incorrect technical fac­
tors during radiography.
1. Technical factors causing artefactual
l .
t·, · ·· .
. . · ...
,' .
osteopenia (see Appendix).
a. Overexposure.
��
'
'r ..
I
\; l
b. Overdevelopment.
c. Fogging of the film (numerous causes). · il
!I
\'
\ 11 I'
2. Artefactual due to changes in the thickness of ,
overlying soft tissue.
\!, 11,
a. Reduction in overlying soft tissuef leading to Figure 1 .20 Nutritional secondary hyperparathyroidism:
relative overexposure of the bone (e.g. in a folding fractures in an osteopenic tibia and fibula.
22 Handbook of Small Animal Radiology and U ltrasound

anal sac adenocarcinoma; also mammary proven; due to liver damage and effect on
adenocarcinomaf myelomaf gastric vitamin D production.
squamous cell carcinomaf thyroid 18. Cats - hypervitaminosis A - osteopenia due to
adenocarcinomaf testicular interstitial cell reduced periosteal activityf disuse and
tUIIlOurs. concomitant nutritional secondary
e. Other causes of secondary hyperparathyroidism; howeverf the proliferative
hyperparathyroidism (e.g. pregnancy and spine and joint changes predominate.
lactationf vitamin D deficienCYf acidosisf 19. Cats - mucopolysaccharidosis and
osteomalacic anticonvulsant therapy). mucolipidosis - as hypervitaminosis A; may
5. Corticosteroid excess. occur rarely in dogs (see 5.4.9).
a. Hyperadrenocorticism - Cushingfs disease.
b. Iatrogenic - long-term corticosteroid 1 . 1 7 COARSE TRABECULAR PATTERN
administration.
1. Osteopenia - osteopenia is most apparent in
6. Senility - especially aged cats. areas of trabecular bonef because here bone
7. Chronic protein deprivation or loss. turnover is highest. Small trabeculae are
a. Starvation. resorbed firstf leaving a coarse trabecular
b. Liver disease. pattern due to the remaining larger trabeculae.
c. Malabsorption. For causesf see Section 1.16.
8. Hyperthyroidism. 2. Panosteitis - coarsef sclerotic trabeculae may be
9. Diabetes mellitus. seen in large or small patches or arising from the
endosteal surface of the cortices (see 1.13.6 and
10. Panosteitis - not a true osteopenia but residual
Fig. 1 .17). In a dog of suggestive age and breed,
changes include paucity of trabeculae in long
bonesf giving a hollow appearancef although this finding is usually considered
pathognomonic for the disease.
the cortices are of normal thickness and
radiopacity. 3. Distal ulnar and/or radial metaphyseal changes
11. Rickets - probably via associated nutritional consisting primarily of thickened trabeculae have
secondary hyperparathyroidism (see 1.23.8 been described as an incidental finding in young
and Fig. 1.30). Newfoundland dogs in Norway (see 3.4.11).
12. Multiple myeloma (plasma cell myeloma) - 4. Multiple myeloma (plasma cell myeloma) - the
genuine osteopenia; also apparent osteopenia disease may produce multiple confluent
due to confluence of areas of osteolysis (see osteolytic lesions and osteopeniaf which
1.18.2 and Fig. 1.24). together can create an apparent coarse
13. Osteogenesis imperfecta - a rare inherited type trabecular pattern (see 1.18.2 and Fig. 1.24).
I collagen defect characterized by osteopenia 5. Osteopetrosis (see 1.13.15).
and excessive bone fragility and resulting in
multiple pathological fractures; it may occur
with dentinogenesis imperfectaf in which teeth
1 . 1 8 OSTEOLYTIC lESIONS
also fracture. Seen in young animalsf so the Ultrasonography is increasingly being used for
main differential diagnosis is nutritional various areas of the skeletal system. Although the
secondary hyperparathyroidism. ultrasound beam cannot penetrate normal bonef it
14. Lead poisoning in immature animals; sclerotic can show areas of superficial osteolysis such as cor­
metaphyseal lines may also be seen. tical defectsf allowing the needle to be guided into
15. Hypervitaminosis D - a massive intake in a the bone for fine needle aspiration biopsYf which
yOilllg animal can produce osteopenia with bone will sometimes give a cytological diagnosis. Adja­
deformity and retarded growthf but the main cent soft tissue masses may also be aspirated illlder
changes are soft tissue calcification (see 12.2). ultrasound guidance. The procedure does not
16. Copper deficiency. always require general anaesthesia and is therefore
17. Prolonged high-dose anticonvulsant therapy - rapid and cost-effective as well as being less inva­
primidonef phenytoin and phenobarbitone in sive than a bone biopsy. Howeverf a negative ultra­
humansf although effects in animals are not sound-guided fine needle aspiration biopsy does
Chapter 1 Skeletal system: general 23

not rule out neoplasia and should be followed by a
tissue core biopsy and histological analysis.
1. Artefactual.
a. Superimposition of skin defect or gas in an
open wound.

b. Superimposition of anal sac gas on the
ischium on ventrodorsal pelvic radiographs.
2. Neoplasia (see 1.19.1 and 1.20.1). •
a. Primary malignant bone tumour of osteolytic

type (especially in cats) (Fig. 1.21), although
usually there is some evidence of new bone
production as well.

b. Bone metastases (Fig. 1.22) - may be
Figure 1 .22 Bone metastases: m ultiple osteolytic lesions in
osteolytic or sclerotic; usually in atypical sites atypical sites for primary neoplasia.
for primary tmnours (e.g. diaphyses); often
multiple in one bone or polyostotic.
Metastatic carcinoma is predominantly
osteolytic without accompanying new bone.
Any primary tmnour may metastasizef but
mammary tumours are over-represented.
c. Malignant soft tissue tmnour invading bone
(Fig. 1.23) - usually soft tissue swelling and
cortical destruction starting subperiosteally are
obvious. If near a jointf more than one bone
may be affected (see 2.4.7 and Fig. 2.4).
Haemangiosarcomaf synovial sarcomaf
histiocytic sarcoma (malignant histiocytosis)f
plasmacytoma and liposarcoma are Figure 1 .23 Malignant soft tissue tumour invading bone:
predominantly osteolytic with an aggressive osteolysis predominates, and more than one bone may be
involved.

Figure 1 .24 Multiple myeloma in a dog, producing several
discrete punched-out areas of osteolysis in l u m bar vertebrae.

appearance. Infiltrative lipoma or liposarcoma
will have a characteristic fat opacity.
d. Lymphoma - usually predominantly
osteolytic lesionsf which may be multifocal;
tendency for pathological fracture.
e. Multiple myeloma (plasma cell myeloma)
Figure 1 .2 1 Osteolytic osteosarcoma of the proximal (Fig. 1.24) - discrete, punched-out osteolytic
humerus in a cat: severe bone destruction with pathological areas of variable size and lacking any
fracture. sclerotic margin; usually multiplef confluent
24 Handbook of Small Animal Radiology and U ltrasound

or polyostoticf less often solitary. Where pathological fracture. Often the adjacent mid­
lesions are confluentf the affected bone has a radial and mid-ulnar diaphyses.
polycystic or marbled appearance or may 7. Idiopathic multifocal osteopathy - one report
appear osteopenic with coarse trabeculation. of four adult Scottish Terriers in which there
Mainly affects pelvisf spinef ribsf and long was multifocal absence of bonef mainly affecting
bones. Pathological fractures are common. the spine. Howeverf it was unclear whether
3. Infection, osteomyelitis (see 1.20.2 and Figs 1.28 this was true osteolysis or failure of the bone
and 1.29). to form.
a. Bacterial. S. Osteolytic lesions at specific locations.
- Osteolytic halo around infected teeth due to a. Metaphyseal osteopathy (hypertrophic
periapical granuloma; differential diagnosis osteodystrophy; see 1.24.4 and Fig. 1.31).
is renal secondary hyperparathyroidism b. Metaphyseal osteomyelitis (see 1.24.5 and
(see 4.9.5 and Fig. 4.5). Fig. 1.32).
- Around sequestra. c. Retained cartilaginous cores (see 1.24.3f 3.5.3
- Around metallic implants; differential and Fig. 3.12) - not truly osteolytic but areas
diagnoses are movementf bone necrosis of non-ossification of cartilage.
due to heat from high-speed drill, artefact d. Large osteochondrosis lesions - not truly
around metallic implant on some digital osteolytic but areas of non-ossification of
radiographs. cartilage.
- At fracture sitesf especially following an e. Avascular necrosis of the femoral head
open wound. (Legg-Calve-Perthes disease) - young dogs
- Haematogenous osteomyelitisf especially of Terrier breeds - may affect both hips (see
in metaphyses; differential diagnosis is 3.9.4 and Fig. 3.24).
metaphyseal osteopathy (hypertrophic f. Intraosseous epidermoid cysts - rare in bone;
osteodystrophy) (see 1.24.4 and 1.24.5 and usually osteolytic; distal phalanges and
Figs 1.31 and 1.32). vertebrae.
b. Fungal* - usually spread by the g. Physeal dysplasia, slipped capital femoral
haematogenous route and therefore likely to epiphysis and feline femoral neck
be multiple lesions. metaphyseal osteopathy with subsequent
c. Protozoal - leislunaniasis* - may cause severe bone resorption of the femoral neck (see 3.9.6
osteolytic arthritis. and 3.9.10 and Fig. 3.25).
4. Trauma.
a. Superimposition of skin defect or gas in open 1 . 1 9 EXPANSllE OSTEOLYTIC lESIONS
wound.
b. Fracture line before full bridging. The following lesions are likely to be expansilef that
c. Osteolytic halo around surgical implants iSf they are osteolytic lesions arising within bonesf
caused by infectionf movement or bone which displace the cortex progressively outwards
necrosis due to the use of a high-speed drill; and cause predominantly thinning rather than
also artefactual on some digital radiographs. frank lysis of the cortex. Pathological fracture may
d. Stress protection - a localized area of occur. They are usually benign or of low-grade
osteopenia and bone weakness at the end of a malignancy.
bone plate. 1. Neoplasia.
S. Pressure atrophy - a smoothly bordered area of a. Giant cell tumour (osteoclastoma) (Fig. 1.25) -
superficial bone loss due to pressure from an a rare tumour usually seen in the epiphyses
adjacent mass (e.g. rib tumourf mass between and metaphyses of long bonesf especially the
digitsf elastic band aroillld limb). distal ulna. Expansilef osteolytic lesion with
6. Fibrous dysplasia - rare fibro-osseous defect of multiloculatedf septate appearance and
bone thought to be developmental in origin as variable transition to normal bone. May look
mainly seen in young animals; mono- or identical to a bone cystf but the patients are
polyostotic osteolytic lesions that may undergo usually older.
Chapter 1 Skeletal system: general 25

Figure 1 .25 Expansile bone lesio n : giant cell tumour of the
distal ulna. Although malignant, the lesion does not appear
particularly aggressive. Figure 1 .26 Benign bone cyst i n the distal humerus of a
skeletally immature dog, producing an expansile bone lesion
with non-aggressive characteristics.
b. RarelYf other non-osteogenic malignancies
may appear expansile.
c. Enchondroma (single) or enchondromatosis 4. Fibrous dysplasia (see 1.18.6) - may be
(multiple) - syn. osseous chondromatosisf expansile.
dyschondroplasiaf Olliees disease. Rare; larger 5. Bone abscess - rare.
breeds. A benign but debilitating condition in
which foci of physeal cartilage are displaced 1 .2 0 M IXED OSTEOLYTIC-OSTEOGENIC
through the metaphyses into the diaphyses, LESIONS
causing weakening of the bone due to expansilef
non-ossified lesions; animals usually present Because bone can respond to disease or injury only
while immature due to pathological fractures. by loss of bone or by production of new bonef dis­
d. Osteochondroma or multiple cartilaginous eases of different aetiology can appear very similar
exostoses - may appear expansile because the radiographically. One of the main challenges for
cortex is continuous with underlying bone the radiologist is to distinguish between neoplasia
(see 1.15.2 and Fig. 1.19). and infectionf although it may be impossible to
2. Benign bone cysts (Fig. 1.26) - rare, mainly do this with certaintYf and a biopsYf follow-up
young dogs of large breeds; male predominance; radiographs or other tests may be required. There
often distal radius or ulna. Expansilef often may be an equal combination of bone destruction
septatedf osteolytic lesions that may appear and new bone productionf and the mixed nature
identical to giant cell tumoursf although affected of the lesion may be obvious; in other casesf one
dogs are generally younger. The lesion is likely or other process may predominate.
to be confined to the metaphysisf not crossing Ultrasound-guided fine needle aspiration of
the growth platef although it may migrate along bone lesions that involve osteolysis is possible
the diaphysis with skeletal maturity. Usually and may give a cytological diagnosis (see 1.18).
single (unicamerat monostotic)f occasionally 1. Neoplasia.
multiple (polyostotic). a. Primary malignant bone tumour (Fig. 1 .27) -
3. Aneurysmal bone cysts appear similar but are primary malignant bone tumours are usually
due to vascular anomalies such as arteriovenous confined to single bones and rarely cross
fistulae or vascular defects resulting from joints. Eighty per cent are osteosarcoma; also
tramna or neoplasia; an enlarged nutrient chondrosarcomaf fibrosarcoma and tumours
foramen may be seen. Usually older animals. arising from soft tissue elements such as
Doppler ultrasound through the thin cortices haemangiosarcomaf histiocytic sarcoma and
may demonstrate blood flow. liposarcoma. It is impossible to differentiate
26 Handbook of Small Animal Radiology and U ltrasound

fracturesf chronic infectionf infarcts or
radiation therapYf sometimes years later.
b. Bone metastases - mixedf fairly aggressive
lesionsf although lysis or sclerosis may
predominate strongly and periosteal reaction
may be minimal; usually in atypical sites for
primary tumoursf such as diaphyses; often
multiple in one bone or polyostotic. Rarer
than in humans; usually from primary
tumours of epithelial type such as mammary
or prostate. The main differential diagnosis is
osteomyelitisf especially where fungal
diseases are endemic; sclerotic lesions may
Figure 1 .27 Primary malignant bone tumour: osteosarcoma mimic panosteitisf although patients with
of the distal radius. A mixed osteolytic-proliferative lesion of metastases are likely to be older. Scintigraphy
aggressive appearance. using technetium-99m methylene
diphosphonate is more sensitive for bone
histological types radiographically. In dogs, metastases than is radiographic screening.
osteosarcoma usually arises in long bone c. Malignant soft tissue tumour invading bone -
metaphyses in larger breeds (especially the osteolysis usually predominatesf although
proximal humerus and distal radiusf the there may be some bony reaction or pre­
thoracic limb being affected twice as often as existing osteoarthritis. If arising near a jointf
the pelvic limb), although any bone including more than one bone may be affected (see
the axial skeleton may be affected by 1.18.2, 2.4.7 and Figs 1.23 and 2.4).
malignancy. Most are endosteal in originf but d. Neoplastic transformation at the site of a
periosteal and parosteal osteosarcomas may previous fracture - rare but well recognized
occur. Affected dogs are usually middle- to in humans and animals. Usually several years
old-agedf although a smaller population is after internal fixation - postulated causes
affected at 1-2 years of age. Primary include the presence of a metallic implant or
malignant bone tumours are usually mixed chronic low-grade infection. Radiographic
osteolytic-proliferative and aggressive with a signs are of an active and aggressive lesion
wide transition zone to normal bonef superimposed over obvious previous
although some lesions may appear ahnost fracture; differential diagnosis is chronic
entirely osteolytic (osteoclastic type) or infection.
proliferative (osteoblastic type). New bone e. Benign bone tumours may occasionally show
production varies from minimal to floridf and lysis as well as a bony mass (osteomaf
in the case of osteosarcoma includes tumour osteochondroma) or bone reaction as well as
bone as well as reactive bone. High-grade lysis (enchondroma).
tumours tend to show more cortical 2. Infection - bone inflammation and infection
destruction and surrounding soft tissue (osteomyelitis) generally produces a mixed
swelling than low-grade tumours. osteolytic-proliferative bone lesionf although
Pathological fracture may occur. Lung the proportions of bone loss and new bone
metastases are common in most dog breedsf production vary. The lesions are often hard to
although in small dogs the tumours may be differentiate from neoplasiaf but soft tissue
less aggressive and less likely to metastasize. swelling is often more marked with infection.
In catsf osteosarcomas tend to be mainly Small pockets of gas may be seen if gas­
osteolytic and are more often seen in the pelvis producing organisms are present.
and pelvic limb. They are less aggressive in a. BacteriaL
their behaviour than in larger dogsf with a - Solitary lesions in older animals are
relatively low metastatic rate. Osteosarcomas usually associated with a known woundf
may occasionally arise at the site of previous surgerYf extension from soft tissue
Chapter 1 Skeletal system: general 27

osteolysis around surgical implants.
Differential diagnoses are movement of
implantf necrosis from high-speed drilt
artefact around metallic implants on some
digital radiographs.
'I' - Multiple lesionsf often bilaterally
'" symmetricat are seen with haematogenous
osteomyelitisf which is more common in
young animals. Especially in metaphyses
due to sluggish blood flow. Aggressive
osteolytic lesions resultf with surroilllding
sclerosis and/or periosteal reaction;
pathological fracture may occur.
Figure 1 .28 Acute osteomyelitis in the ulna of a cat, Differential diagnosis is metaphyseal
following a dog bite: a mixed, aggressive lesion with marked osteopathy (hypertrophic osteodystrophy)
surrounding soft tissue swelling. The two focal radiolucent in young dogs (see 1.24.4 and 1.24.5 and
areas are the result of injury caused by the canine teeth of Figs 1.31 and 1.32).
the attacking animal. - A mycetoma is a localizedf suppurativef
granulomatousf inflammatory lesion with
infection or a migrating foreign body. In sinus formationf which shows a
the acute stagef osteomyelitis is a mixedf predilection for skinf subcutisf fascia and
fairly aggressive lesion but is more likely bone. Lesions usually develop following
to show a surrounding sclerotic zone (due traumatic implantation of soil organisms
to walling off) than is neoplasia (Fig. 1.28). into the tissues. The cause may be bacterial
Chronic or resolving osteomyelitis appears (actinomycotic mycetoma) or fungal
less aggressivef and new bone formation (eumycotic mycetoma).
may predominate. Sequestrum or b. Fungal - usually spread haematogenouslYf
involucrum formation is an occasional producing single or multiple lesionsf again
finding (Fig. 1.29). Pathological fractures often metaphyseaL Usually aggressivef mixed
are less common than with neoplasia. osteolytic-proliferative bone lesions. Main
Osteomyelitis predisposes to delayed or differential diagnosis is metastatic neoplasiaf
non-union of fractures and causes but with hmgal infection the patient is more
likely to be systemically ill; also consider
bacterial osteomyelitis.
- Coccidioidomycosis* - pyrexia and
depression with respiratoryf skinf ocular
and skeletal lesions; 90% of the bone
lesions are in the appendicular skeletonf
mainly in the distal ends of long bones.
- Blastomycosis* - affects mainly large-breedf
young male dogsf causing a spectrum of
syndromes as above; 30% of dogs have bone
involvementf with lesions usually solitary
and distal to the elbow or stifle.
- Aspergillosis* - as well as destructive
rhinitisf other aggressive bone lesions (e.g.
discospondylitis) and pneumonia have
Figure 1 .29 Chronic osteomyelitis and sequestrum been reported in the German Shepherd
formation in the metatarsus of a cat, following a cat bite. dog and immunocompromised patients in
This lesion is less aggressive in nature and appears partly areas where other fungal diseases are not
walled off. endemic (e.g. the UK).
28 Handbook of Small Animal Radiology and U ltrasound

- Histoplasmosis* - various systemic • A Codmanfs triangle of new bone at one end of
illnesses (mainly gastrointestinal in the the lesion is more likely to be associated with
dog); rarely causes osteolytic or mixed neoplasia.
bone lesions. • Sequestrum formation may occur with
- Cryptococcosis* - usually part of a more osteomyelitis but not neoplasia.
generalized disease processf especially in • Most primary malignant bone tumours affect
immunosuppressed patients. only a single bone and rarely cross joints.
- Mycetoma - see above.
• Soft tissue swelling is often more extensive with
c. Protozoal - leishmaniasis* - may cause acute osteomyelitisf and gas bubbles may be
multifocat often bilateral bone lesions that seen due to gas-producing organisms.
are mainly diaphyseal periosteal reactions
• The thorax should be radiographed to check for
and increased intramedullary radiopacitYf lung metastases if there is a suspicion of
especially near the nutrient foramen; another
neoplasia.
common presentation is erosive or non­
• Ultrasonography may be used to look for
erosive joint disease (see 2.4.12).
abdominal metastases.
d. Cats - feline tuberculosis - various
Mycobacterium species (rare). Skin and lung
lesions predominate but occasionally
1 .2 1 M U LTI FOCAL DISEASES
aggressive mixed bone lesions are seen; also
periosteal reactionsf discospondylitis and Multifocal diseases may produce more than one
os teoarthritis. lesion in the same bone (monostotic) or may affect
3. Trauma. multiple bones (polyostotic). For multifocal joint
a. Healing fracture - partial bridging of the diseasesf see 2.7.
fracture line with resorption of damaged
bone. Multiple lesions of increased radiopacity
b. Osteomyelitis at a fracture site. (see 1 . 1 3)
c. Late neoplastic transformation at a fracture
site. 1. Panosteitis (see 1.13.6 and Fig. 1 .17).
4. Metaphyseal osteopathy (hypertrophic 2. Sclerotic bone metastases.
osteodystrophy) - lesions in metaphyses only; 3. Haematogenous osteomyelitisf especially
differential diagnosis is metaphyseal osteomyelitis fungal.
(see 1 .24.4 and 1.24.5 and Figs 1.31 and 1 .32). 4. Bone infarcts - rare.
5. Multifocal idiopathic pyogranulomatous bone 5. Osteopetrosis - rare (see 1.13.15).
disease- sterilef polyostotic bone disease thought
to be part of the group of histiocytic diseases.
6. Canine leucocyte adhesion deficiency (CLAD) Multiple lesions of reduced radiopacity
(see 1.24.9). (see 1 . 1 8 and 1 . 1 9)
6. Osteolytic bone metastases.
Differentiating malignant bone neoplasia 7. Disseminated histiocytic sarcoma - especially
from osteomyelitis Rottweilers.
• The degree and extent of osteolysis is usually 8. Multiple myeloma (plasma cell myeloma) (see
greater in malignancYf and the cortex is more 1.18.2 and Fig. 1 .24).
likely to be breached. 9. Enchondromatosis (see 1.19.1).
• Pathological fracture is therefore more likely 10. Lymphoma - may occasionally produce
with neoplasia. multiple or polyostotic osteolytic bone lesions;
• Periosteal new bone formation is much more prone to pathological fracture.
irregular in neoplasiaf with a tendency to form 11. Multiple bone cysts (more often single) (see
spiculesf often radiating out from the centre of 1.19.2 and Fig. 1 .26).
the lesionf whereas with osteomyelitis the new 12. Metaphyseal osteopathy (hypertrophic
bone tends to be more solid and extensive. osteodystrophy) - early cases show a
Chapter 1 Skeletal system: general 29

radiolucent metaphyseal band (see 1.24.4 and humeral condylar fracture seen especially in
Fig. 1.31). Spaniel breeds (see 3.4.17 and Fig. 3.10).
13. Metaphyseal osteomyelitis (see 1.24.5 and 2. Remodelling of epiphyses due to altered
Fig. 1.32). stresses following angular limb deformities and
14. Disuse osteopenia - seen especially in tramnatic subluxations (e.g. of the distal radial
epiphyses and small bones. epiphysis following radiocarpal subluxation as
a result of premature closure of the distal ulnar
growth plate); may be bilateral in giant breeds.
Multiple lesions of mixed radiopacity
3. Disuse osteopenia (see 1.16.3) - due to fracture
(see 1 .20)
or paralysis of a limb; the osteopenia usually
15. Bone metastases. affects the distal limb most severelYf with loss
16. Haematogenous osteomyelitis. of bone radiopacity especially in epiphyses
and cuboidal bones (e.g. non-union of radial or
a. Fungal*.
ulnar fractures in toy breeds of dogf with
b. Bacteriat especially in young animals. severe osteopenia in the carpus and distal limb
c. Protozoal - leislunaniasis*. epiphyses). Disuse osteopenia is reversible if
17. Multifocal idiopathic pyogranulomatous bone the cause is corrected.
disease. 4. Giant cell tumour (osteoclastoma) (see 1.19.1
and Fig. 1.25).
Multiple mineralized or bony masses 5. Irregularity or osteolysis of the articular
surface of an epiphysis (see 2.4-2.6).
18. Multiple cartilaginous exostoses (multiple a. Osteochondrosis - may be bilateral or in
osteochondromata) (see 1.15.2 and Fig. 1.19). other joints.
19. Calcinosis circumscripta - usually singlef b. Septic arthritis - in multiple joints if of
occasionally multiple; in soft tissues close haematogenous origin.
to but not attached to bone (see 12.2.2 and c. Chronic osteoarthritis - may affect more
Fig. 12.1). than one joint depending on the illlderlying
20. Synovial osteochondromatosis - masses cause.
around joints (see 2.8.18 and Fig. 2.7). d. Soft tissue tumour near a joint.
21. Cats - hypervitaminosis A (cats over 2 years e. Avascular necrosis of the femoral head
old on raw bovine liver diet) - leads to masses (Legg-Calve-Perthes disease) - young dogs
around joints; mainly spinal new bone but may of Terrier breedsf especially West Highland
also see exostoses near the limb jointsf White Terrier - may affect both hips (see
especially the elbowf and on the occipital bone. 3.9.4 and Fig. 3.24).
f. Dysplasia epiphysealis hemimelica - seen in
humans as a growth disorder involving
1 .2 2 LESIONS AFFECTING EPI PHYSES preferentially the medial compartment of
the lower limbs; epiphyseal hypertrophy
See also Chapter 2 for joint diseases in generat
and lack of ossification. One case has been
Chapter 3 for specific joints and Chapter 5 for ver­
described in a Boxerf affecting a medial
tebral epiphyseal lesions.
femoral condyle.

Lesions usually affecting single or few Lesions usually affecting numerous
epiphyses epiphyses
1. Fractures (see 1.9 and Fig. 1.10) - usually These include diseases that result in epiphyseal dys­
Salter-Harris growth plate fractures in plasia or dysgenesisf often together with other wide­
skeletally immature animals; types III and IV spread skeletal defects such as delayed growth plate
cross the epiphysisf causing disruption to the closuref long bone curvature and dwarfism.
articular surface with variable displacement of 6. Normal skeletal immaturity - endochondral
the fragment. In skeletally mature animalsf the ossification occurs from the centre of epiphyses
commonest epiphyseal fracture is the lateral and apophysesf and in the young animal the
30 Handbook of Small Animal Radiology and U ltrasound

bone surface may appear ragged and irregular mucopolysaccharidosis type I (Plot! Hound) and
due to normat incomplete ossification 11 (Pointers) are reported to cause epiphyseal
(particularly the humeral greater tubercle and dysplasia and periarticular bony proliferations
femoral condyles); compare with other animals and type VII to affect vertebral epiphyses.
of similar age. 12. Cats - mucolipidosis type 11 - rare; less severe
7. Chondrodysplasias (dyschondroplasias) epiphyseal lesions reported.
recognized in nmnerous breeds (e.g. Alaskan
Malamutef Australian Shepherd dog**f Beaglef 1 .2 3 LESIONS AFFECTING PHYSES
Bedlington Terrier**f Cocker Spaniet
Dachshillldf Dobermann**f English Pointerf Loss of physeal line
English Springer Spaniel" , French Bulldog,
1. Poor positioningf so the growth plate is not
German Short-haired Pointerf Irish Setterf
parallel to the X-ray beam.
Japanese Akitaf Labrador**f Miniature Poodlef
2. Premature closure of the growth plate due to
Newfoundland, Norwegian Elkhound,
trauma.
Pyrenean Mountain dogf Saint Bemardf
a. Salter-Harris type V crushing injury -
Samoyed**f Scottish Deerhoundf Scottish
probably responsible for 'idiopathic'
Terrier, Shetland Sheepdog, Swedish
premature closure of the distal ulnar growth
Lapphund**; may be with ocular defects as
plate in giant breeds; may be bilateral
well. Cats - Domestic Short-hair.
(see 3.5.4 and Fig. 3.13).
8. Chondrodysplasias are inherited abnormalities b. Bridging of the margin of a growth plate
of endochondral ossification that produce due to superimposed periosteal new bone;
generalized stippling and fragmentation of may be seen with metaphyseal osteopathy
epiphyses on radiographs and that lead to (hypertrophic osteodystrophy; see 1.24.4
secondary osteoarthritis. ClinicallYf they may and Fig. 1 .31).
mimic rickets but may be seen prior to
weaning and in related animals on different Widening of physeal lines: single
diets; radiographicallYf rickets does not show
epiphyseal changesf just physeal widening and 3. Salter-Harris type I fracture with displacement
long bone bowing. Multiple epiphyseal (see 1.9.11 and Fig. LlD).
dysplasia (stippled epiphyses, dysplasia 4. Infection (physitis) - although haematogenous
epiphysealis pilllctata) - inherited deficiency of osteomyelitis more often occurs in metaphyses
ossification of epiphysesf apophyses and due to sluggish blood flow in these areas. May
cuboidal bones; especially Beagle and be associated with a portosystemic shunt.
Miniature Poodle. Vertebral physitis is recognized in younger
9. Congenital hypothyroidism - especially the dogsf affecting caudal lumbar physes.
Boxer. A congenital disease resulting in
disproportionate dwarfism; differential Widening of physeal lines: general ized
diagnosis is chondrodysplasia. Affected dogs
suffer from epiphyseal dysgenesis leading to Affected animals are often stunted and may also
secondary osteoarthritisf delayed growth plate have epiphyseal dysplasia leading to secondary
closure and shortenedf bowed limbs. Facial osteoarthritis. Physeal lesions are often most severe
and spinal changes are also seen (see 5.3.11). in the distal radius and ulna due to the normally
10. Pituitary dwarfism - some cases show rapid growth rate at these sites.
epiphyseal dysplasia, although this may be 5. Chondrodysplasias - variable effects on growth
due to concurrent hypothyroidism. platesf with wideningf ragged margination and
11. Mucopolysaccharidosis types I, VI and VII - delayed closure in some affected animals. Often
especially cats with Siamese ancestry; facial and initially misdiagnosed as rickets.
spinal lesions with varying degrees of epiphyseal 6. Congenital hypothyroidism - wide and
dysplasia and secondary osteoarthritisf irregular growth plates with delayed closuref
especially in the shoulders and hips (see 5.4.9). particularly in the spine (see 5.3.11); especially
Rarely occurs in dogsf but the Boxer.
Chapter 1 Skeletal system: general 31

Masses arising at physes
11. Osteochondroma (single) or multiple
cartilaginous exostoses (multiple) - arise at
osteochondral junctions in young dogsf so are
often seen protruding from the site of previous
growth plates (see 1.15.2 and Fig. 1.19).

1 .2 4 LESIONS AFFECTING METAPHYSES
1. Normal cut-back zone - area of cortical
remodelling adjacent to the physis in young
Figure 1 .30 Rickets: thoracic limb of a young puppy,
dogsf which results in an irregular bone
showing changes especially in the distal radial and ulnar surface (see 1.3 and Fig. 1.1A).
growth plates. 2. Neoplasia.
a. Primary malignant bone tumours (e.g.
osteosarcoma) - the long bone metaphyses
7. Pituitary dwarfism - some cases may show are a strong predilection sitef especially the
wide and irregular growth plates with delayed proximal humerus and distal radius in giant
closuref perhaps due to concomitant dog breeds (see 1.20.1 and Fig. 1 .27).
hypothyroidism. b. Osteochondroma (single) or multiple
8. Rickets Guvenile osteomalacia) (Fig. 1.30). cartilaginous exostoses (multiple) - in
a. Now raref due to a dietary deficiency of young dogsf arising at osteochondral
phosphorus or vitamin D and seen after junctions and therefore often protruding
weaning. from the metaphyses (see 1.15.2 and
b. Hypovitaminosis D due to failure to absorb Fig. 1.19).
vitamin D (e.g. extrahepatic biliary atresia or c. Enchondromatosis - persistent segments of
common bile duct obstruction in young physeal cartilage are displaced through
animals). metaphyses into diaphysesf producing
c. Hypovitaminosis D due to failure to multiplef expansilef osteolytic lesions that
metabolize vitamin D - vitamin D­ may illldergo pathological fracture (see
dependent rickets types I and 11 are due to 1.19.1).
gene mutations leading to errors of vitamin 3. Retained cartilaginous cores - retention of
D metabolism. physeal cartilage in metaphyses due to
d. Renal dysplasia preventing final incomplete endochondral ossificationf
hydroxylation pathway to create active producing conical or candle flame-shaped
metabolite. radiolucent areas with finef sclerotic margins
Physes are wide transversely and in the distal ulnar metaphyses (occasionally
longitudinally due to failure of ossification and the distal radius or femur). Giant breedsf often
accumulation of unmineralized osteoid; bilateral; may coexist with retarded growth or
metaphyses flare laterally and show beaked premature closure of the distal ulnar growth
margins due to continued periosteal bone platef but a causal relationship is not certain
growth. Long bones are shortened and may be (see 3.5.3 and Fig. 3.12).
bowedf leading to stunting; osteopenia may be 4. Metaphyseal osteopathy (syn. hypertrophic
present due to concomitant nutritional osteodystrophy (MOD), skeletal scurvy,
secondary hyperparathyroidism. Unlike Moller-Barlow's disease) (Fig. 1.31A and B) -
hereditary chondrodysplasiasf the epiphyses skeletally immature (usually 2-8 months old)
are normal. dogs of larger breedsf with a higher incidence
9. Infection - haematogenous physitis may affect in the German Shepherd dog, Irish Setter,
more than one growth plate. Weimaranerf Great Dane and Chesapeake Bay
10. Copper deficiency. Retriever; male preponderance in some
32 Handbook of Small Animal Radiology and U ltrasound

affected. Differential diagnoses are
metaphyseal osteomyelitisf normal cut-back
zone in large dogs (areas of ill-defined cortical
irregularity due to remodelling of bone)f
unusual manifestation of craniomandibular
osteopathYf canine leucocyte adhesion
disorder; lead poisoning if the band appears
mainly sclerotic.
5. Infection - usually produces metaphyseal
lesions if the infection is spread
haematogenouslYf especially in young animals
due to sluggish blood flow at these sites; likely
to be multifocal and often bilaterally
symmetricaL
a. Bacterial - metaphyseal osteomyelitis
(Fig. 1.32) is an unusual condition in
young dogs with aggressivef osteolytic
metaphyseal lesions that may undergo
pathological fracture; definitive diagnosis
requires blood culture; differential diagnosis
is metaphyseal osteopathy (hypertrophic
osteodystrophy).
b. Filllgal* - aggressivef usually mixed lesions.
6. Bone cysts - often metaphyseal (see 1.19.2 and
® \
Fig. 1 .26).
7. Chondrodysplasiasf rickets and other growth
Figure 1 .3 1 (A) Early metaphyseal osteopathy (hypertrophic abnormalities (see 1.12) - often metaphyses are
osteodystrophy): a mottled band of radiolucency in the widened due to abnormal endochondral
metaphysis parallel to the growth plate. (8) Late metaphyseal ossification at the growth plate.
osteopathy (hypertrophic osteodystrophy): the metaphyses S. Distal ulnar and/or radial metaphyseal
are surrounded by successive layers of periosteal and changes have been described as an incidental
para periosteal new bone, the deeper layers becoming finding in young Newfoundland dogs in
remodelled into the cortex. Superimposition of new bone Norway (see 3.5.11).
creates a sclerotic appearance.

reports. The aetiology is unknownf but the
disease can be associated with a high plane of
nutrition. Painf heat and swelling are found at
metaphyses; the patient is depressedf febrile
and anorexicf but the condition is usually self­
limiting. Radiography shows a radiolucent
band ± narrow sclerotic marginsf or a mottled
bandf crossing metaphyses parallel to but not
involving the growth plate (note: the normal
periphery of the conical distal ulnar growth
plate should not be mistaken for a transverse
radiolucent band). Laterf subperiosteal
haemorrhages provoke collars of
mineralization and paraperiosteal new bone Figure 1.32 Metaphyseal osteomyelitis: the osteolysis is
that may become large and deforming. The more diffuse and aggressive than with metaphyseal
distal radius and ulna are most severely osteopathy.
Chapter 1 Skeletal system: general 33

9. Canine leucocyte adhesion deficiency - an 8. Hypertrophic osteopathy (Mariefs disease; see
inherited disease in the Irish Setter causing 1.14.6 and Fig. 1 . 18) - a specific cause of
osteolytic or mixed osteolytic-proliferative periosteal reaction.
lesions in metaphysesf especially the distal 9. Healing fracture.
radius and ulnaf and skull changes similar 10. Chronic osteomyelitis and involucrum
to craniomandibular osteopathy; clinical signs formation.
include gingivitisf lamenessf mandibular 11. Leisrunaniasis* - periosteal and intramedullary
swelling and lymphadenopathy.
bone proliferation in diaphyses and flat bones
10. Craniomandibular osteopathy - rarely see provoked by chronic osteomyelitis; increased
additional masses of paraperiosteal new bone
medullary radiopacity often near the nutrient
adjacent to distal ulnar metaphyses; may
foramina. Erosive and non-erosive
mimic metaphyseal osteopathy (hypertrophic polyarthritis are also seen.
osteodystrophy) (see 3.5.14, 4.10.1 and Figs
12. Concave side of bowed long bone in response
3.14 and 4.6).
to increased load.
11. Lead poisoning - rarely see radiographic
lesions; thinf transverse sclerotic bands in 13. Congenital hypothyroidism - especially
metaphyses. Boxers; shortenedf bowed radius and ulna with
thickened cortices and increased medullary
radiopacity (see 5.3.11).
1 .2 5 LESIONS AFFECTING DIAPHYSES 14. Osteopetrosis and certain myeloproliferative
Conditions that are mainly seen in diaphyses are disorders - rare (see 1.13.15).
listed in this sectionf although some of these
lesions may also produce changes in other parts Interruption of cortices
of the skeleton.
15. Fracture.
16. Neoplasia.
Thinning of cortices 17. Osteomyelitis.
1. Osteopenia - various causes (see 1.16). 18. Large expansile lesion.
Also results in reduced bone radiopacitYf 19. Biopsy site.
coarse trabecular pattern and folding 20. Site of drill hole or implant removal.
fractures.
2. Expansile lesion within medullary cavitYf for Radiolucent lines in diaphyses
example bone cystf giant cell tumourf
enchondroma (see 1.19 and Figs 1 .25 and 1.26). 21. Artefacts
The cortex is displaced outwards and is a. Overlying skin defect.
smoothly thinned but may not be interrupted. b. Overlying fat or gas in fascial planes.
3. Osteolytic lesions (e.g. neoplasiaf c. Mach effect from other superimposed bones.
osteomyelitis). The cortex is irregularly 22. Nutrient foramen - location usually known
thinned and often interrupted. anatomically; compare with the opposite limb
4. Pressure atrophy - a smoothly bordered area if in doubt.
of superficial bone loss due to pressure from 23. Fissure fractures.
an adjacent mass (e.g. rib tumourf mass
between digits).
Sclerotic lines in diaphyses (see 1 . 1 3)
5. Convex side of a bowed long bone.
6. Atrophic non-union of a fracture. 24. Growth arrest lines.
25. Panosteitis.
Thickening of cortices 26. Fractures - if impaction of bone or overlapping
of fragments occursf a sclerotic band rather
7. Remodelling periosteal reaction - numerous than a bone defect may be seen.
causes (see 1.14). a. Folding fractures.
34 Handbook of Small Animal Radiology and U ltrasound

- Greenstick fractures (single cortex) in b. Osteoproductive primary bone tmnour
young animals. extending into the diaphysis or in an
- Osteopeniaf especially due to nutritional atypical location (usually they are
secondary hyperparathyroidism. metaphyseal).
b. Compression or impaction fractures - c. Certain myeloproliferative disorders.
especially vertebrae. d. Lymphoma - may rarely cause medullary
c. Superimposition of overridden fragments osteosclerosis.
seen on one radiographic projection but e. Cats - feline leukaemia-induced medullary
shown to be displaced using the orthogonal osteosclerosis - rare; likely to be widespread
view. in the skeleton.
d. Healing fracture. 32. Osteomyelitis - haematogenous
osteomyelitis may produce ill-defined patches
Osteolytic areas in dia physes (see 1 . 1 8 and of sclerosis.
1 .1 9) 33. Panosteitis.
34. Healing fractures.
27. Neoplasia. 35. Bone infarcts.
a. Bone metastases - may be predominantly 36. Osteopetrosis - rare; affects the whole skeleton
osteolytic; often multiple in one bone or but is most obvious radiographically in the
polyostotic. diaphyses.
b. Multiple myeloma (plasma cell myeloma) -
usually multiplef discrete osteolytic lesions Mixed osteolytic-osteogenic lesions in
affecting more than one bone. dia physes (see 1 .20)
c. Malignant soft tissue tumour invading bone
- osteolysis usually predominates. 37. Neoplasia.
d. Osteolytic primary bone tumour extending a. Bone metastases - may be mixed lesionsf
into the diaphysis or in an atypical location although they are often predominantly
(usually they are metaphyseal). osteolytic or sclerotic; often multiple in one
e. Lymphoma. bone or polyostotic.
28. Infection - mixed lesions are more common b. Malignant soft tissue tumour invading
than purely osteolytic lesionsf although a bone.
bone abscess (rare) may appear as a well­ c. Neoplastic transformation at the site of a
defined radiolucent area with a sclerotic previous fracture.
margin. d. Mixed primary bone tumour in an atypical
29. Bone cysts - discretef expansile lesions; rare. location (usually they are metaphyseal).
30. Enchondromatosis - discretef expansile 38. Infection.
lesions; rare. 39. Trauma.
a. Healing fracture.
Sclerotic areas in diaphyses (see 1 . 1 3) b. Infected fracture.
c. Neoplastic transformation at the site of a
31. Neoplasia.
previous fracture.
a. Bone metastases - may be predominantly
sclerotic; often multiple in one bone or Altered shape of dia physes (see 1 . 1 0)
polyostotic.
Chapter 1 Skeletal system: general 35

Further reading
General biopsy of bone lesion: a multiple epiphyseal dysplasia:
Papageorges, M., 1991. How the prelim.inary report. Vet. RadioL 19 cases (1991 2005). j. Am. Vet.
Mach phenomenon and shape Ultrasound 40, 82 86. Med, Assoc. 233, 600 606.
affect the radjographic Scott, H, 1998, Non traumatic causes
appearance of skeletal structures. Normal anatomy. normal variants of lameness in the forelimb of
Vet. Radiol. 32, 191 195. and artefacts the growing dog. In Pract. 20,
Papageorges, M., Sande, RD., 1990. Fagin, B,D" Aronson, E" 539 554,
The Mach phenomenon. Vet. Gutzmer, M.A., 1992, Closure of ScoUt H" 1999, Non traumatic causes
Radiol. 32, 191 195. the iliac crest ossification centre of of lameness in the hindlimb of the
Thompson, K., 2007. Bones and dogs, J, Am, Vet. Med, Assoc, 200, growing dog, In Pract. 21,
joints, In: Maxie, M,G, (Ed.), jubb, 1709, 176 188,
Kennedy and Palmer's Pathology Root, M,V" Johnston, S.D" Olson, p, Trowald Wigh, G" Ekman, S"
of Domestic Animals, fifth ed, vol. N" 1997, The effect of prepubertal Hansson, A, Hedhanunar, A,
1. Saunders, New York. and postpubertal gonadectomy on Hard af Segerstad, C, 2000,
Weinstein, J .M., Mongil, CM., radial physeal closure in male and Clinical, radiological and
Rhodes, W.H., Smith, GK., 1995. female domestic cats. Vet. RadioL pathological features of 12 Irish
Orthopedic conditions of the Ultrasound 38, 42 47. Setters with canine leucocyte
Rottweiler Part U. Compend. adhesion deficiency. J. Small
Contin. Educ. Pract. Veterinarian Congenital and developmental Anim. Pract. 41, 211 217.
(Small Animal) 17, 925 938, diseases; diseases of young animals
Weinstein, J.M., MongH, CM., CampbeIJ, B,G., Wootton, JAM., Metabolic bone d isease (some
Smith, GK., 1995, Orthopedic Krook, J" DeMarco, J., Minor, R overlap with above)
conditions of the Rottweiler R, 1997, Clinical signs and Allan, CS" Huxtable, CRR,
Part 1. Compend. Contin. Educ. diagnosis of osteogenesis Howlett, CR., Baxter, R.C,
Pract. Veterinarian (Small imperfecta in three dogs, J, Am, DufC B,RH" Farrow, B,RH" 1978,
Animal) 17, 813 830, Vet, Med, Assoc, 211, 183 187, Pituitary dwarfism in German
Demko, L McLaughlin, R" 2005, Shepherd dogs, j, Small Anim,
Skeletal ultrasonography Developmental orthopedic Pract. 19, 711 729,
Britt, T" Clifford, C, Barger, A, disease, Vet. Clin, North Am, Buckley, j,c., 1984, Pathophysiologic
Moroff, K" Drobatz, K" Small Anim, Pract. 35, 1111 1135, considerations of osteopenia,
Thacher, G., Davis, G, 2007, Konde, L.J., Thrall, M,A, Gasper, P., Compend, Contin, Educ, Pract.
DiagnOSing appendicular Dial, S.M., McBiJes, K., Colgan, S., Veterinarian (Small Animal) 6,
osteosarcoma with ultrasound HaslOns, M., 1987. 552 562,
guided fine needle aspiration: Radiographically visualized Dennis, R, 1989. Radiology of
36 cases. J. Small Anim. Pract. 48, skeletal changes associated with metabolic bone disease. Vet. Ann.
145 150. mucopolysaccharidosis VI in cats. 29, 195 206.
Kramer, M., Gerwing.. M" Hach, V" Vet. Radiol. 28, 223 228, Dunn, M,E., Blond, L., Letard, D.,
Schimke, E" 1997, Sonography of Muir, p" Dubielzig, RR., DiFruscia, R" 2007. Hypertrophic
the musculoskeletal system in Johnson, K.A, 1996, Panosteitis, osteopathy associated with
dogs and cats, Vet. RadioL Compend. Contin. Educ, Pract. infective endocarditis in an adult
Ultrasound 38, 139 149, Veterinarian (Small Animal) 18, boxer dog, J, Small Anim, Pract.
Risselada, M" Karmer, M" de 29 33, 48, 99 103,
Rooster, 0" Taeymans, 0" Muir, p" Dubielzig, RR, Codfrey, D,R, Anderson, RM"
Verleyen, H" van Bree, H" 2005, johnson, D,G, Shelton, D,G" 1996, Barber, P,L Hewison, M" 2005,
Ultrasonographic and Hypertrophic osteodystrophy and Vitamin D dependent rickets type
radiographic assessment of calvarial hyperostosis, Compend, 11 in a cat. J, Small Anim, Pract, 46,
uncomplicated secondary fracture Contin, Educ, Pract. Veterinarian 440 444,
healing of long bones in dogs and (Small Animal) 18, 143 15L Johnsoo, K.A., Church, D,B"
cats. Vet. Surg, 34, 9 107. R�nrik. A.M., Tiege, J., Ottesen, N" Barton, Rj" Wood, A.KW., 1988.
Samu, V.F., Nyland, T.G, Wemer, L. Lingaas, F., 2008. Clinical, Vitamin D dependent rickets in a
L, Baker, TW., 1999. Ultrasound radiographic, and pathologic Saint Bemard dog. J. Small Anim.
guided fine needle aspiration abnonnalities in dogs with Pract. 29, 657 666.
36 Handbook of Small Animal Radiology and U ltrasound

Konde, L.L Thralt M.A, Gasper, P., Stead, AC, 1984. Osteomyelitis in bone in dogs and cats. Vet. Clin.
Dial, S.M., McBiles, K., Colgan, S., the dog and cat. J. Small Anim. North Am. 13, 163 180.
Haskins, M., 1987. Pract. 25, 1 13. Schrader, S.C, Burk, RL., Un, S.,
Radiographically visualized Turrel, J.M., Poot RR, 1982. Bone 1983. Bone cysts in two dogs and
skeletal changes associated with lesions in four dogs with visceral a review of similar cystic bone
mucopolysaccharidosis VI in cats. leishmaniasis. Vet. Radiol. 23, lesions in the dog. J Am Vet Med
Vet. Radiol. 28, 223 228. 243 249. Assoc 182, 490 495.
Lamb, CR, 1990. The double cortical Schultz, RM., Puchalski, S.M.,
line: a sign of osteopenia. J. Small Neoplasia Kent, P.F., Moore, P.F., 2007.
Anim. Pract. 31, 189 192. Blackwood, 1., 1999. Bone tumours in Skeletal lesions of histiocytic
Saunders, H.M., Jezyk, P.K., 1991. small animals. In Pract. 21, 31 37. sarcoma in nineteen dogs. Vet.
The radiographic appearance of Dubielzig, RR, Biery, D.N., Radiol. Ultrasound 48, 539 543.
canine congenital Brodey, RS., 1981. Bone sarcomas Turret J.M., Poot RR, 1982. Primary
hypothyroidism: skeletal changes associated with multifocal bone tumors in the cat: a
with delayed treatment. Vet. medullary bone infarction in retrospective study of 15 cats and
Radiol. 32, 171 177. dogs. J. Am. Vet. Med. Assoc. 179, a literature review. Vet. Radiol.
Tanner, K, Langley Hobbs, S.L 2005. 64 68. 23, 152 166.
Vitamin D dependent rickets type Gibbs, C, Denny, H.R, Kelly, D.F., Wrigley, RH., 2000. Malignant
2 with characteristic radiographic 1984. The radiological features of versus nonmalignant bone
changes in a 4 month old kitten. J. osteosarcoma of the appendicular disease. Vet. Clin. North Am.
Feline Med. Surg. 7, 307 311. skeleton of dogs: a review of 74 Small Anim. Pract. 30, 315 348.
Tomsa, K., Glaus, T., Hauser, B., cases. J. Small Anim. Pract. 25,
Flueckiger, M., Arnold, P., 177 192. Trauma
Wess, C, Reusch, C, 1999. Gibbs, C, Denny, H.R, Lucke, V.M., Anderson, M.A, Dee, L.G., Dee, J.F.,
Nutritional secondary 1985. The radiological features of 1995. Fractures and dislocations of
hyperparathyroidism in six cats. J. non osteogenic malignant the racing greyhound Part I.
Small Anim. Pract. 40, 533 539. tumours of bone in the Compend. Contin. Educ. Pract.
appendicular skeleton of the dog: Veterinarian (Small Animal) 17,
Infective and inflammatory a review of 34 cases. J. Small 779 786.
conditions Anim. Pract. 26, 537 553. Anderson, M.A, Dee, L.G., Dee, J.F.,
Agut, A., Corzo, N., Murciano, L Gorra, M., Burk, RL., Greenlee, P., 1995. Fractures and dislocations of
Laredo, F.G., Soler, M., 2003. Weeren, F.R, 2002. Osteoid the racing greyhound Part 11.
Clinical and radiographic study of osteoma in a dog. Vet. Radiol. Compend. Contin. Educ. Pract.
bone and joint lesions in 26 dogs Ultrasound 43, 28 30. Veterinarian (Small Animal) 17,
with leishmaniasis. Vet. Rec. 153, Jacobson, L.S., Kirberger, RM., 1996. 899 909.
648 652. Canine multiple cartilaginous Langley Hobbs, S., 2003. Biology and
Canfield, P.L Malik, R, Davis, P.K, exostoses: unusual manifestations radiological assessment of
Martin, P., 1994. Multifocal and a review of the literature. fracture healing. In Pract. 25,
idiopathic pyogranulomatous J. Am. Anim. Hosp. Assoc. 32, 26 35.
bone disease in a dog. J. Small 45 51. Sande, R, 1999. Radiography of
Anim. Pract. 35, 370 373. Lamb, CR, Berg, L Schellin& S.H., orthopaedic trauma and fracture
Dunn, J.K., Dennis, R, Houlton, 1993. Radiographic diagnosis of repair. Vet. Clin. North Am. Small
J.KF., 1992. Successful treatment an expansile bone lesion in a Anim. Pract. 29, 1247 1260.
of two cases of metaphyseal dog. J. Small Anim. Pract. 34,
osteomyelitis in the dog. J. Small 239 241. Miscellaneous
Anim. Pract. 33, 85 89. Matis, U., Krauser, K., Schwartz Baines, K, 2006. Clinically significant
Macintire, D.K., Vincent Johnson, N., Porsche, AV., Putzer Breni& A developmental radiological
Dillon, AR, Blagbum, B., V., 1989. Multiple changes in the skeletally
Undsay, KM., Whitley, KM., enchondromatosis in the dog. Vet. immature dog: 1. Long bones. In
Banfield, C, 1997. Com. Orthop. Traumatol. 4, Pract. 28, 188 199.
Hepatozoonosis in dogs: 22 cases 144 151. Canfield, P.L Malik, R, Davis, P.K,
(1989 1994). j. Am. Vet. Med. Russet RG., Walker, M., 1983. Martin, P., 1994. Multifocal
Assoc. 210, 916 922. Metastatic and invasive tumors of idiopathic pyogranulomatous
Chapter 1 Skeletal system: general 37

bone disease in a dog. J. Small terriers (1991 1996). J. Am. Anim. O'Bden, S.K, Riedeset KA,
Anim. Pract. 35, 370 373. Hosp. Assoc. 35, 62 67. Miller, L.D., 1987. Osteopetrosis
Hanet RM., Graham, J.P., Levy, J.K., Kramers, P., Flueckiger, M.A, in an adult dog. J. Am. Anim.
Buergelt, C.D., Creamer, L 2004. Rahn, B.A, Cordey, L 1988. Hosp. Assoc. 23, 213 216.
Generalized osteosclerosis in a Osteopetrosis in cats. J. Small Wright, M.W., Hudson, J.S.A,
cat. Vet. Radiol. Ultrasound 45, Anim. Pract. 29, 153 164. Hathcock, J.T., 2003. Osteopetrosis
318 324. Morgan, J.P., Stavenbom, M., 1991. in cats: clarification of a
Hay, C.W., Dueland, R.T., Disseminated idiopathic skeletal misnomer. Vet. Radiol.
Dubielzig, R.R., Bjorenson, J.B., hyperostosis (DISH) in a dog. Vet. Ultrasound 44, 106 (abstract).
1999. Idiopathic multifocal Radiol. 32, 65 70.
osteopathy in four Scottish
39

Chapter 2

Joi nts

2 . 1 RADIOGRAPHY OF JOI NTS: TECHN IQUE
CHAPTER CONTENTS AND INTERPRETATION
2.1 Radiography of joints: technique and Technique
interpretation 39
2.2 Soft tissue changes associated with Lesions in joints may be radiographically subtlef
joints 41 and so attention to good radiographic technique
2.3 Altered width of joint space 42 is essential.
2.4 Osteolytic (erosive) joint disease 42 1. Highest definition fihn-screen combination
2.5 Proliferative joint disease 44 consistent with the thickness of the area or
2.6 Mixed osteolytic-proliferative joint disease 45 appropriate digital radiography algorithm.
2.7 Conditions that may affect more than 2. No grid is necessary except for the shoulder
one joint 45 and hip joints in large dogs.
2.8 Mineralization in or near joints 46 3. Accurate positioning and centringf with a
small object-film distance to minimize
geometric distortion and blurring due to the
penumbra effect.
4. Straight radiographs in two planes are usually
required (i.e. orthogonal views)f with oblique
views as necessary.
5. Close collimation to enhance radiographic
definition by minimizing scatterf and for
radiation safety.
6. Correct exposure factors to allow examination
of soft tissues as well as bone.
7. Beware of hair coat debris creating artefactual
shadows.
8. Radiograph the opposite joint for comparison
if necessary.
9. Use of stressed views (tractionf rotationf
sheerf hyperextension/flexion and fulcrum­
assisted) and weight-bearing or simulated
weight-bearing views for the detection of
subluxation and altered joint width - great
care with radiation safety is needed if the

© 2010 Els�yi�r Ltd.
40 Handbook of Small Animal Radiology and U ltrasound

patient is manually restrained. The Interpretation of joint radiographs
vacuum phenomenon may occur with 1. Use optimum viewing conditions - for
traction views of the shoulderf hip and spine analogue films a darkened roomf bright light
(see 2.2.13). and dimmer facilitYf magnifying glassf glare
10. For analogue filmf ensure good processing around periphery of film masked off.
technique to optimize contrast and 2. With digital imagesf manipulation of greyscale
definition. and size is readily performed but beware of
digital artefacts.
Arthrography (negative. positive. double 3. Compare with the contralateral joint and use
contrast) radiographic atlases and bone specimens.
4. Consider patient signahnent and associated
Indications
clinical and laboratory findings.
Detection of the extent of the joint capsule or of Assess the following.
rupture of the joint capsule; examination of the 5. Number of joints affected (e.g. single - traumaf
bicipital tendon sheath (shoulder joint); assessment sepsis or neoplasia; bilateral - osteochondrosisf
of cartilage thickness and flap formation; detection bilateral trauma; multiple - systemic or
of synovial masses and intra-articular filling immune-mediated disease).
defects such as radiolucent joint 'mice'; to see if a 6. Aligrunent of bones forming the joint; examine
mineralized body is intra-articular. Most often per­ bones and joints proximally and distally.
formed in the shoulder joint. 7. Epiphyseal shape and joint space congruity.
Preparation 8. Joint space width (changes reliable only if
General anaesthesia; survey radiographs; sterile severe or if weight-bearing views obtained).
preparation of the injection site. 9. Articular surface contour - remodellingf
erosion.
Technique (shoulder)
10. Subchondral bone opacity - sclerosisf erosionf
Insert a 20- to 22-gauge short-bevel needle 1 cm
cyst formationf osteopenia.
distal to the acromion and direct it caudallYf dis­
11. Joint space opacity - gasf fatf mineralizationf
tally and medially into the joint space. Joint fluid
foreign material.
may flow freely or require aspiration; obtain a sam­
12. Presence of osteoarthrosis (see 2.5 and Fig. 2.6).
ple for laboratory analysis.
13. Soft tissue changes (may be more obvious
• Positive contrast arthrogram - inject 2-7 mL of radiographically than clinically).
100-150 mg I/mL isotonic iodinated contrast a. Increased soft tissue - concept of 'synovial
medium (e.g. a non-ionic medimn such as massIf as synovial tissue and synovial fluid
iohexol) depending on the patient sizef cannot be differentiated on survey
withdraw the needle and apply pressure to the radiographs.
injection site; manipulate the joint gently to b. Reduced soft tissue - muscle wastage due to
ensure even contrast medium distribution; take disuse (especially in the thighs).
mediolaterat caudocranial and cranioproximal­
14. Other articular and periarticular changes.
craniodistal (skyline) radiographs. Use lower
a. Intra- and periarticular mineralization (see
volumes for assessment of the joint space only
2.8).
and higher volumes for the biceps tendon
b. Joint mice (apparently loosef mineralized
sheath.
articular bodiesf although they may in fact
• Negative contrast arthrogram - use air.
be attached to soft tissue).
• Double-contrast arthrogram - use a small c. Intra-articular fat pads reduced by synovial
volume of positive contrast medium followed effusion.
by air. d. Fascial planes and sesamoids displaced by
Technical errors on arthrography effusions and soft tissue swelling.
Contrast medium not entering the joint space but e. Periarticular chip and avulsion fractures.
injected into surrounding soft tissues; insufficient f. Periarticular osteolysis.
or too much contrast medium used; gas bubbles g. Periarticular new bone other than due to
mimicking radiolucent joint mice. osteoarthrosis.
Chapter 2 Joints 41

2 .2 SOFT TISSUE CHANGES ASSOCIATED j. Polyarthritis-meningitis syndrome -
WITH JOINTS Weimaranerf German Short-haired Pointerf
Boxerf Bernese Mountain dogf Japanese
Soft tissue swelling Akitaf also cats.
Differentiation between joint effusion and sur­ k. Heritable polyarthritis of the adolescent
rounding soft tissue swelling may not be possible Japanese Akita.
except in the stifle jointf but both are often present. 1. Polyarteritis nodosa - stiff Beagle disease.
A joint effusion will compress or displace any m. Drug-induced polyarthritisf especially
intra-articular fat and adjacent fascial planes and certain antibiotics (e.g. fluoroquinolones
is limited in extent by the joint capsule; the effusion such as enrofloxacin).
may be visible only when the radiograph is exam­ n. Immune-mediated vaccine reactions.
ined using a bright light. Periarticular swelling o. Other idiopathic polyarthritides.
may be more extensive and will obliterate fascial p. Chinese Shar Pei fever syndrome - short­
planes. OccasionallYf arthrography may reveal soft lived episodes of acute pyrexia and
tissue pathology even when survey radiographs lameness with mono- or pauciarticular joint
are normat for example in synovial sarcoma or vil­ pain and swelling of the tarsi and carpi;
lonodular synovitis. occasionally enthesiopathies.
1. Joint effusion or soft tissue swelling (Fig. 2.1). 2. Recent haemarthrosis.
a. External trauma. a. Trauma.
b. Damage to an intra-articular structure such b. Coagulopathy.
as a cruciate ligament or meniscus. 3. Joint capsule thickening.
c. Early osteochondrosis confined to cartilage;
4. Periarticular oedemaf haematomaf cellulitisf
medial coronoid disease.
abscessf fibrosis.
d. Early septic arthritis.
5. Soft tissue tmnour.
e. Systemic lupus erythematosus (SLE) -
6. Synovial cysts - herniation of joint capsulef
usually multiple jointsf symmetrical.
bursa or tendon sheath. Infrequentf and
f. Early rheumatoid arthritis (canine idiopathic
usually associated with degenerative joint
erosive polyarthritis - see 2.4.8 and Fig. 2.5).
changes. In catsf described only at the elbow.
g. Ehrlichiosis*.
7. Soft tissue callus - large dogsf especially elbows.
h. Lyme disease* (Borrelia burgdorferi infection).
8. Villonodular synovitis - often bone erosion at
i. Polyarthritis-polymyositis syndromef the chondrosynovial junction too.
especially Spaniel breeds. 9. Cats - various erosive and non-erosive feline
polyarthritides; the latter showing soft tissue
swelling only.

Gas in joints
10. Fat mistaken for gas.
11. Superimposed skin defect.
12. Post arthrocentesis.
13. Vacuum phenomenon - seen in hmnans in joints
under tractionf when gas (mainly nitrogen)
diffuses out from extracellular fluid. In dogsf
reported only in the shoulderf hipf intervertebral
disc spaces and intersternebral or sternocostal
spaces and only in the presence of joint disease
(e.g. shoulder osteochondrosisf degenerative
Figure 2.1 Joint effusion: stifle. The effusion is seen as a joint disease and chronic disc disease).
soft tissue radiopacity compressing the patellar fat pad and 14. Open wOillld communicating with the joint.
displacing fascial planes caudal to the joint (arrows). 15. Infection with gas-producing bacteria.
42 Handbook of Small Animal Radiology and U ltrasound

2 .3 ALTERED WIDTH OF JOINT SPACE
Decreased joi nt space width
1. Artefactual - X-ray beam not centred over the
joint spacef or joint space not parallel to X-ray
beam.
2. Artefactual - flexed joint in craniocaudal or
caudocranial view.
3. Articular cartilage erosion due to severef
chronic degenerative joint disease.
4. Articular cartilage erosion due to rheumatoid
disease; usually multiple joints (see 2.4.8 and
Fig. 2.5).
5. Periarticular fibrosis.
6. Advanced septic arthritis with erosion of o
articular cartilage and collapse of subchondral
Figure 2.2 Lateral collateral ligament rupture of the tarsus:
bone (see 2.4.6 and Fig. 2.3).
(A) the u nstressed dorsoplantar view appears normal;
7. Cats - arthropathy is seen in some cases of
(8) subluxation of the intertarsal joint space caused by
acromegaly (growth hormone-secreting laterally applied stress.
pituitary tumour). Cartilage hypertrophy and
hyperplasia lead to osteoarthrosis. In early
casesf the joint space may be widened due to 20. Asymmetric narrowing or widening of the
cartilage thickeningf but in later stages the joint joint space due to other pathology - see above.
space collapses.

Increased joint space width 2 .4 OSTEOLYTIC (EROSIVE) JOINT D ISEASE
8. Traction during radiography. 1. Apparent osteolysis due to incomplete
9. Skeletal immaturity and incomplete epiphyseal epiphyseal ossification in the young animal.
ossification. 2. Apparent osteolysis due to abnormalities of
10. Severe joint effusion. ossification (see epiphyseal dysplasiasf
11. Recent haemarthrosis. 1.22.7-12).
3. Artefactual in cases of severe osteoarthrosisf
12. Subluxation.
when superimposition of irregular amounts of
13. Intra-articular soft tissue mass.
new bone creates areas of relative lucencYf
14. Intra-articular pathology causing subchondral mimicking osteolysis. Diagnosis of neoplasia
osteolysis (e.g. osteochondrosisf septic arthritisf or sepsis superimposed over osteoarthrosis
soft tissue tumourf rheumatoid arthritis). may be very difficult radiographically.
15. Various epiphyseal dysplasias (see 1.22.7-12). 4. Osteochondrosis - focal subchondral lucencies
16. Cats - early acromegalic arthropathy (see at specific locationsf mainly the shoulderf
above). elbowf stifle and tarsus in YOilllgf larger breed
dogs; often bilateral. There is a male
Asymmetric joint space width preponderancef and affected dogs are often
rapidly growing and on a high plane of
17. Normal variant in some jointsf dependent on nutrition. Also see joint effusion ± mineralized
positioning (e.g. caudocranial views of the cartilage flapf fragmentation of subchondral
shoulder and stifle). bonef joint micef subchondral sclerosisf
18. Congenital subluxation or dysplasia. secondary osteoarthrosis (see 3.2.4f 3.4.6-9f
19. Collateral ligament rupture (Fig. 2.2) - stressed 3.11.4 and 3.13.1). Note: this is not true
views may be required to demonstrate osteolysis but rather failure of primary
subluxation. ossification of subchondral bone.
Chapter 2 Joints 43

5. Legg-Calve-Perthes disease (avascular
necrosis of the femoral head) - patchy
osteolysis and collapse of femoral head in
youngf small-breed dogs; often bilateral
(see 3.9.4).
6. Septic arthritis (bacterial or fungal) (Fig. 2.3) ­

usually involves the articular surfaces of both or
all bones of a joint and is associated with joint
effusion ± limb cellulitis. Multiple joints may be
affected if the infection has been spread
haematogenouslYf which is more common in
YOilllger animals. Animals with multifocal
pathology are more likely to be systemically ill.
Pre-existing joint disease may predispose a joint
to sepsisf for example after dentistry. In such Figure 2.4 Soft tissue tumour around the stifle joint:
casesf radiographs may be hard to interpret but osteolysis in several bones, joint effusion and surrounding
the animal is usually very lamef with clinical soft tissue swelling. The articular surfaces are relatively
signs more severe than with degenerative or spared (cf. Fig. 2.3).
neoplastic joint disease. Radiographic signs in
established cases include joint effusion and
periarticular swellingf changes in joint space the elbow and stifle; may be a large soft
widthf subchondral erosions and sclerosisf peri­ tissue component.
articular new bone and soft tissue mineralization. b. Other periarticular soft tissue tumours; if
Arthrocentesis is important for diagnosis. liposarcoma then a characteristic fat opacity
7. Soft tissue tumour (Fig. 2.4) - if at or near a will be recognized.
joint will usually affect more than one bonef 8. Rheumatoid arthritis (canine idiopathic erosive
causing multiple areas of discrete osteolysis; polyarthritis) (Fig. 2.5) - immune-mediated,
the articular surfaces may be sparedf as erosivef symmetrical polyarthritis; progressive
cartilage is protectivef with osteolysis and deforming; usually small to medium
predominantly at sites of soft tissue middle-aged dogs and rare in cats; many joints
attachment - this is an important sign may be affectedf but there is a predilection for
to help distinguish from sepsis. the carpus and tarsus. Radiographic changes
a. Synovial sarcoma; uncommon in dogs and are progressive and include joint effusion and
rare in cats. Mainly middle-aged and older soft tissue swellingf changes in joint space
large breeds of dogf and most often affects widthf subchondral osteolysis and cyst
formationf osteolysis at sites of soft tissue
attachmentf worsening osteoarthrosisf
periarticular calcificationf juxta-articular
osteopenia and eventual (sub)luxationf
malalignmentf collapse or ankylosis of the
joint.
9. Osteopenia (e.g. disusef metabolic) - epiphyses
and carpal or tarsal bones are especially
affeeled (see 1.16).
10. Chronic haemarthrosis - usually also with
secondary osteoarthrosis.
11. Villonodular synovitis - intracapsularf nodular
synovial hyperplasia thought to be due to
trauma. Smoothf cup-shaped areas of
Figure 2.3 Septic arthritis in a dog's stifle: there is ragged osteolysis at the chondrosynovial junction;
osteolysis of articular su rfaces, severe joint effusion and intra-articular mass can be shown by
su rrou nding soft tissue swelling. arthrography or ultrasonography.
44 Handbook of Small Animal Radiology and U ltrasound

1. Osteoarthrosis secondary to elbow and hip
dysplasia (see 3.4.6-9 and 3.4.19, 3.9.3, and Figs
3.11 and 3.21).
2. Osteoarthrosis secondary to damaged articular
soft tissues (e.g. strained or ruptured cranial
cruciate ligament; Fig. 2.6).
3. Osteoarthrosis secondary to osteochondrosis -
typical breeds and jointsf may be bilateral
(3.2.4, 3.4.6-9, 3.11.4 and 3.13.1).
4. Primary (idiopathic) osteoarthrosis - an
ageing changef but less common in small
Figure 2.5 Rheumatoid arthritis affecting the carpus:
animals than in humans; mainly the shoulder
widening of joint spaces (they may also be narrowed), and elbow.
subchondral osteolysis and surrounding soft tissue swelling. 5. Osteoarthrosis secondary to growth
abnormalities (see 1 .22.7-12).
6. Osteoarthrosis secondary to trauma or other
12. Leislunaniasis* - 30% of affected dogs develop abnormal stresses (e.g. angular limb
locomotor problems including severe deformities).
osteolytic joint diseasef which may affect 7. Osteoarthrosis secondary to repeated
multiple joints. Main differential diagnoses haemarthroses (may also see osteolysis).
are septic arthritisf rheumatoid arthritis. 8. Enthesiopathies at specific locationsf although
13. Mycoplasma polyarthritis - immunosuppressed these may not be clinically significant (e.g.
or debilitated animals; also M. spumans enthesiopathy of the short radial collateral
polyarthritis in young greyhounds. ligament in the greyhound; see 3.6.11 and
14. Subchondral cysts associated with Fig. 3.16).
osteoarthrosis - an occasional finding. 9. Neoplasia - single jointsf large bony masses
15. Severe drug-induced polyarthritis adjacent to joint.
progressing from cartilage to subchondral a. Osteoma - rare in small animals.
bone (e.g. fluoroquinolones such as b. Parosteal osteosarcoma - mainly
enrofloxacin). proliferativef unlike other osteosarcomas
16. Cats - feline metastatic digital carcinoma - (see 1.15.2 and 3.11.12 and Fig. 3.29).
multiple digits or feetf primary lesion in lung. 10. Disseminated idiopathic skeletal hyperostosis -
Differential diagnosis is paronychia (see 3.7.11 large dogsf mainly spondylotic lesions in the
and 3.7.13, and Fig. 3.18) . spine but may also affect appendicular jointsf
17. Cats - feline tuberculosis - various causing osteoarthrosisf enthesiopathies and
Mycobacterium species; occasionally affects the
skeletal system - osteolytic joint disease and
osteoarthrosis; also periostitis and mixed bone
lesions.

2 . 5 PROLIFERATIVE JOINT DISEASE
The term osteoarthritis implies the presence of an
inflammatory component to the disease processf
whereas osteoarthrosis is generally used to imply a
non-inflammatory condition. Howeverf the two
conditions may exist together and cannot be differ­
entiated radiographicallYf and so the terms are
often used synonymously. In some casesf new bone
proliferation may be accompanied by marked
remodelling of underlying bone. Severe prolifera­ Figure 2.6 Osteoarthrosis of the stifle: joint effusion
tive joint disease may lead to ankylosis. and periarticular osteophytes.
Chapter 2 Joints 45

prominence of tuberosities and trochanters 5. Chronic or repeated haemarthroses -
(see 5.4.5). animals with bleeding disordersf often
11. Synovial osteochondromatosis - mineralized multiple joints.
intra- and periarticular bodies ± osteoarthrosis 6. Leisrunaniasis* - mainly osteolytic.
(see 2.8.18 and Fig. 2.7) . 7. Villonodular synovitis (see 2.4.11).
12. Systemic lupus erythematosus - very mild 8. Cats - feline non-infectious erosive
osteoarthrosis may occur in chronic cases. polyarthritis.
13. Cats - hypervitaminosis A - raw liver diet;
9. Cats - feline tuberculosis.
mainly spinal new bone (see 5.4.8) but may
also see exostoses near the limb joints at 10. Cats - periosteal proliferative polyarthritis
insertions of tendons and ligamentsf especially (Reitees disease); especially carpi and tarsi.
the elbow. Rare in dogs.
14. Cats - mucopolysaccharidoses (see 5.4.9) -
mainly spinal changes similar to
hypervitaminosis A but also osteoarthrosis 2 .7 CON D ITIONS THAT MAY AFFECT MORE
secondary to epiphyseal dysplasia. Epiphyses THAN ONE JOINT
become broad and irregularf and the For further details of conditions that affect specific
osteoarthrosis may appear rather aggressive. jointsf see Chapter 3.
Rare in dogs.
1. Elbow and hip dysplasia - often bilateral
15. Cats - osteochondromata or osteocartilaginous
exostoses - especially the elbows. (see 3.4.6-9 and 3.9.2 and Figs 3.5-3.8, 3.11
16. Cats - acromegalic arthropathy (see 2.3.7) . and 3.21).
17. Cats - Cryptococcus neoformans has been 2. Osteochondrosis - primary lesions and
reported to cause bilateral proliferative tarsal secondary osteoarthrosis; mainly shoulderf
lesions. elbowf stifle and tarsus in larger breed dogs.
18. Cats - osteochondrodysplasia of the Scottish Often bilateral and may affect more than one
Fold cat (see 3.7.8) . pair of joints (see 3.2.4, 3.4.6-9, 3.11.4 and
3.13.1).
3. Primary osteoarthrosis - an ageing changef but
less common in small animals than in humans;
2 . 6 M IXED OSTEOLYTIC-PROLIFERATIVE mainly the shoulder and elbow; often bilateral
JOINT DISEASE or multiple joints affected.
4. Stifle osteoarthrosis secondary to cruciate
1. Soft tissue neoplasia - osteolysis
ligament disease or patellar subluxation;
usually predominatesf but there may be
often bilateral (see 2.5.2 and Fig. 2.6, and
some periosteal reaction or the tumour
3.11.17).
may be superimposed over pre-existing
osteoarthrosisf as patients are usually 5. Rheumatoid arthritis - erosive or mixed joint
older (see 2.4.7 and Fig. 2.4). Osteolysis lesions affecting small joints especially (see
is mainly at sites of soft tissue attachment. 2.4.8 and Fig. 2.5).
2. Rheumatoid arthritis (canine idiopathic 6. Systemic lupus erythematosus - usually mild
erosive polyarthritis) - osteolytic or mixed soft tissue swelling only; multiple jointsf
joint lesions affecting mainly small joints symmetrical.
such as carpus and tarsus (see 2.4.8 and 7. Haematogenous bacterial or fungal septic
Fig. 2.5). arthritis - mixed osteolytic-proliferative
3. Legg-Calve-Perthes disease (avascular changes.
necrosis of the femoral head) with secondary 8. Leisrunaniasis* - erosive joint disease.
osteoarthrosis - hip only (see 3.9.4 and 9. Chronic or repeated haemarthroses - animals
Fig. 3.24). with bleeding disorders.
4. Septic arthritis (see 2.4.6 and Fig. 2.3) - 10. Disseminated idiopathic skeletal hyperostosis -
especially if chronic or if superimposed over large dogsf mainly spondylotic lesions in the
pre-existing osteoarthrosis. spine but may also affect appendicular jointsf
46 Handbook of Small Animal Radiology and U ltrasound

causing osteoarthrosisf enthesiopathies and 28. Cats - mucopolysaccharidoses (see 2.5.14 and
prominence of tuberosities and trochanters 5.4.9).
(see 5.4.5). 29. Cats - feline tuberculosis.
11. Skeletal dysplasias (e.g. chondrodysplasias, 30. Cats - osteochondromata or osteocartilaginous
pituitary dwarfism and congenital exostoses - especially the elbows.
hypothyroidism); multiple joints affected
(see 1.22.7-12).
12. Multiple epiphyseal dysplasia (stippled 2 .8 M I N E RALIZATION IN OR NEAR JOINTS
epiphyses, dysplasia epiphysealis punctata) -
inherited deficiency of ossification of
Normal anatomical structu res
epiphyses, apophyses and cuboidal 1. Small sesamoid in tendon of abductor pollicis
bones; especially Beagle and Miniature longus et indicus proprius muscle f medial aspect
Poodle. of carpus.
13. Rocky Mountain spotted fever* (Rickettsia 2. Sesamoids of metacarpo- or
rickettsii infection). metatarsophalangeal joints (one dorsat two
14. Ehrlichiosis*. pahnar and plantar).
15. Lyme disease' (Borrelia burgdorferi infection) - 3. Patella.
usually a shifting monoarticular or 4. Fabellae in heads of gastrocnemius muscle -
pauciarticular condition rather than a true caudal aspect of distal femur; medial much
polyarthritis. larger than lateral in cats and some small dogs.
16. Polyarthritis-polymyositis syndromef 5. Popliteal sesamoid - caudolateral aspect of
especially Spaniel breeds. stifle or proximal tibia; may be absent in
17. Polyarthritis-meningitis syndrome­ small dogs.
Weimaranerf German Short-haired Pointerf Boxerf 6. Epiphyseat apophyseal and small bone centres
Bemese MOillltain dogf Japanese Akitaf also cats. of ossification in young animals.
18. Heritable polyarthritis of the adolescent 7. Cats - clavicles.
Japanese Akita.
19. Mycoplasma polyarthritis - immunosuppressed
or debilitated animals; also M. spumans Normal variants: occasional findings of
polyarthritis in young greyhounds. no clin ical significance
20. Chinese Shar Pei fever syndrome - short-lived These are likely to be bilaterat so if there is doubt
episodes of acute pyrexia and lameness with as to their significancef radiograph the other leg.
mono- or pauciarticular joint pain and
8. Accessory centres of ossification - usually
swelling of tarsi and carpi; occasionally
larger dogsf for example caudal glenoid rimf
enthesiopathies.
anconeusf dorsal aspect of wing of ilium (often
21. Polyarteritis nodosa - stiff Beagle disease.
remains unfused)f craniodorsal margin of
22. Drug-induced polyarthritisf especially certain acetabulum.
antibiotics.
9. Occasional sesamoids - for example sesamoid
23. Immune-mediated vaccine reactions. craniolateral to elbow (in humeroradial
24. Cats - feline non-infectious erosive and non­ ligamentf lateral collateral ligamentf supinator
erosive polyarthritides. or ulnaris lateralis muscles).
25. Cats - feline calicivirus. 10. Bipartite or multipartite sesamoids - for
26. Cats - periosteal proliferative polyarthritis example palmar metacarpophalangeal
(Reiter's disease); especially carpi and tarsi. sesamoids 2 and 7 commonly seen in
Rare in dogs. Rottweilers; medial fabella of stifle (see 3.7.4
27. Cats - hypervitaminosis A - raw liver diet; and Fig. 3.17 and 3.11.2); differential diagnosis
mainly spinal new bone but may also see is traumatic fragmentation.
exostoses near the limb jointsf especially the 11. Rudimentary clavicles in some larger breed
elbow (see 5.4.8). dogs.
Chapter 2 Joints 47

12. Stifle meniscal calcification or ossification -
especially old cats (may also be associated with
lameness in some animals).

Mineralization likely to be clinically
sign ificant
See also Chapter 3 for details of specific joints.
13. Osteochondrosis - mineralized cartilage
flaps and osteochondral fragments
Goint mice).
14. Fractures.
a. Avulsion fractures.
b. Chip fractures.
c. Fractured osteophytes from pre-existing
osteoarthrosis.
15. Calcifying tendinopathy.
16. Meniscal calcification or ossification (stifle; see
3.11.19).
17. Synovial osteochondromatosis Figure 2.7 Synovial osteochondromatosis in the stifle of a
(chondrometaplasia) (Fig. 2.7) - primary, cat. Extensive, nodular mineralization in the soft tissues of
or secondary to joint disease; osteochondral the stifle joint. The patella is slightly displaced.
nodules form in synovial connective
tissue of a jointf bursa or tendon sheath. a. Primary idiopathic.
Uncornmonf but reported in both the dog b. Secondary to trauma.
(shoulder, hip, stifle and tarsus) and cat.
21. Chondrocalcinosis or pseudogout
May be rather dramatic and suggest
(calcium pyrophosphate deposition
malignancy.
disease) - uncommonf unknown
18. Calcinosis circumscripta - usually young
aetiology; older dogs. May affect single or
German Shepherd dogs; masses of stippled
multiple jointsf causing markedf acute-onset
calcified material in soft tissues over limb
lameness. Radiographs may be normal or
prominences; also in the neck and tongue (see
may show punctate areas of mineralization.
12.2.2 and Fig. 12.1).
Diagnosed by the presence of crystals on
19. Severe osteoarthrosis or osteoarthritis -
arthrocentesis.
dystrophic calcification of soft tissues around
22. Von Willebrand heterotopic
joint; other arthritic changes seen too.
osteochondrofibrosis in Dobermann Pinschers
a. Severe degenerative joint disease.
(hip see 3.9.12).
b. Rheumatoid arthritis. 23. Extraskeletal osteosarcoma has been
c. Septic arthritis. reported as arising from the synovium of
d. Steroid arthropathy following intra-articular the elbow in one dogf and produced
steroid injection. multiple periarticular and articular
20. Myositis ossificans - heterotopic bone mineralized bodies without evidence of
formation in muscle (see 12.2.3). osteolysis.
48 Handbook of Small Animal Radiology and U ltrasound

Further reading
General Infective and inflammatory Neoplasia
Carrig, C.B., 1997. Diagnostic conditions Clements, D.N., Kelly, D.F.,
imaging of osteoarthritis. Vet. Bennett, D., 1988. hnmune based Philbey, AW., Bennett, D.,
Clin. North Am. Small Anim. erosive inflammatory joint disease 2005. Arthrographic diagnosis
Pract. 27, 777 814. of the dog: canine rheumatoid of shoulder joint masses
Farrow, C.S., 1982. Stress arthritis. 1. Clinical, radiological in two dogs. Vet. Rec. 156,
radiography: applications in small and laboratory investigations. 254 255.
animal practice. J. Am . Vet. Med. J. Small Anim. Pract. 28, McClennon, N.L Houlton, J.KF.,
Assoc. 181, 777 784. 779 797. Connan, N.T., 1988. Synovial
Hoskinson, J.L Tucker, RL., 2001. Bennett, D., Nash, AS., 1988. Feline sarcoma in the dog a review.
Diagnostic imaging of lameness in immune based polyarthritis: a J. Small Anim. Pract. 29,
small animals. Vet. Clin. North study of thirty one cases. J. Small 139 152.
Am. Small Anim. Pract. 31, Anim. Pract. 29, 501 523. Thamm, D.H., Mauldin, KA,
165 180. Bennett, D., Taylor, D.L 1988. Edinger, D.T., Lustgarten, c.,
Various sections in: Ettinger, S.L Bacterial infective arthritis in the 2000. Primary osteosarcoma
Feldman, KC., 2005. Textbook of dog. J. Small Anim. Pract. 29, of the synovium in a dog. J. Am.
Veterinary Internal Medicine, 207 230. Anim. Hosp. Assoc. 36,
sixth ed. Saunders, Philadelphia. Cunn Moore, D.A, Jenkins, P.A, 326 331.
Lucke, V.M., 1996. Feline Whitelock, RG., Dyce, L Houlton, J.
Techniques and normal anatomy
tuberculosis: a literature review KF., Jeffries, AR, 1997. A review
Muhumuza, L., Morgan, J.P.,
and discussion of 19 cases caused of 30 tumours affecting joints. Vet.
Miyabayashi, A.Q., Atilola, AO.,
by an unusual mycobacterial Com. Orthop. Traumatol. 10,
1988. Positive contrast
variant. Vet. Rec. 138, 53 58. 146 152.
arthrography a study of the
Hanson, J.A, 1998. Radiographic
humeral joints in nonnal beagle
diagnosis Canine carpal Trauma
dogs. Vet. Radiol. 29, 157 161.
villonodular synovitis. Vet. Macias, c., McKee, M., 2003.
Congenital and developmental Radiol. Ultrasound 39, 15 17. Articular and periarticular
disease; diseases of young animals Marti, J.M., 1997. Bilateral pigmented fractures in the dog and cat. In
Baines, K, 2006. Clinically significant villonodular synovitis in a dog. Pract. 25, 446 465.
developmental radiological J. Small Anim. Pract. 38, Owens, J.M., Ackennan, N.,
changes in the skeletally 256 260. Nyland, T., 1978. Roentgenology
immature dog: 2. Joints. In Pract. May, c., 2005. Diagnosis and of joint trauma. Vet. Clin. North
28, 247 254. management of bacterial infective Am. Small Anim. Pract. 8,
Demko, L McLaughlin, R, 2005. arthritis in dogs and cats. In Pract. 419 451.
Developmental orthopedic 27, 316 321.
disease. Vet. Clin. North Am. May, c., Hammilt L Bennett, D., Miscellaneous conditions
Small Anim. Pract. 35, 1111 1135. 1992. Chinese Shar Pei fever Agut, A., Corzo, N., Murciano, L
Morgan, J.P., Wind, A, Davidson, A syndrome: a preliminary report. Laredo, F.G., Soler, M., 2003.
P., 1999. Bone dysplasias in the Vet. Rec. 131, 586 587. Clinical and radiographic study of
Labrador retriever: a radiographic Owens, J.M., Ackennan, N., bone and joint lesions in 26 dogs
study. J. Am. Anim. Hosp. Assoc. Nyland, T., 1978. Roentgenology with leishmaniasis. Vet. Rec. 153,
35, 332 340. of arthritis. Vet. Clin. North Am. 648 652.
Rprvik, AM., Tiege, L Ottesen, N., Small Anim. Pract. 8, 453 464. Akselen, B., Hot L 2007. Quinolone
Lingaas, F., 2008. Clinicat Ralphs, S.c., Beale, B., 2000. Canine related arthropathy in a 12 week
radiographic, and pathologic idiopathic erosive polyarthritis. old Pyrenean Mountain dog
abnonnalities in dogs with Compend. Contin. Educ. Pract. clinical and radiographic findings.
multiple epiphyseal dysplasia: 19 Veterinarian (Small Animal) 22, Eur. J. Companion Anim. Pract.
cases (1991 2005). j. Am. Vet. 671 677. 17, 149 151.
Med. Assoc. 233, 600 606. Tisdall, P.L.c., Martin, P., Malik, R, Allan, C.S., 2000. Radiographic
Various authors, 1998. 2007. Cryptic disease in a cat with features of feline joint diseases.
Osteochondrosis. Vet. Clin. North painful and swollen hocks. J. Vet. Clin. North Am. Small Anim.
Am. Small Anim. Pract. 28 (1). Feline Med. Surg. 9, 418 423. Pract. 30, 281 302.
Chapter 2 Joints 49

De Haan, J.L Andreasen, CB., 1992. dogs and cats. Vet. Radiol. Short, RP., Jardine, J.B., 1993.
Calcium crystal associated Ultrasound 38, 139 149. Calcium pyrophosphate
arthropathy (pseudogout) in a Mahoney, P.N., Lamb, CR, 1996. deposition disease in a Fox
dog. J. Am. Vet. Med. Assoc. 200, Articular, periarticular and Terrier. J. Am. Anim. Hosp.
943 946. juxtaarticular calcified bodies in Assoc. 29, 363 366.
Forsyth, S.F., Thompson, K.G., the dog and cat: a radiological Stead, AC, Else, RW., Stead, M.CP.,
Donald, J.L 2007. Possible review. Vet. Radiol. Ultrasound 1995. Synovial cysts in cats. J.
pseudogout in two dogs. J. Small 37, 3 19. Small Anim. Pract. 36, 450 454.
Anim. Pract. 48, 174 176. Morgan, J.P., Stavenbom, M., 1991. Weber, W.L Berry, CR, Kanner, R
Gregory, S.P., Pearson, G.P., 1990. Disseminated idiopathic skeletal W., 1995. Vacuum phenomenon
Synovial osteochondromatosis in hyperostosis (DISH) in a dog. Vet. in twelve dogs. Vet. Radiol.
a Labrador retriever bitch. J. Small Radiol. 32, 65 70. Ultrasound 36, 493 498.
Anim. Pract. 31, 580 583. Prymak, C, Goldschmidt, M.H., White, J.D., Martin, P., Hudson, D.,
Kramer, M., Gerwin& M., Hach, V., 1991. Synovial cysts in five dogs Clark, R, Malik, R, 2004. What is
Schimke, B., 1997. Sonography of and one cat. J. Am. Anim. Hosp. your diagnosis? (synovial cyst). J.
the musculoskeletal system in Assoc. 27, 151 154. Feline Med. Surg. 6, 339 344.
51

Chapter 3

Appe n d i c u lar skeleto n

This chapter describes conditions that are most
CHAPTER CONTENTS commonly associated with specific bones or joints.
Lack of inclusion of a condition under an anatomi­
3.1 Scapula 52 cal area may not mean that it cannot occur theref
3.2 Shoulder 53 simply that this area is not a predilection site; for
3.3 Humerus 55 example synovial sarcomas most often arise
3.4 Elbow 55 around the elbow and stifle, although they may
3.5 Radius and ulna (antebrachium,
arise near any synovial joint. Conditions that may
forearm) 60 occur in any joint (e.g. infectious arthritis) are
3.6 Carpus 63 described in Chapter 2, Joints.
3.7 Metacarpus, metatarsus and
For each anatomical areaf the conditions are
phalanges 65 listed in the following order:
3.8 Pelvis and sacroiliac joint 67
• artefacts and normal anatomical variants
3.9 Hip (coxofemoral joint) 68
3.10 Femur 71 • congenital or developmental
3.1 1 Stifle 71 • metabolic
3.12 Tibia and fibula 77 • infective
3.13 Tarsus (hock) 77 • inflammatory
• neoplastic
• tramnatic
• degenerative
• miscellaneous conditions.
Conditions that most closely resemble each other
radiographically are indicated by 'differential diag­
nosis'. Conditions involving joints are listed under
the relevant bone but described more fully under
the appropriate joint.
Joint trauma tends to affect the weakest area,
hence physeal fractures occur in skeletally imma­
ture animals and ligamentous damage in older
animals; young dogs rarely suffer from ligament
trauma.
In many cases in which there is doubt as to the
presence of genuine pathology, always consider
radiographing the opposite limb for comparison.

© 2010 Els�yi�r Ltd.
52 Handbook of Small Animal Radiology and U ltrasound

Useful terminology Normal muscle is hypoechoic to anechoic with finef
oblique echogenic striations. Muscle injuries can be
Amelia - absence of a limb.
detectedf their appearance varying with age of the
Brachymyelia - abnormally short limb.
injury; as with tendonsf healing can be monitored.
Dimelia - duplication of a limb.
Joints may be assessed ultrasonographically
Dysmelia - congenital deformity of a limb.
provided that an acoustic window can be foundf
Ectromelia - absence of part of a limb.
although often only small areas can be seen. The bone
Hemimelia - absence of the distal part of a limb;
surfacef articular cartilagef synovium and synovial
also used to denote absence of radius or ulna or
fluid may be recognizedf but ligaments are usually
tibia or fibula.
too small to see. Joint effusionf chronic synovitisf
Meromelia - incomplete limb development.
articular cartilage defectsf joint micef chronic synovi­
Micromelia - abnormally small limb.
tis and osteophytes may be identified.
Notomelia - accessory limb attached to the back.
Ultrasonography may be used to examine the
Peromelia - as dysmelia.
surface of bones and soft tissue lesions such as
Phocomelia - absence of the proximal portion of a
abscessesf haematomasf foreign bodies and soft tis­
limb.
sue tumoursf allowing ultrasound-guided aspira­
Adactyly - absence of a digit.
tion in many cases.
Brachydactyly - reduced size of outer digits.
See the further reading list for more information.
Dactomegaly - abnormally large digit.
Ect rodactyly - absence of part or all of a digit;
also used to describe split hand (lobster claw) 3 . 1 SCAPULA
deformity.
Polydactyly - supernumerary digit(s). Views
Polymyelia - supernumerary limb. Mediolateral (ML); ML with dorsal displacement
Polypodia - supernumerary feet. of the limb; caudocranial (CdCr); distoproximal -
Syndactyly - fusion of digits. dorsal recumbency with the affected limb pulled
Valgus - lateral deviation of a limb distal to an caudally so the scapula is vertical and the shoulder
abnormal growth plate or fracture malunion. joint is flexed to 90°.
Varus - medial deviation of a limb distal to an
abnormal growth plate or fracture malunion. Development
The ossification centre of the scapular body is pres­
ent at birthf and the scapular tuberosity appears at
Ultrasonography of the musculoskeletal 7 weeks; fusion occurs at 4-7 months.
system 1. Ossification centre of the scapular tuberosity
The use of ultrasonography is now well documen­ (supraglenoid tubercle) fuses to the body of the
scapula by 4-7 months; differential diagnosis is
ted for investigation of musculotendinous lesionsf
fracture.
although it requires considerable experience.
High-frequency transducers of 7.5 MHz or more 2. Chondrosarcoma - flat bones are predisposed
are requiredf and linear transducers give contact (scapulaf pelvisf craniumf ribs).
over a larger area. 3. Scapular fractures. Usually youngf medium
The appearance of a normal tendon in longitu­ to large breeds of dog and after major trauma;
dinal section is a band of medium echogenicity often concurrent thoracic injuries.
a. Scapular body - non-articular.
with parallel hyperechoic lines representing the
fibrillar texture of the tendonf and in transverse b. Scapular spine - non-articular.
section is of a round to ovoid structure with cen­ c. Scapular neck - non-articular.
tral inhomogeneities. The peritenon appears as a d. Scapular tuberosity (supraglenoid tubercle) -
hyperechoicf continuous line. Acute and chronic usually avulsed by biceps brachii tendon in
tendinitisf tenosynovitisf mineralizationf partial skeletally immature animalsf articular;
or complete tendon ruptures and tendon disloca­ differential diagnosis is separate centre of
tions can be detectedf and tendon healing after ossification.
injury can be monitored. e. Other glenoid fractures; articular.
Chapter 3 Appendicular skeleton 53

3 .2 SHOULDER
Views
ML; ML with pronation and/or supination; CdCr;
flexed cranioproximal-craniodistal oblique (CrPr­
/
CrDiO) for the intertubercular groove through
which biceps tendon runs; arthrography (see 2.1).
On the CdCr viewf the joint space is often wider
medially.

Ultrasonography
The use of ultrasonography for shoulder disease
has been described (see Further reading).
Figure 3.1 Shoulder osteochondritis dissecans with
1. Clavicles - clearly seen in cats; smaller and secondary osteoarthrosis: subchondral bone erosion affecting
less mineralized in dogsf but rudimentary the caudal part of the h u meral head, an overlying
structures are sometimes visiblef especially on mineralized cartilage flap and an osteophyte on the caudal
the CdCr view of the shoulder; bilaterally articular margin of the h u merus.
symmetrical.
2. Caudal circumflex hmneral artery seen end on
caudoventral to the jointf surrounded by fat; also in the biceps tendon sheath or the
differential diagnosis is poorly mineralized subscapular joint pouch (CdCr view)f as well as
joint mouse. mild secondary osteoarthrosis. The presence of
3. Separate ossification centre of glenoid - smalt the vacuum phenomenon (see 2.2.13) is highly
crescentic mineralized opacity adjacent to the suggestive of an OC lesion. Arthrography is
caudal rim of the glenoid; may fuse to the helpful in demonstrating thickening and
scapula or persist throughout life; may be an irregularity of the articular cartilage layerf
incidental finding but differential diagnosis is non-mineralized cartilage flap formation and
osteochondrosis (QC) of glenoid (see 3.2.5 non-mineralized joint mice. Ultrasonography
below). Howeverf incomplete ossification of can also be used to show OCD lesionsf joint
the caudal glenoid has recently been reported micef joint effusions and new bone.
as causing lameness in a number of larger S. Osteochondrosis of the glenoid rim - unusual -
breed dogs of varying agesf especially the separate mineralized fragment adjacent to
Rottweiler. Possibly associated with minor articular rim; differential diagnosis is separate
traumaf abnormal growth and OC (or centre of ossificationf but usually larger.
osteochondritis dissecansf OCD). Damage to 6. Congenital shoulder luxation or subluxation
the medial glenohumeral ligament may also be (Fig. 3.2) - raref mainly miniature and toy
present. Radiographs show a bony fragment breeds of dog, especially the Toy Poodle; may
adjacent to the caudal glenoid margin ± be bilateral. Usually present at 3-10 months of
secondary osteoarthrosis. agef but older animals may show luxation after
4. Osteochondrosis of the humeral head; also minor trauma. The humerus is normally
called OCD if there is evidence of cartilage flap displaced medially due to underdevelopment
formation (Fig. 3.1) - young dogs mainly 5-7 of the medial labrum of the scapular glenoidf
months old of larger breeds; Border Colliesf but spontaneous reduction may occur on
Labradors and Great Danes over-represented; positioning for radiography. Radiographic
male preponderance; often bilateral. Reported signs include a flattenedf underdeveloped
only twice in cats. Radiographic signs include glenoid with progressive remodelling of
flattening or concavity of the caudal third of articular surfaces leading to osteoarthrosis;
the humeral articular surface ± subchondral differential diagnosis is trauma at an early age.
lucency or sclerosisf overlying mineralized 7. Traumatic shoulder luxation - uncornmonf
cartilage flap. In chronic cases joint mice may unilateral. The humerus is usually displaced
be seenf usually in the caudal joint pouch but medially or laterallYf occasionally cranially or
54 Handbook of Small Animal Radiology and U ltrasound

hyperechoic and heterogeneous. With partial
rupturef the tendon is swollen and of irregular
echotexture with tendon sheath effusion.
10. Biceps brachii tendon sheath rupture -
reported in two Labradors. Rupture of the
tendon sheath distallYf diagnosed by positive
contrast arthrography that showed leakage of
contrast medium distallYf outlining the
proximal part of the muscle belly.
11. Shoulder osteoarthrosis - usually osteophytes
on the caudal glenoid rim and caudal articular
margin of the humeral head. The amOilllt of new
bone formation is often relatively mild. Joint
mice may be visible in the caudal joint pouch
and may become very large in old dogs. Some
Figure 3.2 Congenital shoulder luxation or remodelling may develop into synovial osteochondromas.
following trauma at a very early age: the glenoid of the a. Primary - ageing change; often clinically
scapula and the hu meral head are both deformed, with loss of insignificant.
congruity of the joint space; superim position of the two bones
b. Secondary- for example following QC (QCD).
on the mediolateral view implies luxation in the sagittal plane.
12. Calcifying tendinopathy - usually
supraspinatus and biceps brachii tendons
(Fig. 3.3); changes in the infraspinatus tendon
caudally. With sagittal displacement, ML
and bursa and coracobrachialis tendon are
radiographs show a slight overlap of the
also reported. Mainly medium to largef
scapula and hmnerus with loss of the joint
middle-aged dogs, especially Rottweilers
space; on CdCr radiographsf the luxation is
and Labradors; aetiology unknown. Mildf
obvious unless spontaneous reduction has
chronic or intermittent lameness or clinically
occurred; differential diagnosis is normal
silent. May be bilateraL Radiographic signs
medial widening of the shoulder joint space on
include areas of mineralization in the region of
a CdCr viewf especially if poorly positioned
the affected tendon or bursa; differential
and particularly in smaller dog breeds. Check
diagnosis is rudimentary clavicles or joint mice
also for associated chip fractures.
8. Fractures involving the shoulder joint.
a. Scapular tuberosity (supraglenoid tubercle) -
Salter-Harris type I growth plate fracture in a


skeletally immature animat or bone fracture
in a mature animaL May be avulsed by

(�
�1

biceps brachii tendon. Differential diagnosis B
is separate centre of ossification.
b. Other articular glenoid fractures.
c. Salter-Harris type I fracture of the proximal
B ·' ',
humeral epiphysis in young animals - rare.
Medial , Lateral
d. Articular fracture of the proximal humeral
epiphysis - rare.
9. Biceps brachii tendon rupture - acute or
gradual onset; partial or complete; Bernese ®
MOillltain Dog and Rottweiler predisposed. Figure 3.3 Calcifying tendinopathy of the shoulder joint:
Diagnosed by positive contrast arthrography (A) mediolateral view and (8) cranioproximal-craniodistal
or ultrasonography. With ultrasonography of oblique view (right shoulder). Calcification is seen as a
complete tendon rupturef there is an area radiopaque area radiographically, although shown here in
that is hypo- to anechoic due to bleeding black. 8, in biceps brachii tendon; and 5 , in supraspinatus
between the tendon endsf which are swollenf tendon or its bu rsa slightly more cranial, lateral and proximal.
Chapter 3 Appendicular skeleton 55

in the biceps tendon sheath. Orthogonal radial and/or ulnar growth plates. The
radiographs (ML and CdCr) are essential to mechanism is thought to be secondary to either
differentiate lesions within the bicipital groove reduced physeal compression as a result of
from those medial or lateral to the shoulderf and decreased weight bearingf or alteration in blood
the CrPr-CrDiO view and arthrography are also flow.
helpful in identifying the tendon of origin. 2. Panosteitis - the humerus is a predilection site
Radiographs of the opposite shoulder should be (see 1.13.6 and Fig. 1.17).
obtained for comparison. Bicipital calcifying 3. Metaphyseal osteopathy (hypertrophic
tendinopathy may be associated with osteodystrophy) - proximal and distal humeral
tenosynovitis (see 3.2.13). Ultrasonography metaphyses are a minor site; the most obvious
of the tendons may be helpful in showing lesions are usually in the distal radius and ulna
fibre disruptionf areas of mineralization (see 1.24.4 and Fig. 1.31).
(hyperechoic foci with distal acoustic 4. Primary malignant bone tmnours (most
shadowing) and joint capsule or tendon sheath commonly osteosarcoma) - the proximal
effusion. humeral metaphysis is a predilection site (see
13. Bicipital tenosynovitis and bursitis - signahnent 1.20.1 and Fig. 1.27); the distal humerus is very
as above. Radiographs may be normal or may rarely affected.
show ill-defined sclerosis and new bone in the 5. Humeral fractures.
intertubercular groovef enthesiophytes on the a. Distal two-thirds of diaphysis - commonest
supraglenoid tubercle and mild osteoarthrosis. area; usually spiral or oblique and may be
Arthrography may show reduced or irregular comminutedf following the musculospiral
filling of the biceps tendon sheath due to groove; commonly associated with transient
synovial villous hypertrophy. Ultrasonography radial paralysis.
may be used to demonstrate fluid distension of b. Proximal third of diaphysis - usually a
the bursa and tendon sheath and changes transverse fracture near the deltoid tuberosity.
within the tendon itself. c. Salter-Harris type I fracture of the proximal
humeral growth plate in skeletally immature
animals.
3 .3 H UMERUS d. Distal epiphysis (see 3.4.17 and Fig. 3.10);
may be secondary to incomplete ossification
Views
of the condylef especially in Spaniels (see
ML; CdCr or craniocaudal (CrCd). 3.4.5. and Fig. 3.4).
- Lateral humeral condylar fracture.
Development - Y fracture affecting both medial and lateral
parts of the condyle.
The ossification centre of the humeral diaphysis is
present at birthf and the proximal epiphysis - Medial humeral condylar fracture.
appears at 1-2 weeks. Fusion of the greater tubercle
to the humeral head occurs at 4 months and of the
proximal epiphysis to the diaphysis at 10-13 3 .4 ELBOW
months. At the distal end of the bonef the ossifica­ Views
tion centres of the medial and lateral parts of the
humeral condyle appear at 2-3 weeks and of the Flexed, extended and neutral ML; CrCd; CdCr,
medial epicondyle at 6-8 weeks; the two halves of although results in magnification and blurring;
the condyle fuse at 8-12 weeksf the medial epicon­ craniolateral-caudomedial oblique (CrL-CdMO);
dyle at 6 months and the condyle to the diaphysis craniomedial-caudolateral oblique (CrM-CdLO);
at 5-8 months. arthrography. Oblique views may be obtained by
pronating or supinating the limb.
1. Compensatory overgrowth of the humerus -
increase in humeral length compared with
Ultrasonography
the contralateral limb has been described in
dogs in which there is significant antebrachial Normal ultrasonographic anatomy of the canine
shortening due to premature closure of elbow has been described (see Further reading).
56 Handbook of Small Animal Radiology and U ltrasound

1. Ossification centres visible in the elbow: results in a residual sagittal cartilaginous plate
medial and lateral parts of the distal humeral that may be clinically silent or cause lameness
condylef medial hmneral epicondylef in its own right as well as predisposing to
anconeusf olecranonf proximal radial condylar fractures (see 3.4.17 and Fig. 3.10).
epiphysis; occasional small separate centre The fissure may be seen on CrCd or Cr 15°
of ossification in the lateral humeral M-CdLO radiographs when the X-ray beam is
epicondyle seen on the CrCd view. parallel to the fissuref extending proximally
2. Elbow sesamoids - mineralized elbow from the articular surface to the physis and
sesamoids are commonly seen in both dogs sometimes beyond into the supratrochlear
(mainly larger breeds) and cats; smalt smoothf foramen. Differential diagnosis is Mach effect
round bodies craniolateral to the radial head; along the edge of the superimposed olecranon
usually bilateral. Mainly in the supinator (see 1.9).
muscle but also reported in the annular 6. Coronoid disease: fragmentation of the medial
ligament and lateral collateral ligament. coronoid process of the ulna (FMCP) (Fig. 3.5) -
Differential diagnoses are joint micef chip part of the elbow dysplasia complex seen
fractures; should not be confused with a in young dogs of medium and large
fragmented medial coronoid process. breedsf especially the Labradorf Golden
3. Absence of the supratrochlear foramen of the Retrieverf Bernese Mountain Dogf Rottweilerf
distal humerus - occasionally noted in smalt Newfoundland; male preponderance; often
chondrodystrophic breeds of dog. bilateral. Lameness is first seen from 4-12
4. Cats - the supracondylar foramen is present on months of age. In some casesf initial lameness
the medial aspect of the distal humerus and is is not detectedf particularly if bilateral disease
visible on a CrCd or CrL-CdMO radiograph; is presentf and the dog presents at an older
the brachial artery and median nerve pass age with osteoarthrosis. Predisposed to by
through this foramen. elbow incongruity with widening of the
5. Incomplete ossification of the humeral condyle humeroradial joint spacef which puts increased
(Fig. 3.4) - especially English Springer Spaniels pressure on the medial coronoid process. The
and American Cocker Spaniels but also seen in diagnosis of FMCP and of humeral condylar
other Spaniel breeds and crosses and in some OC is often made by identification of
other pure breeds; male preponderance; often secondary osteoarthrosis in an appropriate
bilateral. Failure of fusion of the medial and patient rather than by visualization of a
lateral centres of ossification in the condyle primary lesion (see 3.4.19 and Fig. 3.11); a
specific diagnosis may not be possible without
arthrotomYf arthroscopy or high-resolution CT

Co

Figure 3.5 Fragmented medial coronoid process with early
Figure 3.4 Incomplete condylar ossification of the right secondary osteoarthrosis: a small bone fragment is seen lying
elbow on a craniocaudal view. A sagittal radiolucent line adjacent to the medial coronoid region of the ulna, which is
extends from the articular surface to the distal hu meral flattened. Small osteophytes are present on the radial head
growth plate. The ulna has been omitted for clarity. and anconeal process (arrowed).
Chapter 3 Appendicular skeleton 57

or magnetic resonance imaging. The primary
radiographic findings are flatteningf rounding
or fragmentation of the process on the ML and
Cr 15° L-CdMO views; the CrCd view shows
not the process itself but a more medial
projection of bonef which may be remodelled.
'Kissing' subchondral lesions may also be seen
on the opposing articular surface of the
humeral condyle; differential diagnosis is
humeral OC (OCD).
7. Osteochondrosis (OCD) of the medial part of
Figure 3.7 U n u n ited anconeal process: a large, triangular
the distal humeral condyle (Fig. 3.6) - also part
bone fragment is clearly seen, separated from the adjacent
of the elbow dysplasia complex affecting the
ulna.
same breeds as above but with no gender
predilection; often bilateral. The primary lesion
is best seen on the CrCd view as subchondral separate centre of ossification for the anconeus
bone flattening or irregularityf subchondral usually fuses to the ulna between 3 and 5
sclerosisf ± overlying mineralized cartilage monthsf and persistence of a radiolucent
flap; severe lesions may also be visible on the cleavage line beyond this time indicates
ML view; differential diagnosis is kissing separation. The flexed ML view is diagnosticf
lesion created by a fragmented medial showing a substantial triangular bone
coronoid process. Osteoarthrosis develops as fragment either adjacent to ulna or displaced
with FMCP. proximally; chronic cases showing remodelling
8. Ununited anconeal process (Fig. 3.7) - also part of the fragment and/or osteoarthrosis.
of the elbow dysplasia complex, although 9. Elbow incongruity - seen in the various breeds
mainly in the German Shepherd Dog, Irish predisposed to elbow dysplasia but especially
Wolfhoundf Great Danef Gordon Setter and in the Bemese Mountain Dog. Poor congruity
Basset Hound; no gender predilection; often between the hmnerusf radius and ulna puts
bilateral. Predisposed to by elbow incongruity increased pressure on the medial coronoid
with a slightly shorter ulna or longer radius process or the anconeus and may lead to
putting pressure on the anconeusf but may also fragmentation or separation of these processesf
be due to trauma; some cases are bilateral. The respectively. Usually the hmneroradial joint
space is widenedf best assessed on a CrCd
viewf as it is quite position-sensitive. May be
seen alone or with HvICPf OCf unilllited
anconeal process ± osteoarthrosis. The clinical
significance of incongruity alone is uncertain.
10. Medial epicondylar spurs (flexor tendon
enthesiopathy) (Fig. 3.8) - usually larger
breed dogs; may be bilateral; aetiology and
significance not known and in some dogs is an
incidental radiographic finding. The ML
radiograph shows a distally projecting bony
spur on the caudal aspect of the medial
humeral epicondylef or less commonly linear
mineralization in adjacent soft tissues.
11. 'Ununited medial epicondyle' - unusual;
Figure 3.6 H umeral condylar osteochondritis dissecans aetiology not known but may be part of the
(craniocaudal view of the right elbow): a shallow elbow dysplasia complexf as similar breeds are
subchondral defect with adjacent sclerosis is seen in the affectedf mainly young Labradors; may be
medial part of the hu meral condyle, with an overlying small bilateral. Single or multiple mineralized
mineralized cartilage flap. fragments of varying size and shape are seen
58 Handbook of Small Animal Radiology and U ltrasound

BOX 3.1 International Elbow Working Group
grading system for elbow dysplasia

)
The I nternational Elbow Working Group recommends the
following grading system for elbow dysplasia screening
based on the degree of secondary osteoarthrosis, from 12
months of age onwards:
• grade 0 - normal elbow, no osteoarthrosis or
primary lesion
• grade 1 - mild osteoarthrosis with osteophytes
< 2 mm
• grade 2 - moderate osteoarthrosis with
osteophytes 2-5 mm
Figure 3.8 Medial epicondylar spur: a small, distally
• grade 3 - severe osteoarthrosis with osteophytes
projecting enthesiophyte arises from the caudal aspect of the
> 5 mm.
medial h umeral epicondyle (arrowed).
Primary lesions described include malformed or
fragmented medial coronoid process, u n u nited anconeal
at several locations near the medial epicondylef process, osteochondrosis (osteochondritis dissecans) of
sometimes with an adjacent bone defect. the h umeral condyle and incongruity of the articular
Secondary osteoarthrosis may be very surfaces. Grading schemes in different countries vary in
minor. Some cases are radiographically similar the n u m ber of radiographic views required and in their
to flexor enthesiopathiesf and these may be grading of primary lesions; the m i n i m u m requirement is a
different manifestations of the same condition. flexed mediolateral view of each elbow.
Box 3.1 describes the grading system
recommended by the International Elbow Working
Group for elbow dysplasia screening.
12. Elbow subluxation. in flexion and the distal limb is pronated.
a. Severe elbow incongruity (see 3.4.9). Radiographically, the ulna is displaced
b. Secondary to relative shortening ± laterally so its trochlear notch faces medially
curvature of the ulna or radiusf usually due and is seen in profile on a CrCd view
to traumatic lesions at the distal growth of the elbow; affected areas of bone are
plates or chondrodysplasiaf and therefore remodelledf and in chronic casesf
recognized in yOilllg animals (see 3.5.4-7). osteoarthrosis develops.
Shortening of the ulna causes widening e. Congenital or developmental displacement of
of the humeroulnar space distally and the radial head (Fig. 3.9) - mainly larger breeds
increased pressure on the anconeal process; of dog with no gender predilection; may be
shortening of the radius causes widening of bilateraL May also be secondary to growth
the humeroradial space and of the disturbances of the distal radius and ulna.
humeroulnar space proximallYf resulting in Deformity is milder than with humeroulnar
increased pressure on the medial coronoid subluxationf although progressive
process of the ulna. degenerative joint changes develop. The radial
c. Distractio cubiti or dysostosis enchondralis head is (sub)luxated laterally or caudolaterally
in chondrodystrophic breeds (see 3.5.5). and is remodelled; the radius may appear
d. Congenital humeroulnar (sub)luxation ­ longer than normaL
mainly small breeds of dogs (e.g. Pekinese) f. Congenital complex elbow (sub)luxation ­
but also cats; male preponderance; often may be seen with other deformities such
bilateraL Deformity is severef with obvious as ectrodactyly and split hand deformity
limb dysfunctionf and is therefore (see 3.7.7).
recognized at an early age (3-6 weeks). 13. Patella cubiti - a rare fusion defect through
There is lateral displacement and 90° the trochlear notch of the ulna such that the
medial rotation of the ulna with a normal olecranon and proximal ulnar metaphysis
humeroradial articulation; the elbow is held are separated from the rest of the ulna and
Chapter 3 Appendicular skeleton 59

' j�
-
l
- - - -------- -- - --..
-�
"
Figure 3.9 Congenital lateral luxation of the radial head
(craniocaudal view of the right elbow): the radial head is markedly
remodelled and no longer contoured to the humeral condyle.

distracted by the triceps muscle; so-called
because the fragment of bone is patella-shaped.
May be bilateral. Differential diagnosis is
avulsion fracture through the proximal ulnar
growth plate or trochlear notch.
14. Cats - hypervitaminosis A; usually due to
excessive ingestion of raw liverf leading to bony
exostoses mainly on the spinef but the elbow is
also a predilection site (see 5.4.8 and Fig. 5.8).
15. Synovial sarcoma (occasionally other soft ®
tissue tumoursf such as histiocytic sarcoma; see Figure 3 . 1 0 Lateral humeral condylar fracture: (A) on the
2.4.7 and Fig. 2.4) - the elbow is a predilection mediolateral view, the medial and lateral parts of the humeral
site; mainly larger breeds of dog; differential condyle are no longer superim posed; and (8) on the craniocaudal
diagnoses are severe osteoarthrosisf in which view (right elbow), the displaced fracture is clearly seen (the
superimposition of new bone may mimic ulna has been omitted on this view for clarity). The radius
osteolysis; septic arthritis. The diagnosis may remains articulating with the lateral condylar fragment, and
be difficult in cases in which tumour is these bones override the humeral shaft.
superimposed over pre-existing osteoarthrosis.
In the case of a tumourf a soft tissue mass may with the radius and its weak attachment to
be palpable or radiographically visible adjacent the humeral shaft. Best seen on the CrCd
to the joint. viewf but overriding of the fragments is also
16. Cats - osteocartilaginous exostoses are often seen on the ML view. The mos t common
seen aroillld the elbow and may be bilateral. elbow fracturef because the lateral condyle
Possibly a type of osteochondroma (see 1.15.2 articulates with the radius and takes most of
and Fig. 1.19). the loadf and also because its epicondyle is
17. Fractures involving the elbow joint. relatively insubstantial.
a. Lateral humeral condylar fracture (Fig. 3.10) - b. y fractures of the hmneral condyle - also
usually Spaniels and Spaniel crosses; often Spaniels and predisposed to by incomplete
minor trauma only; may be bilateral. Young ossification of the humeral condyle; the
dogs or adults; in the latter, thought to be fracture line runs proximally between the
predisposed to by incomplete ossification medial and lateral parts of the condyle into
between the medial and lateral parts of the the supracondylar foramenf and then
humeral condyle (see 3.4.5 and Fig. 3.4), separate fracture lines emerge through the
together with the increased loading of the medial and lateral hmneral cortices. Best
lateral part of the condyle by its articulation seen on the CrCd view.
60 Handbook of Small Animal Radiology and U ltrasound

c. Medial humeral condylar fractures - process. The lameness may be quite severe
illlcommon; also predisposed to by incomplete with mild radiographic changes.
ossification of the humeral condyle. a. Primary - ageing change; radiographic
d. Salter-Harris type I fracture of the distal findings are usually minor.
humeral epiphysis in skeletally immature b. Secondary - usually due to elbow dysplasia;
aniInals - uncommon. radiographic findings may be severe.
e. Olecranon fractures - through the proximal
ulnar physis in skeletally immature animals
3 .5 RADIUS AND U LNA (ANTEBRAC H I U M ,
(non-articular) or into the trochlear notch
FOREARM)
(articular)f both with distraction by triceps
muscle; differential diagnosis is patella Views
cubiti (see 3.4.13).
ML; CrCd.
f. Proximal radial fracture - uncommon;
occasionally Salter-Harris type I fracture
Development
through the physis in young animals.
g. Monteggia fracture - uncommon; a Radius - the ossification centre of the diaphysis is
proximal ulnar fracture (articular or non­ present at birth; the proximal epiphysis appears
articular) with cranial luxation of the radius at 3-5 weeks and fuses to the diaphysis at 5-11
and distal ulnar fragment. months; the distal epiphysis appears at 2-4 weeks
18. Tramnatic elbow luxation - usually due to a road and fuses to the diaphysis at 6-12 months. Ulna -
traffic accident or suspension by the limb from a the ossification centre of the diaphysis is present
fence. ML radiographs may be almost normat at birth; the ossification centre of the anconeus
but the CrCd view shows dislocation of radius or appears at about 11-12 weeks and fuses to the olec­
ulna from humerus clearly; small avulsion or chip ranon at 3-5 months in large dogs; the olecranon
fractures may also be seen. Usually the radius and appears at 8 weeks and fuses to the diaphysis at
ulna luxate laterally as the large medial humeral 5-10 months; the distal epiphysis appears at 2-4
epicondylar ridge prevents medial luxation. weeks and fuses to the diaphysis at 6-12 months.
Ulnar luxation alone also reported. The distal ulnar physis is conical in the dogf
19. Elbow osteoarthrosis (Fig. 3.11) - new bone appearing V-shaped radiographically, and is flat
mainly on the anconeus and radial head (seen and horizontal in the cat.
on the ML view) and medial and lateral 1. Late closure of the radial growth plates in
humeral epicondyles (seen on the CrCd view). neutered cats (males - distal only; females -
Sclerosis of the ulnar trochlear notch is due to a both proximal and distal); leads to an overall
combination of increased bone density and longer radius than in entire cats.
superimposition of osteophytesf and is seen 2. Hemimelia (radial or ulnar agenesis) - one of
especially in dogs with fragmented coronoid the paired bones is congenitally absentf usually
the radius; rare; usually unilateral. Medial
carpal bones and the first digit may also be
absent in the case of radial hemimelia; the
remaining bone shows variable shape changes.
Severe liInb deformity and disability are
· . \-/L..J/ � evident from birth. Possibly heritablef as
-
, reported in several sibling cats.
l- �
,, - - .
- - '.

{�
3. Retained cartilaginous coref distal ulnar
F+-- metaphysis (Fig. 3.12) - common, often
I

! bilaterat ossification defect in giant dog
I

"�,
breedsf in which a central core of distal growth
./ plate cartilage is slow to ossifyf forming a
... _
-
-
-_
.
® candle flame-shaped lucency with faintly
Figure 3.1 1 Elbow osteoarthrosis: (A) mediolateral and sclerotic borders. Implicated in growth
(8) craniocaudal view (right elbow), showing periarticular disturbances but may be a coincidental
new bone (arrowed). findingf as often seen in normal dogs too.
Chapter 3 Appendicular skeleton 61

which prevents lateral movement. May also
occur unilaterally in other breeds.
b. Metaphyseal QC or retained cartilaginous
core.
Radiographs should include the whole
antebrachium including the elbow and
carpusf and show shortening of the ulna
and distraction of the lateral styloid
process from the carpusf craniomedial
bowing of the radius and ulna with
thickening of the adjacent radial and ulnar
corticesf carpal subluxation and remodelling of
the distal radiusf carpal valgus and external
Figure 3 . 1 2 Retained cartilaginous core in the distal ulnar rotation of the footf and secondary elbow
metaphysis: seen as a conical radiolucent area extending subluxationf usually of the distal aspect of
proximally from the growth plate. the humeroulnar articulation. Carpal valgus
may also be due to distal radius or ulna
4. Premature closure of the distal ulnar growth fracture or to developmental laxity of the
plate (radius curvus syndrome) (Fig. 3.13) - a short radial collateral ligamentf and
common growth disturbance in young dogs of radiography permits differentiation of these
giant breedsf leading to angular limb conditions.
deformitYf often bilateral. The cause is usually 5. Distractio cubiti or dysostosis enchondralis -
not identifiedf so deemed idiopathicf but asynchronous growth of the radius and ulna in
proposed mechanisms include: chondrodystrophic breeds (e.g. Bassett
a. Salter-Harris type V crush injury of the Hound), leading to elbow incongruity and
distal ulnar growth plate - susceptible to pain; widening of the distal aspect of the
such injury due to its deep conical shapef humeroulnar articulation. Usually present
with elbow lameness at about 12 months of
age; may be bilateral.
6. Premature closure of the distal radial growth
plate - trauma at or near the growth plate
causes reduction in growth of the radius with
shortening of the bone and subluxation of the
elbow; widening of the humeroradial
articulation ± increased width of the
humeroulnar space proximally. Angular limb
deformity is usually minorf and the main
clinical problem is elbow pain.
a. Symmetric closure - radius short and
unusually straight, ulna may be slightly
short toof elbow subluxation.
b. Asymmetric closure - distal radius
remodelled.
- Lateral aspect (more common) - mimics
premature closure of the distal ulnar
growth plate with bowing of the radius
and ulna and carpal valgus.
Figure 3 . 1 3 Premature closure of the distal ulnar growth - Medial aspect - carpal varus.
plate: relative shortening of the ulna leading to cranial
7. Premature closure of the proximal radial
bowing of the antebrachium and often elbow and carpal
growth plate - rare; presumed to be due to
subluxation. There is thickening of the adjacent radial and
ulnar cortices.
trauma; radiographic signs as for 6af but the
62 Handbook of Small Animal Radiology and U ltrasound

proximal radius may be obviously remodelled. 14. Rickets (syn. juvenile osteomalacia) - young
Only 30% of the radial growth occurs animals after weaning; lesions usually most
proximallYf therefore radial shortening is less severe in the distal ulnar and radial growth
severe than that following distal growth plate plates (see 1.23.8 and Fig. 1.30).
trauma. 15. Hypertrophic (puhnonary) osteopathy (syn.
8. Osteochondrodysplasias - various types of Mariefs disease) - the radius and ulna may be
hereditary dwarfism are recognized in a affected by palisading periosteal new bonef
number of dog breeds and in cats (see 1.22.7). although the distal limb is likely to be affected
Pathological and radiographic lesions are first (see 1.14.6 and Fig. 1.18).
often most severe in the distal ulna and radius 16. Craniomandibular osteopathy - rarelYf
due to the high rate of growth at this site. The paracortical new bone may be seen
main abnormality is delayed growth at the surroilllding the distal ulna and radiusf
distal ulnar growth platef leading to shortening mimicking metaphyseal osteopathy (Fig. 3.14),
and bowing of the antebrachium. Some sometimes in the absence of the typical skull
conditions may also resemble rickets lesionsf although in dogs of appropriate breed
radiographically (see 1.23.8 and Fig. 1.30). The and age (see 4.10.1 and Fig. 4.6).
pelvic limbs are less severely affected and may 17. Canine leucocyte adhesion deficiency - a
be normal. hereditaryf fatal disease in Irish Settersf
9. Congenital hypothyroidism - causes causing lesions similar to metaphyseal
dwarfism with radiographic changes similar osteopathy and craniomandibular osteopathy.
to hereditary osteochondrodysplasias 18. Primary malignant bone tumours (most
(see 1.22.9). commonly osteosarcoma) - the distal radial
10. Radioulnar synostosis (fusion of the bones) metaphysis is the main predilection sitef
leading to secondary radial head subluxation especially in large and giant dog breedsf
and external rotation of the foot has been
described in a cat and is recognized in
children. The radius and ulna are fused
proximally at the interosseous spacef
preventing pronation-supinationf and
secondary elbow malformation results. May
also occur following antebrachial fractures.
11. Bone remodelling in the distal ulnar and/or
radial metaphyses has been described in
Newfoundland dogs in Norway: 45% of dogs
examined radiographically over a period of
time showed islands of reduced opacity
outlined by thickened trabeculae in the distal
metaphyses at 6 months of age; the changes
progressed up the diaphyses and persisted for
up to 24 months of age. Aetiopathogenesis
unclear. No clinical signsf but should not be
mistaken for other conditions.
12. Metaphyseal osteopathy (syn. hypertrophic
osteodystrophy) - young, rapidly growing
dogs of larger breeds; lesions are usually most
severe in the distal ulnar and radial
metaphyses (see 1 .24.4 and Fig. 1.31). Extensive
periosteal and paracortical new bone may
occasionally bridge growth platesf leading to
angular limb deformities.
13. Panosteitis - the radius and ulna are Figure 3.1 4 Lesions associated with craniomandibular
predilection sites (see 1.13.6 and Fig. 1.17). osteopathy on the ulna and radius.
Chapter 3 Appendicular skeleton 63

for example Great Danef Irish Wolfhound antebrachiocarpal joint accounts for the majority of
(see 1.20.1 and Fig. 1.27). joint flexionf the middle carpal joint for some and
19. Giant cell tumour (syn. osteoclastoma) - the the carpometacarpal joint for relatively little. The
distal ulnar metaphysis is a predilection site; antebrachiocarpal joint normally also allows slight
differential diagnosis is solitary bone cyst hyperextension.
(see 1.19.1 and Fig. 1.25).
20. Solitary bone cyst - the distal ulnar metaphysis Development
is a predilection site; differential diagnosis is
The ossification centres of the radiat ulnar and
giant cell tumour (see 1.19.2 and Fig. 1.26).
numbered carpal bones appear at 3--4 weeks; the
21. Fractures of the antebrachium.
body of the accessory carpal bone appears at
a. Transverse fracture of the radius and ulna is
2 weeks and its epiphysis at 7 weeksf with fusion
very common; usually distal one-third.
occurring at 10 weeks to 5 months.
b. Fracture of one bone only occurs
occasionally due to direct trauma. 1. Normal sesamoid in the insertion of abductor
c. Fissure fracture of the cranial cortex of the pollicis longus muscle on proximal metacarpal
radius mid-shaft after jumping from a If seen on a DPa radiograph medial to the
height has been reported. radial carpal bone; differential diagnosis is old
d. Oistal radial (medial styloid process) chip fracture.
fractures usually occur as avulsion fractures 2. Developmental antebrachiocarpal
of the short radial collateral ligaments and subluxations - secondary to growth
result in medial joint instabilitYf detected on disturbances in the antebrachium and angular
stressed radiographs. limb deformities; most commonly premature
e. Oistal ulnar (lateral styloid process) closure of the distal ulnar growth plate with
fractures may be associated with damage to cranial bowing of the radiusf leading to
the origins of the short ulnar collateral articulation of the distal radius with the
ligaments and result in lateral joint dorsoproximal margin of the radial carpal
instabilitYf detected on stressed bone and remodelling of the distal radial
radiographs. epiphysis (see 3.5.4. and Fig. 3.13).
f. Avulsion of the origin of the dorsal 3. Carpal flexural deformity - skeletally
radiocarpal ligament - racing Greyhounds; immature dogs at about 6-12 weeks of agef
avulsion fragment from dorsomedial aspect especially the Dobermann. Thought to be due
of the distal radius. to relative shortening of flexor carpi ulnaris
22. Radial or ulnar fracture delayed union or non­ muscle. Radiographs are normal and are
union - common in toy dog breeds due to used to exclude bony pathology.
failure to use the injured limb; radiographs 4. Cats - osteodystrophy of the Scottish Fold
show atrophic non-union and disuse cat; changes are more severe in the pelvic
osteopenia (see 1.9 and 1.16). limbs (see 3.7.8).
5. Rheumatoid arthritis - the carpus and tarsus
are predilection sites; often bilateral (see 2.4.8
3 . 6 CARPUS and Fig. 2.5).
6. Cats - various feline polyarthritides; the carpus
Views
and tarsus are predilection sites.
ML; flexed ML; dorsopalmar (OPa); dorsolateral­ 7. Chinese Shar Pei fever syndromef also known
pahnaromedial oblique; dorsomedial-palmarolat­ as familial renal amyloidosis of Chinese Shar
eral oblique; stressed and weight-bearing views. Pei dogs - mainly the tarsusf but the carpus is
Stressed views allow more accurate diagnosis of lig­ occasionally affected (see 3.13.6).
amentous injuries and should be obtained by using 8. Carpal fractures - often associated with
soft ties around the distal antebrachium and meta­ avulsions of tendons or ligamentsf so what
carpus and not by manual restraint. Oblique views appear to be minor fractures may cause
of the carpus are helpful in interpretationf and simi­ serious effects.
lar radiographs of the normal leg for comparison a. Accessory carpal bone fractures (Fig. 3.15) -
are invaluable. On flexed ML radiographsf the especially racing Greyhounds and other
64 H a n d book of S m a l l An i m a l Rad i o l ogy a n d U l traso u n d

of a jump or fall, particularly high rise
syndrome. Hyperextension and medial or
lateral collateral instabilities are the most
common injuries.
a. Carpal overextension injuries or palmar
ligament rupture - due to jumping from a
height; also arise insidiously in older Shetland
Sheepdogs and Collies; may be bilateral.
Unstressed ML radiographs may appear
normal, but with pressure from the palmar
aspect or weight-bearing radiographs,
F i g u re 3 . 1 5 D i a g ra m matic re p rese ntation of types 1 -4
overextension may be seen at any of the three
a ccesso ry ca rpa l bone fra ctu res (med i o l atera l view).
carpal joints. Small chip fractures may be seen
ACB, a ccessory ca rpa l b o n e ; U , u l n a ; UCB, u l n a r ca rpa l bone.
on the dorsal aspect of the radial carpal bone in
cases of injury. Associated injuries such as
athletic dogs; mainly the right carpus due to proximal metacarpal 2 or 5 fractures or
loading when running anticlockwise; best collateral ligament injuries may be seen as
seen on extended and flexed ML well. Chronic cases show secondary
radiographs. Five types are described: osteoarthrosis.
- type 1 - accessoroulnar ligament avulsion b. Carpal overextension due to poor tone in the
from the base of the bone flexor tendons may be seen in skeletally
- type 2 - avulsion of ligaments attaching immature dogs of larger breeds, especially
to the radius and ulna, on the proximal the German Shepherd dog, but is not
border of the bone associated with bony radiographic changes.
- type 3 - avulsion of the origin of the c. Antebrachiocarpal joint (sub )luxation - the
accessorometacarpal ligaments carpus is usually displaced in a palmar
- type 4 - avulsion of the tendon of direction; ± ligament damage and avulsion
insertion of flexor carpi ulnaris muscle fractures; a serious injury.
- type 5 - comminuted. d. Radial carpal bone luxation - an uncommon
Types 1, 2 and 5 are articular and may lead to injury that appears to be due to antebrachial
osteoarthrosis of the accessoroulnar joint. joint hyperextension and rotation combined
b. Radial carpal bone fractures - may occur with rupture of the short radial collateral
without known trauma, and Boxers are ligament and dorsal joint capsule; the radial
over-represented; may be bilateral; possibly carpal bone is displaced palmarly or
due to a fusion defect of the three palmaroproximally.
embryological centres of ossification in the 10. Collateral ligament trauma.
bone (radial, intermediate and central, a. Rupture of the collateral ligaments (short
which normally fuse before birth) . Usually radial medially and short ulnar laterally) ­
sagittal or oblique sagittal fractures that are medially and laterally stressed DPa
best seen on DPa views. radiographs are needed to confirm the injury.
c. Ulnar carpal bone fractures - rare; usually Radial (medial) collateral ligamentous
associated with ligamentous injury. injuries are more common, because the
d. Other carpal bones - small chip fractures on normal joint has up to 15° valgus deviation
the dorsal aspect of the small, numbered during weight bearing. Radiographs of
carpal bones may result from hyperextension chronic cases may show local soft tissue
injuries, although may be hard to identify swelling and enthesiophyte formation at the
radiographically due to their small size and origins and insertions of the ligaments.
the complexity of the joint. b. Avulsion fractures of the origins of the
9. Carpal luxations and subluxations - carpal oblique and straight short radial collateral
ligamentous injuries are more common ligaments - especially racing Greyhounds;
than fractures and are usually the result best seen on a DPa view. Chronic cases may
Chapter 3 Appendicular skeleton 65

aspect of the distal radius and proximal
second metacarpal bone. In severe casesf joint
spaces may be irregular.

-

3 .7 M ETACARPUS, M ETATARSUS
AND PHALANGES
Views
ML; OFa or dorsoplantar (OFI); dorsolateral-pahnaro­
or plantaromedial oblique; dorsomedial-pahnaro- or
plantarolateral oblique; ML with digits separated
using ties (splayed toe view).

Figure 3.1 6 Enthesiopathy of the short radial collateral Development
ligament (arrow): small spurs may be seen in racing
Greyhounds; larger masses of new bone may be associated The ossification centres of the metapodial and pha­
with carpal osteoarthrosis in other large breeds of dog. langeal diaphyses are present at birthf and asso­
ciated epiphyses are seen from 4-6 weeksf with
fusion at 4-7 months. The proximal metapodial
show dystrophic mineralization and
and distal phalangeal physes are closed at birth.
enthesiopathy (see below).
Palmar or plantar sesamoids appear at 2 months
11. Enthesiopathy of the short radial collateral
and dorsal sesamoids at 4-5 months.
ligament (Fig. 3.16) - racing Greyhounds and
sometimes other breedsf although not 1. Artefacts created by radiopaque dirt on the
necessarily causing lameness. Remodelling footf especially between the pads.
and osteophyte production may be seen on the 2. Radiopaque foreign bodies embedded in the
small bony tubercle that forms the proximal pads (e.g. wire, glass).
margin of the medial radial sulcus. 3. Variation in the appearance of digit 1 (dew
12. Abductor pollicis longus tenosynovitis - large claw)f especially in dogs that have undergone
dogs of varying ages in which chronic tendon removal of this digit as puppies.
sheath synovitis occursf sometimes with bony 4. Sesamoid disease (Fig. 3.17) - especially young
stenosis caused by osteophytes on either side Rottweilers; fragmentation of the palmar
of the medial sulcus of the distal radius metacarpal sesamoids (metatarsal less
through which it passes; radiographic signs are commonlY)f mainly sesamoids 2 and 7 (axial
of varying degrees of soft tissue swelling and sesamoids of digits 2 and 5); unknown causef
bony proliferation along the course of the
tendon sheath but do not correlate well with
the degree of lameness. This muscle originates
on the lateral margins of the radial and ulnar
diaphyses and crosses the dorsal aspect of the
distal radius obliquelYf passing through the
medial radial sulcus and between the two parts
of the short radial collateral ligament to insert
on the first digit.
13. Carpal osteoarthrosis and enthesiopathy -
common in older dogsf especially of larger
breedsf and also develops following trauma;
radiographic changes may be much less severe
than the clinical signs suggest. Often a focat
firm soft tissue swelling medial to the carpusf Figure 3.1 7 Fragmentation of the palmar metacarpophalangeal
with underlying enthesiophytes on the medial sesamoids: typically sesamoids 2 and 7.
66 Handbook of Small Animal Radiology and U ltrasound

but possibly abnormal endochondral
ossification; lameness variable or absentf as
these may be incidental findingsf so check
for other causes too. Scintigraphy has been
reported to be useful in demonstrating
significance. Differential diagnoses are
congenital bipartite or multipartite sesamoids;
fractures.
5. Polydactyly (e.g. six-toed cats); may be
hereditary .
6. Syndactyly - lack of differentiation between
two or more toes on single or multiple feet due
to incomplete separation between soft tissues ±
bone in utero; may be hereditary. May be
complicated by other anomalies too.
Figure 3.1 8 Paronychia or digital neoplasia: osteolysis of
Radiographic signs may be dramaticf with
adjacent articular surfaces of phalanges 2 and 3, with
complete or incomplete fusion of phalanges surrou nding soft tissue swelling.
and metapodial bonesf but lameness is unusual.
7. Ectrodactyly (split hand or lobster claw
deformity) - seen sporadically in a number of
dog breeds and in cats usually affecting one P2-3 joint or P3; paronychia may affect
thoracic limb; very variable bony changes but multiple toes and often shows more extensive
appear grossly as a longitudinal cleft in the paw; periosteal reaction; differential diagnoses
hereditary in cats and unknown cause in dogs. are malignant neoplasiaf intraosseous
8. Cats - osteochondrodysplasia of the Scottish epidermoid cysts (see 3.7.13 and 3.7.14 and
Fold cat - an inherited condition arising as a Fig. 3.18).
spontaneous mutation in a female British 12. Malignant neoplasia of the metacarpal and
Short-hair in 1996f from which a new breed metatarsal bones (e.g. osteosarcoma or soft
with folded ears was established. Both tissue tumour) - an occasional occurrence.
homozygotes and to a lesser extent 13. Malignant neoplasia of the digits (Fig. 3.18) -
heterozygotes are affectedf developing osteolytic or mixed osteolytic-proliferative
deformities of the distal limbs and a shortf lesions with soft tissue swelling affecting
thick and inflexible tail early in life. The pelvic phalanx 3 ± phalanx 2. Differential diagnoses
limbs are usually more severely affected. are paronychiaf osteomyelitisf intraosseous
Affected cats show inconsistently shortened epidermoid cysts.
and thickened metapodial bonesf splayed a. Squamous cell carcinoma of nail bed -
phalanges; exostosesf ankylosing mostly large-breed dogs and unpigmented
polyarthropathy and degenerative joint disease areas; primarily osteolytic and usually
affect the tarsusf carpusf digits and tail; destroying bone from distal to proximal.
occasionallYf there is osteolysis and a more b. Malignant melanoma - mainly pigmented
aggressive radiographic appearance. areas.
9. Hypertrophic (puhnonary) osteopathy (syn. c. Cats - polyostotic digital metastases from
Marie's disease) - affects the distal limbs pulmonary carcinoma; often multiple feet
initiallYf with periosteal new bone most affectedf predominantly weight-bearing
obvious on the abaxial margins of metapodial digits.
bones and phalanges (see 1.14.6 and Fig. 1.18). 14. Intraosseous epidermoid cysts - reported to
10. Calcinosis circumscripta - may affect the lower affect phalanx 3 in dogsf although more
limbs, including the pads (see 12.2.2 and common in the skin; unknown causef but
Fig. 12.1). secondary to trauma in humans when arising
11. Paronychia (nail bed infection) and in phalanges. Differential diagnoses are
osteomyelitis of phalanx 3 - an osteolytic or paronychiaf osteomyelitisf malignant
mixed osteolytic-proliferative lesion affecting neoplasia.
Chapter 3 Appendicular skeleton 67

15. Metacarpal and metatarsal fractures.
a. Common traumatic injurYf especially in the
thoracic limb; often multiplef displaced and
with minimal callus formation. Fractures of
proximal metacarpal (metatarsal) 2 and 5 are
associated with collateral ligament injury to
the carpus (tarsus). Figure 3 . 1 9 Main ossification centres of the pelvis
b. Fractures of the first digit may cause (Iaterolateral view). A, acetabular bone; 11, ilium; Is, ischium;
lameness even though this digit is not P, pu bis.
weight bearing.
c. Metatarsal 3 stress fracture of right pelvic
limb occasionally seen in racing The tuber ischii appear at 3 months and fuse
Greyhounds; minimally displacedf as to the ischia at 8-10 months; the caudal margin
supported by adjacent metatarsal bones. of the ischimn often appears roughenedf especially
16. Interphalangeal subluxations - racing in larger dogs. The iliac crest appears at 4 months
Greyhounds, especially digit 5 of the left and may fuse at 1-2 years or may remain open lon­
forefoot. May reduce spontaneouslYf leaving ger (its appearance is highly variable). OccasionallYf
only soft tissue swelling. a triangular centre of ossification is seen from 7
a. Distal interphalangeal joint - 'knocked-up' months in the caudal part of the pelvic symphysis.
or 'sprung' toe; dorsal elastic ligament
remains intact. Sacroiliac joints
b. Proximal interphalangeal joint. Sacroiliac disease is recognized as a cause of back
17. Sesamoid fractures - usually palmar pain in humans but is poorly documented in dogs.
metacarpal sesamoids 2 and 7; especially the The sacroiliac joints consist of synovial joints ven­
right forefoot in racing Greyhounds. Recent trally and caudallYf and roughf interdigitating
injuries show sharp fracture lines; fragments fibrocartilaginous synchondroses dorsally. VD
remodel with time. Differential diagnoses are radiographs with the pelvic limbs extended only
congenital bipartite or multipartite bones; slightly caudally result in a horizontal orientation
sesamoid disease in Rottweilers. of the sacrum and are best for demonstrating
18. Osteoarthrosis of the digits - singlef few or dorsat middle and ventral parts of the jointsf while
numerous joints affectedf with varying VD views with full pelvic limb extension angle the
amounts of new bone; usually olderf activef sacrmn relative to the film and demonstrate the
large-breed dogs and may sometimes be cranial part of the joints better. Changes that may
severef splaying the toes apart. Variable be recognized radiographically include arthrosisf
clinical signs. sclerosisf various degrees of mineralization leading
to ankylosisf neoplasia and osteomyelitis.
1. Artefact - apparent osteolysis of the ischimn on
3 . 8 PELVIS AND SACROILIAC JOINT a VD viewf due to superimposed gas in an anal
Views sac.
2. Pelvic bone shape changes in Golden Retrievers
Ventrodorsal (VD); laterolateral; oblique lateral to
with muscular dystrophy.
reduce superimposition of the two hemipelves.
3. Neoplasia.
A tangential VD view angling the X-ray beam 200
a. Osteochondroma - especially the wing of the
cranially (ventro 200 cranial-dorsocaudal oblique)
ilium, young dogs (see 1.15.2 and Fig. 1.19).
may give extra information in trauma cases.
b. Chondrosarcoma - flat bones are predisposed
to chondrosarcomaf although other primary
Development
malignant tumours (e.g. osteosarcomaf
Ossification centres of the ilimnf ischium and pubis fibrosarcoma) may also occur in the pelvis.
are present at birthf and the acetabular bone c. Multiple myeloma (plasma cell myeloma) -
appears at 7 weeks; fusion of these four bones at the pelvis is a predilection site (see 1.18.2 and
the acetabulum occurs at 4-{) months (Fig. 3.19). Fig. 1.24).
68 Handbook of Small Animal Radiology and U ltrasound

1. Fovea capitis - focal area of irregularity on the
femoral head for insertion of the teres ligament;
variable in size and may be seen as flattening of
the centre of the femoral head on a VD extended
hip radiograph; should not be mistaken for
evidence of hip dysplasia.
2. Accessory ossification centre of the craniodorsal
margin of the acetabular rim - an occasional
finding and may remain unfused; differential
diagnosis is QC of the dorsal acetabular edge
(see 3.9.5).
3. Hip dysplasia (Fig. 3.21) - a developmental and
partly inherited condition of hip joint laxityf
Figure 3.20 Pelvic fractures and un ilateral sacroiliac leading to subluxationf bony deformity and
separation in a cat. secondary degenerative changes; clinical signs
are usually limited to larger breeds of dog
4. Pelvic fractures (Fig. 3.20) - common traumatic (especially prevalent in the German Shepherd
injuries; usually multiple and displaced. dog and Labrador), but radiographic changes
Complications include concurrent lower urinary may also be observed in small breeds and in cats
tract injUryf sacrocaudal luxations and (especially the Maine Coon). Radiographic
subsequent pelvic malunion leading to screening programmes exist in a number of
obstipation and dystocia. May also be countries. The main radiographic signs include
accompanied by thoracic pathologYf so femoral head subluxationf shallow conformation
abdominal and thoracic radiographs are of acetabuhunf flattening of the cranial
advised. acetabular edgef new bone around the acetabular
5. Sacroiliac separation (Fig. 3.20) - a common margins and femoral neckf recontouring of the
injUryf especially in cats; alone or associated femoral head and muscle wastage in severe
with pelvic fractures. If bilaterat or if associated cases. In catsf the changes predominantly affect
with ipsilateral pelvic fracturesf cranial the acetabulum rather than the femoral head and
displacement of part of the pelvis may occur.
Differential diagnosis is the normal
radiolucency of the sacroiliac joint seen on a
slightly oblique VD radiograph.
6. Cats - prepubic tendon avulsion following blunt
trauma such as a road traffic accident; in some
casesf an avulsed bone fragrrtent may be seen
cranial to the pubic brim.
7. Von Willebrand heterotopic
osteochondrofibrosis in Dobermanns (see
3.9.12).

3 . 9 HIP (COXO FEMORAL JOINT)
Views Figure 3.21 Severe h i p dysplasia and secondary
osteoarthrosis. The femoral head is subluxated and
Extended VD; flexed (frog-legged) VD; ML with remodelled, and the acetabulum is shallow and irregular.
opposite leg abducted; laterolateral pelvis but hips New bone is present in the acetabular fossa, around the
superimposed; dorsal acetabular rim view; distrac­ margins of the acetabulum, encircling the femoral neck and
tion VD view (PennHIP); stress applied craniodor­ running vertically along the metaphyseal area as a
sally to femora on a VD view. caudolateral curvilinear osteophyte (a Morgan line).
Chapter 3 Appendicular skeleton 69

the position of the femoral head centre without
and with traction applied to the hip joints using a
fulcrum between the femora. DI of 0 means a fully
congruent and non-lax joint; DI of If luxation. DI is
a good predictor of subsequent hip osteoarthrosisf
as hips with a DI of < 0.3 rarely develop secondary
change.

Dorsal aceta bular rim view
Figure 3.22 Method for measuring the Norberg angle. The To assess dogs for suitability for triple pelvic
base line joins the centres of the femoral heads, and then for osteotomy. The dog is positioned in sternal recum­
each hip joint, a second line is taken from the femoral head bency with the pelvic limbs pulled cranially, the
centre to the ju nction between the cranial and dorsal femora parallel to the body and the tarsi elevated
acetabular edges. In normal h i ps, the angle between the lines slightly from the table top. This causes flexion of
is 105° or greater. Reduction in the Norberg angle denotes the lumbosacral and hip jointsf resulting in steep
femoral head subluxation and/or a shallow acetabulum, in angulation of pelvis - the roof of the acetabuhun
proportion to the degree of dysplasia present. is projected tangentially and its slope can be
measured.
neck. Symmetrical VD radiographs are requiredf 4. Legg-Calve-Perthes disease (Perthes disease;
because lateral tilting of the pelvis may result avascular necrosis of the femoral head)
in apparent subluxation of the hip joint closer to (Fig. 3.24) - adolescent dogs of small breeds,
the table. The extended VD view is standard; especially terriers; no gender predisposition;
some screening programmes also require a usually unilateral but occasionally bilateral.
flexed VD radiograph. The degree of subluxation Ischaemic necrosis of the femoral head with
and the depth of the acetabuhun together are repair by fibrovascular tissue; probable
evaluated by measuring the Norberg angle autosomal recessive inheritance in some
(Fig. 3.22). Normal values in the dog are > 105°, breeds (e.g. West Highland White Terrier).
and in the catf > 95°. Radiographic signs include uneven radiopacity
of the femoral headf leading to femoral head
PennHIP scheme collapsef widening and irregularity of the joint
Distraction index (DJ) (Fig. 3.23) is a quantitative spacef varus deformity of the femoral neckf
measurement of hip laxity calculated by comparing secondary osteoarthrosis and muscle wastage.

L

o 0
Figure 3.23 Calculation of the distraction index (01). The
right hip remains fully congruent with traction and the
centre of the femoral head does not move; 01 o. The left
=

hip becomes subluxated with traction and the femoral head
centre moves outwards; 01 = distance moved d/radius of Figure 3.24 Advanced Perthes disease: the femoral head
femoral head r. (From the Journal of the American Veterinary shows a moth-eaten radiopacity due to osteolysis and has
Medical Association, with permission.) collapsed, resulting in a wide and irregular joint space.
70 Handbook of Small Animal Radiology and U ltrasound

Differential diagnosis is intracapsular hip to bone resorption (apple core appearance). SCFE
traumaf severe hip dysplasia (but atypical is well recognized in humansf mainly in obese
breeds), femoral head OC (OCD). adolescent boysf and in pigs (in this species
5. Osteochondrosis (OCD) - the hip joint is a known as epiphysiolysis and thought to be due
highly unusual location. to physeal OC).
a. Femoral head - reported in Pekinesef 7. Cats - feline femoral neck metaphyseal
Labrador and Border Collie; focal osteopathy; very similar to SCFE described
subchondral osteolysis ± mineralized flap above and may be a late stage of the same
formation. Differential diagnosis is Perthefs condition.
diseasef although appears more focal. S. Mucopolysaccharidoses or mucolipidoses -
b. Dorsal acetabular rim - differential may produce hip dysplasiaf especially in
diagnosis is accessory ossification centre cats.
(see 3.9.2). 9. Luxation of the hip - a common traumatic
6. Physeal dysplasia with slipped capital femoral injury in skeletally mature dogs and cats; the
epiphysisf SCFE (also known as spontaneous femoral head usually displaces craniodorsally.
femoral capital epiphyseal fracture) (Fig. 3.25) - Both lateral and VD radiographs are required
mainly cats but occasionally in dogs. Uncommon to confirm the direction of displacement. Small
condition of illlknOwn aetiologYf probably a avulsion fractures from the insertion of the
cartilaginous physeal defect in which the femoral teres ligament on to the femoral head may be
head displaces without significant trauma. seen in the acetabulum. Check for other pelvic
Lameness may be insidious onset and or femoral fracturesf sacroiliac separation and
progressive. Affected cats are usually less than lower urinary tract damage. Chronicf
2 years old and predominantly overweight unreduced hip luxation results in new bone on
neutered males with an indoor lifestyle; dogs are the ilial shaft and false joint formation.
usually about 1 year of agef also overweight 10. Fractures involving the hip joint.
neutered malesf and Labradors and Shetland a. Proximal femoral growth plate fractures -
Sheepdogs are possibly over-represented. Salter-Harris type I or II (slipped epiphysis):
Unilateral or bilaterat or unilateral with the other this is the most common injury of the
hip affected at a later date. Radiographs show femoral head in immature dogs and cats and
varying degrees of displacement or 'slippage' of may require both extended and flexed VD
the femoral headf with an open physisf changes radiographs for diagnosisf because the
in bone opacity of the femoral neck and in more fracture may be reduced on one view. In
chronic cases narrowing of the femoral neck due skeletally immature animalsf the only
femoral head blood supply is via the joint
capsulef so untreated intracapsular neck
fractures or growth plate fractures will
probably result in avascular necrosis of the
femoral head and non-union. This leads to
femoral neck resorptionf producing an apple
core appearance.
b. Femoral neck fractures - intracapsular or
o ® extracapsular. In skeletally mature animalsf
blood supply via the medullary cavity exists
and bone resportion is less likely.
c Acetabular fractures - the femoral head
displaces medially; secondary hip
Figure 3.25 Slipped capital femoral epiphysis in a cat: (A) osteoarthrosis is likely.
early and (8) late. (A) I n the right hip, there is a radiolucent d. Femoral head avulsion fractures - small
line in the region of the physis; (8) in the left hip, there is fragment of bone remaining attached to the
osteolysis of the femoral neck, producing an apple core teres ligament when the hip luxates.
appearance, with displacement between the femoral head e. Physeal dysplasia and SCFE (epiphysiolysis ­
and the rest of the femur. see 3.9.6 and Fig. 3.25).
Chapter 3 Appendicular skeleton 71

11. Calcifying tendinopa thy. 4. Metaphyseal osteopathy (hypertrophic
a. Middle gluteal muscle (less commonly deep osteodystrophy) - the proximal and distal
and superficial gluteal muscles) - one or femoral metaphyses are a minor site; the most
more roundedf mineralized bodies near the obvious lesions are usually in the distal radius
greater trochanter of the femurf commonly and ulna (see 1.24.4 and Fig. 1.31).
seen on VD hip radiographs of larger dogs; 5. Hypertrophic (pulmonary) osteopathy (Marie's
clinically insignificant. disease) - the femur is a minor site (see 1.14.6
b. Iliopsoas - a similar finding near the lesser and Fig. 1.18).
trochanter. 6. Neoplasia.
c. Biceps femoris - near the ischiatic a. Primary malignant bone tumours (most
tuberosity. commonly osteosarcoma) - the proximal
12. Von Willebrand heterotopic osteochondrofibrosis femoral metaphysis is an occasional sitef the
of Dobermann Pinschers - variably sized distal metaphysis is affected more commonlYf
masses of mineralized tissue and/or although the incidence is less than in the
periosteal reactions in the region of the hip thoracic limb.
jointf causing severely reduced range of b. Parosteal osteosarcoma - the distal femur is a
motion. Thought to be due to microvascular predilection site (see 3.11.12 and Fig. 3.29).
bleeding in dogs with low levels of von c. Infiltrative lipoma of thigh - swelling of thigh
Willebrand factor. Differential diagnosis is and displacement of muscle bellies by fat
skeletal neoplasia. radiopacity; rarely see femoral osteolysis or
new bone formation.
7. Femoral fractures.
3 . 1 0 FEM U R a. Diaphysis - commonf often comminuted.
Views b. Proximal femur (see 3.9.10).
c. Greater trochanter avulsion; uncommon as a
ML; CrCd.
solitary lesion and more often associated with
hip luxation.
Development d. Distal femur (see 3.11.13).
The ossification centre of the diaphysis is present at
birth. ProximallYf the femoral head appears at
3 . 1 1 STIFLE
2 weeks and the greater and lesser trochanters at
8 weeks, with fusion to the diaphysis at 6-11 Views
monthsf 6-10 months and 8-13 monthsf respec­
ML in various degrees of flexion; CrCd or CdCr;
tively. DistallYf the medial and lateral femoral con­
stressed views; flexed CrPr-CrDiO to skyline the
dyles appear at 3 weeks and fuse to the diaphysis
trochlear groove.
at 6-11 months.
1. Growth arrest lines - finef transversef sclerotic
Development
lines in the medullary cavity of larger dogs; no
clinical significance. Differential diagnosis is The patella ossification centre appears at 9 weeks
previous panosteitis. and the fabellae and popliteal sesamoid at 3 months.
2. Compensatory overgrowth of the femur -
increase in femoral length compared with the Ultrasonography
contralateral limb has been described in dogs in
which there is significant tibial shortening due The use of ultrasonography for stifle joint disease
to premature closure of tibial growth plates. The has been described (see Further reading).
mechanism is thought to be secondary to either 1. Popliteal sesamoid not mineralized - an
reduced physeal compression as a result of occasional findingf especially in small dogs.
decreased weight bearingf or alteration in blood 2. Fabella variants.
flow. a. Cats - the medial fabella is normally smaller
3. Panosteitis - the femur is a predilection site (see than the lateral fabella and may be absent
1.13.6 and Fig. 1.17). (also occasionally in toy dogs).
72 Handbook of Small Animal Radiology and U ltrasound

b. Non-ossification of the medial fabella - an (OCD) and has been reported once in a
occasional finding. domestic short-haired cat; may be bilateral; less
c. Bipartite or multipartite fabellae - two or common than thoracic limb OC (OCD).
more smoothf rounded fragments; a. Lateral femoral condyle (medial aspect)
differential diagnosis is old fabella fracture most common.
(no change over time if a developmental b. Medial femoral condyle.
variant). c. Lateral trochlear ridge - rare; differential
d. Distal displacement of one (usually medial) diagnosis is normal rough appearance of
fabella, particularly in West Highland White immature bone until about 4 months of age.
and other small Terrier breeds.
3. Patella variants. Radiographic signs of stifle OC (OCD) are
a. Congenital patella aplasia - reported in cats. similar to those of shoulder OC (OCD) and
b. Cats - normal taperingf pointed distal pole include stifle joint effusion (see 2.2.1 and
of patellaf not to be confused with new bone. Fig. 2.1), roughening or flattening of
c. Bipartite or multipartite patella - two or subchondral bone and underlying
more smoothf rounded fragments probably radiolucencYf overlying mineralized cartilage
with some distraction; differential diagnosis flapf joint mice in various locations including
is old patella fracture (no soft tissue swelling the supratrochlear pouchf and minor
or change with time if developmental). osteoarthrosis.
d. Patella alta - in some largef straight-legged 5. Medial patellar luxation.
dogsf the patella may lie very high or even a. Congenital or developmental (Fig. 3.27) ­
proximal to the trochlear groove; also usually toy dog breeds; in catsf it is unusual
associated with medial patellar luxation. and may be incidentat although there is a
e. Patella baja - opposite to abovef and genetic predisposition in the Devon Rex and
associated with lateral patellar luxation in Abyssinian. Much more common than later
similar breeds. patellar luxation; may be unilateral or
4. Osteochondrosis (OC or OCD) of the distal bilateral. Usually secondary to underlying
femur (Fig. 3.26) - similar breed, age and sex developmental malalignment of the
predisposition as other manifestations of QCD quadriceps mechanismf with decreased

Figure 3.26 Stifle osteochondritis dissecans affecting the
medial femoral condyle: (A) mediolateral and (8) Figure 3.27 Congenital or developmental medial patellar
craniocaudal views (right stifle). A subchondral erosion with luxation (craniocaudal view of the right stifle). The patella is
adjacent sclerosis is seen on the medial femoral condyle, and displaced medially and rotated about its long axis; the distal
a free mineralized body is present in the joint space. A joint fem u r and proximal tibia are bowed and the femorotibial
effusion would also be present. joint space lies obliquely.
Chapter 3 Appendicular skeleton 73

femoral head and neck anteversion and coxa
varaf leading to outward rotation of the stifle
(genu varum or bow-legged conformation).
Diagnosis is based on palpationf with four
grades of severity recognized. Radiographs
may be useful to show the degree of limb
deformity and secondary osteoarthrosis and
may be normal in mild casesf although it is
not clear which bony deformities are the
cause and which the effect of patellar
luxation. Radiographic signs include medial
displacement of the patella (although this
may reduce on positioning for a CrCd view)f
lateral bowing and external rotation of the Figure 3.28 Premature closure of the proximal tibial growth
distal third of the femurf mediolateral tilting plate (tibial plateau deformans): the proximal tibial articular
of the femorotibial jointf medial displacement su rface slopes caudodistally and the fibula is bowed.
and remodelling of the tibial tuberositYf
medial bowing of the proximal tibia and
internal rotation of the tibial tuberosityf conformation; affected dogs usually present
shallow trochlear groove with hypoplastic due to secondary rupture of the cranial
medial ridge and hypoplastic medial femoral cruciate ligament. Radiographic signs include
condyle (seen on a CrPr-CrDiO view) and remodelling of the tibial plateauf a caudodistal
secondary osteoarthrosis. slope to the femorotibial joint spacef caudal
b. Acquired - usually due to trauma and soft bowing of the fibulaf secondary joint effusion
tissue damage; patella displaced (may and osteoarthrosis due to cruciate ligament
reduce during positioning for radiographY)f damage.
but bones otherwise of normal appearance. 9. Cats - hypervitaminosis A; the stifle may be a
6. Lateral patellar luxation - much less common; predilection site after the spine and elbow;
usually larger breeds of dog. differential diagnosis is synovial
a. Due to trauma causing reduction in growth osteochondromatosis (see 3.11.18).
of the lateral aspect of the distal femur or 10. Idiopathic effusive arthritis or juvenile
proximal tibia. gonitis - especially the Boxer and Rottweilerf
b. Secondary to hip deformity (increased 1-3 years old; may be bilateral; idiopathic
anteversion and coxa valga) leading to arthropathy may lead to rupture of the cranial
inward rotation of the stifle (genu valgum or cruciate ligament (see 3.11.14).
knock-kneed conformation). Radiographic 11. Synovial sarcoma (occasionally other soft
signs are the opposite of those seen with tissue tumours) - the stifle is a predilection site
medial patellar luxation. (see 2.4.7 and Fig. 2.4); mainly larger breeds of
7. Premature closure of the distal femoral growth dog. Differential diagnosis is severe
plate - usually the lateral aspectf leading to osteoarthrosisf in which superimposition of
genu valgum and lateral patellar luxation; may new bone may mimic osteolysis; septic
be associated with hip dysplasia. arthritis. The most significant radiographic
8. Premature closure of the proximal tibial sign may be displacement of the patella by a
growth plate (tibial plateau deformans) soft tissue mass.
(Fig. 3.28) - usually young adult dogs; various 12. Parosteal osteosarcoma (Fig. 3.29; see also
breeds including the Rough Collie and West 1.15.2) - rare: radiographically and
Highland White Terrier; thought to be due to pathologically distinct from other
Salter-Harris type I or V injury to the growth osteosarcomata. Slow-growingf smooth or
plate. In severe casesf leads to inability to lobulatedf non-aggressive bony mass arising
extend the stifle (resulting in a crouching from the periosteum or parosteal connective
pelvic limb stance) ± bow-legged tissue with little or no underlying osteolysis;
74 Handbook of Small Animal Radiology and U ltrasound

bilateral; QC of the growth plate was
fOillld in one litter.
Radiographic signs include proximal
displacement or rotation of the tibial tuberosity
± multiple small mineralized fragmentsf soft
tissue swelling. Differential diagnosis is normal
wide growth plate (compare with the opposite
leg illlless there are bilateral clinical signs).
c. Proximal tibial growth plate fractures -
Salter-Harris type I or 11; the tibial
tuberosity may remain attached or may
separatef and the tibial shaft is usually
displaced cranially; may heal as a malilllion
Figure 3.29 Parosteal osteosarcoma: a large, dense mass of (see 3.11.8). Terrier breeds appear to be
u nstructured bone lies caudal to the distal femur. Apparent predisposed to combined tibial crest
absence of underlying osteolysis misleadingly suggests that avulsion and Salter-Harris type 11 fracture
this could be a benign lesion.
of the proximal tibial epiphysisf the
metaphyseal fragment being caudolateral or
seen especially around the stifle on the caudal
caudomedial.
aspect of the distal femur.
d. Fractured patella - due to a direct blow but
13. Fractures involving the stifle joint.
may be spontaneous and bilateral in cats with
a. Distal femoral supracondylar fractures -
preceding patellar sclerosis; if transversef the
Salter-Harris type I or 11 fractures of the
fragments will distract. With a chronic lesion
distal femoral growth plate in skeletally
with fragment remodellingf the differential
immature animals; the femoral condyles
diagnosis is bipartite or multipartite patella.
usually rotate caudally; may heal as a
e. Fractured fabellae - spontaneous fracture of
malunion.
the lateral fabella is reported in dogsf
b. Avulsion of the tibial tuberosity (Fig. 3.30) -
especially in the Labradorf Golden Retriever
Salter-Harris type I fracture of the tibial
and Border Collie. With a chronic lesion
tuberosity growth plate.
with fragment remodellingf the differential
- Extrinsic; due to external trauma.
diagnosis is bipartite or multipartite fabella.
- Intrinsic; with no or minor trauma;
14. Cruciate ligament disease.
especially the Greyhound and English or
a. Strained or ruptured cranial cruciate
Staffordshire Bull Terrierf may be
ligament - acute tramna or chronic strainf
especially in large dogs with upright pelvic
limb conformation; often bilateral.
Radiographic signs include joint effusionf
secondary osteoarthrosis (see 2.5.2f 3.11.17
a and Figs 2.1 and 2.6), joint mice and
dystrophic mineralization in the region of the
ligamentf remodelling of the tibial plateau at
the site of attaclunent of the ligamentf and
cranial displacement of the tibia on the femur
in severe cases. Tibial compression
radiography has been described as being a
highly sensitive test - with the stifle flexed at
90°f the hock is maximally flexedf causing
o ® cranial displacement of the tibia and distal
Figure 3.30 Avulsion of the tibial tu berosity: (A) normal displacement of the popliteal sesamoid in
u nfused tibial tuberosity, (8) separation and proximal cases of cranial cruciate ligament damage.
displacement. Tibial plateau angle (TPA) can be measured
Chapter 3 Appendicular skeleton 75

®

o
Figure 3.32 Avulsion of the tendon of origin of the long
digital extensor muscle from its origin in the extensor fossa;
a m ineralized fragment is seen in the craniolateral aspect of
the femorotibial joint space: (A) mediolateral view and
(8) craniocaudal view (right stifle).

injury is uncommon. Radiographic signs
Figure 3.31 Measurement of tibial plateau angle (TPA). The
vertical line 'A' is drawn through the centre of the tibial
include joint effusionf caudal displacement
intercondylar eminences and the centre of the talus; it of the tibiaf mineralized fragment(s) in the
represents the functional axis of the tibia. The tibial plateau caudal part of the femoral intercondylar
line '8' joins the cranial and caudal margins of the medial fossa or caudal to the tibial plateau and
tibial plateau. The TPA (c:D) is the angle between a line secondary osteoarthrosis.
perpendicular to line A, and line 8, at their intersection. 15. Tendon avulsions.
a. Avulsion of the origin of the long digital
(Fig. 3.31); the literature is inconsistent as to extensor muscle (Fig. 3.32) - usually
whether dogs with cruciate disease have skeletally immature dogs of larger breeds;
steeper anglesf but measurement of TPA is may be no known tramna. Radiographic
used for planning tibial plateau levelling signs include a mineralized fragment
osteotomy (TPLO)f which creates a more adjacent or near to the extensor fossa of the
horizontal tibial plateauf thus reducing stress distal femurf in the centre of the joint on the
on the cranial cruciate ligament. ML radiograph but shown to be lateral on
b. Avulsion of the insertion of the cranial the CrCd view; also a radiolucent bone
cruciate ligament on to the tibial plateau - defect in the extensor fossa; in some dogsf
dogs < 2 years oldf in which the ligament is the defect is confined to soft tissue and there
stronger than the bone. Radiographic signs are no radiographic changes.
include joint effusion and a small b. Avulsion of one or both heads of the
mineralized fragment in the centre of the gastromemius muscle (Fig. 3.33) - less
joint. Differential diagnoses are QC (QCD), common than distal injury to the Achilles
secondary osteoarthrosis. tendon; may be bilateral; may be no known
c. Partial avulsion of the origin of the cranial trauma; results in a plantigrade stance and
crucia te ligament - rare; small mineralized hock hyperflexion if both the medial and
fragment in the intercondylar region of the lateral heads are affected. Radiographic signs
distal femur and swelling of intracapsular include distal displacement of the associated
soft tissues caudal to the patellar fat pad. fabella accentuated by hock flexion or in
d. Avulsion of the origin or insertion of the some cases only detected on hock flexion; in
caudal cruciate ligament - often associated chronic casesf new bone on the distal femoral
with multiple stifle injuriesf and isolated supracondylar tuberosities where the
76 H a n d book o f S m a l l An i m a l Rad i o l ogy a n d U l traso u n d

cranial cruciate ligament disease but also
associated with OC (OCD), patellar luxation,
trauma, etc. Radiographic signs include joint
effusion that effaces the infrapatellar fat pad
and displaces fascial planes caudal to the
femorotibial joint, periarticular new bone at
various sites (both poles of the patella, along
the trochlear ridges of the distal femur, on the
femoral epicondyles, at the extensor fossa of
the lateral femoral condyle, around the fabellae
and popliteal sesamoid and around the
articular margins of the tibial plateau), intra­
articular mineralization or 'loose bodies',
o subchondral sclerosis, subchondral cysts in the
Fi g u re 3 . 3 3 Avu l s i o n of the m e d i a l head of g a strocn e m i u s intercondyloid fossa and femorotibial joint space
m u scle, resu l t i n g i n d i sta l d i splacement o f the m ed i a l fa be l l a : narrowing on weight-bearing radiographs (see
(A) m e d i o l atera l view a n d (B) c ra n i o ca u d a l view (rig ht stifl e) . 2.2.1 and 2.5.2 and Figs 2.1 and 2.6).
18. Synovial osteochondromatosis or synovial
chondrometaplasia - an uncommon condition;
tendons arise, new bone around the
the stifle is a predilection site, especially in cats
associated fabella and dystrophic
and larger dogs (see 2.8.18 and Fig. 2.7).
mineralization in surrounding soft tissues.
Differential diagnosis in cats is,
c. Avulsion of the origin of the popliteal
hypervitaminosis A.
muscle - due to trauma, and may be
19. Meniscal calcification or ossification ­
associated with rupture of the cranial
uncommon, dogs or cats; idiopathic or
cruciate ligament; the CrCd radiograph may
secondary to trauma (often associated with
show an avulsed bone fragment and
ruptured cranial cruciate ligament); mineralized
radiolucent bone defect on the lateral aspect
body of variable size in the cranial horn of the
of the lateral femoral condyle, with distal
medial (commoner) or lateral meniscus.
displacement of the popliteal sesamoid.
20. Calcifying tendinopathy.
Differential diagnosis is rupture of popliteal
tendon itself or during tibial compression a. Quadriceps.
radiography in cases of damaged cranial b . Gastrocnemius.
cruciate ligament. 2 1 . Mineralized bodies in or near the stifle joint
16. Other stifle ligamentous and soft tissue trauma. (see 2.8).
a. Collateral ligament rupture - medial or a. Normal sesamoids.
lateral stressed CrCd radiographs needed. b. Fragmented sesamoids.
b . Avulsion or rupture of the patellar ligament ­ c. Osteochondrosis (OCD) .
proximal displacement of the patella d. Cruciate ligament damage.
exacerbated by stifle flexion, soft tissue - Dystrophic mineralization of damaged
swelling cranial to the infrapatellar fat pad. tendon.
Tendon changes may also be visible using - Avulsion fragments.
ultrasonography.
e. Osteoarthrosis - fractured osteophytes or
c. Luxation of the stifle - rupture of cruciate
enthesiophytes.
and collateral ligaments; more common in
f. Fracture fragments.
cats; the tibia is usually displaced cranially.
g. Avulsion of the long digital extensor,
d. Quadriceps contracture - due to trauma or
gastrocnemius or popliteal muscles.
myositis and leads to stifle hyperextension
h. Meniscal calcification or ossification.
and proximal displacement of the patella.
i. Synovial osteochondromatosis.
1 7. Stifle osteoarthrosis - a very common
j. Pseudogout.
degenerative condition, especially in larger
dogs; often bilateral; usually secondary to k. Cats - hypervitaminosis A.
Chapter 3 Appendicular skeleton 77

3 . 1 2 TIBIA AND FIBULA although less commonly affected than the
humerus and radius.
Views 8. Tibial and fibular fractures.
ML; CrCd. a. Proximal tibia (see 3.11.13).
b. Diaphyseal - in the tibia may spiral or
Development create incomplete fissure fractures.
The ossification centres of both diaphyses are pres­ c. Oistal tibia (see 3.13.7).
ent at birth. ProximallYf the medial and lateral tib­
ial condyles appear at 3 weeks and the tibial 3 . 1 3 TARSUS (HOCK)
tuberosity at 8 weeks; the condyles fuse together
at 6 weeksf the tuberosity to the condyles at 6- Views
8 months and the tuberosity and condyles to the ML; flexed ML; OPI; flexed OPI to skyline troch­
diaphysis at 6-12 months. The proximal fibular lear ridges; dorsolateral-plantaromedial oblique;
epiphysis appears at 9 weeks and fuses to the dorsomedial-plantarolateral oblique; stressed and
diaphysis at 6-12 months. Oistally, the tibial epi­ weight-bearing views. Like the carpusf the tarsus
physis appears at 3 weeks and the medial malleo­ is a complex joint and bone specimens or compara­
lus at 5 monthsf with fusion at 5-11 months; the ble views of the normal limb may be helpful in
fibular epiphysis appears at 2-7 weeks and fuses interpretation.
at 5-12 months.
1. Qsteochondrodysplasias - various types of
Development
hereditary dwarfism in dogs and cats (see
1.22.7). The distal tibia is the second The ossification centres of the talus and calcaneus
commonest site for lesions after the distal are present at birth or appear within the first week
radius and ulnaf although often the pelvic of life; the remaining tarsal bones appear at 2--4
limbs are less severely affected than the weeks; the tuber calcis appears at 6 weeks and fuses
thoracic limbs. to the calcaneus between 11 weeks and 8 months.
2. Pes varus - medial bowing of the distal tibiaf
resulting in deviation of the tarsus and Ultrasonography
phalanges towards the midline (varus
deformity); unilateral or bilateral; thought to The use of ultrasonography for disease of the com­
be genetic in the Dachshund but may also be mon calcaneal (Achilles) tendon has been
due to trauma. described (see Further reading).
3. Metaphyseal osteopathy (hypertrophic 1. Osteochondrosis (OCO) of the tibiotarsal joint ­
osteodystrophy) - lesions may be seen in the similar breed and age predisposition as other
proximal and distal tibial metaphysesf although manifestations of QC but apparently no sex
less severe than in the distal radius and ulna predisposition; Rottweilerf Labradorf English
(see 1 .24.4 and Fig. 1.31). and Staffordshire Bull Terriers over­
4. Panosteitis - the tibia may be affected (see represented; may be bilateral; less common
1.13.6 and Fig. 1.17). than thoracic limb QC.
5. Rickets Guvenile osteomalacia) - the distal tibial a. Medial trochlear ridge of talus (tibial tarsal
growth plate is the second most severely bone) (Fig. 3.34), usually the proximal or
affected site after the distal radius and ulna plantar aspect - by far the commonest site.
(see 1 .23.8 and Fig. 1.30). Radiographic signs include joint effusion and
6. Hypertrophic (pulmonary) osteopathy (Marie's periarticular soft tissue swellingf flattening and
disease) - the tibia ± fibula may be affected by fragmentation of the ridge with widening of
palisading periosteal new bonef although the tibiotarsal joint space mediallYf joint mice and
distal portion of the limb is likely to be affected marked secondary osteoarthrosis; variably
first (see 1.14.6 and Fig. 1.18). visible on the OP!, extended and flexed ML
7. Primary malignant bone tmnours (most views (may be better seen on ML views if the
commonly osteosarcoma) - the proximal and plantar aspect of the ridge is affected; the
distal tibial metaphyses are predilection sitesf medial ridge is the smaller of the two).
78 Handbook of Small Animal Radiology and U ltrasound

4. Rheumatoid arthritis - the carpus and tarsus
are predilection sites; often bilateral (see 2.4.8
and Fig. 2.5).
5. Cats - various feline polyarthritides; the carpus
and tarsus are predilection sites.
6. Chinese Shar Pei fever syndromef also known
as familial renal amyloidosis of Chinese Shar
Pei dogs - usually young dogs; unknown
aetiology; fever often accompanied by acute
synovitis of tarsal (less commonly carpal)
joints; some dogs develop renal amyloidosis.
7. Tarsal fractures.
a. Distal tibia - Salter-Harris type I fractures of
the distal tibial growth plate.
b. Medial or lateral malleolar fractures of the
distal tibia and fibula - often with
subluxation of the tibiotarsal joint space;
stressed views may be required to
demonstrate subluxation.
c. Central tarsal bone fractures (Fig. 3.35) -
® especially racing Greyhoundsf mainly right
tarsus due to medial joint compression as
running anticlockwise. May coexist with
other tarsal fractures. Five types are
Figure 3.34 Osteochondritis dissecans of the medial described:
trochlear ridge of the talus: (A) mediolateral (ML) and (B) - type 1 - non-displaced dorsal slab
dorsoplantar (DPi) view (right hock). The ML view shows fracture; best seen on a ML view
flattening of one of the bony ridges; the DPI view identifies - type 2 - displaced dorsal slab fracture
this as the medial ridge and shows subchondral radiolucency - type 3 - sagittal fracture; rare; best seen
and overlying fragmentation with widening of the joint space. on a DPI view
- type 4 - combined dorsal plane and
b. Lateral trochlear ridge of talusf usually the sagittal fractures; the most common type
dorsal aspect - uncommon and harder to - type 5 - severe comminution and
diagnose; Rottweiler and Golden Retriever displacement.
predisposed. Oblique views and flexed DPI
are helpful viewsf as this lesion is frequently
missed on ML and DPI views. Differential
diagnosis is avulsion of the fibular talar
ligament.
c. Fragmentation of the medial malleolus of
the tibia - uncommon; possibly part of the
OC complex and may be associated with
medial trochlear ridge OC; Rottweiler
predisposed.
2. Premature closure of the distal tibial growth

orJ
plate - Rough Collie predisposed; usually the
lateral aspect of the growth plate is more
severely affectedf leading to tarsal valgus (cow
hocked conformation).
3. Cats - osteodystrophy of the Scottish Fold cat;
the tarsi and hind paws are most severely Figure 3.35 Classification of central tarsal bone fractures:
affected (see 3.7.8). cross-section of the right central tarsal bone.
Chapter 3 Appendicular skeleton 79

d. Fibular tarsal bone (calcaneal) fractures ­ c. Central tarsal bone luxation has been
especially racing Greyhoillldsf right tarsus; reported; fracture of the plantar process of
often seen with central tarsal bone fractures or the bone may also be present; Border Collies
with proximal intertarsal joint subluxation; possibly predisposed.
various locations of fracturef both simple and d. Dorsal tarsal instability due to rupture of the
comminuted. Fractures through the tuber dorsal tarsal ligaments has been described
calcis may be distracted by the Achilles as a racing injury in Greyhounds.
tendon. 9. Lesions of the Achilles or common calcaneal
e. Other tarsal bone fracturesf for example of tendon (common tendon of gastromemius and
tibial tarsal bone (talus) or tarsal bone 4; rare superficial digital flexorf with minor
except in racing Greyhoundsf although contributions from semitendinosusf gracilis and
cats may be predisposed to talar neck biceps femoris) (Fig. 3.37) - strain, rupture or
fractures. avulsion of one or more components at or near
f. Lateral talar ridge avulsion fractures at the the insertion on to the tuber calcis; maturef large­
insertion of the fibulotalar ligament. breed dogsf often overweightf may be bilateral.
S. Tarsal luxations and subluxations. Radiographic signs include soft tissue swelling
a. Tibiotarsal joint luxation - often with aroillld the tendon and tuber calcisf a cap of
fracture of the medial or lateral malleolus of proliferative new bone on the tuber calcisf
the tibia; stressed views may be needed (see avulsed fragments of bone and dystrophic
2.3.19 and Fig. 2.2). mineralization in the tendon. Ultrasonography of
b. Intertarsal and tarsometatarsal joint the tendon may be helpful in showing fibre
subluxation (Fig. 3.36) - traumatic; also arise disruption and areas of mineralizationf which
insidiously in the Rough Collie, Shetland produce bright echoes with acoustic shadowing
Sheepdog and Border Collie and may be (see 12.7.4 and Fig. 12.6).
bilateral in these dogs; may also be associated 10. Lateral luxation of the superficial digital flexor
with rhemnatoid arthritis (see 2.4.S and tendon - lateral displacement of the tendon
Fig. 2.5) or systemic lupus erythematosus. from the tip of the tuber calcis due to tearing of
Radiographic signs are best seen on a ML its medial attachmentf predisposed to by
view and include soft tissue swellingf flattening of the bone at this sitef as seen on the
subluxation (stressed views may exacerbate)f DPI view. Radiographs usually show soft
new bone especially on the plantar aspect of tissue swelling only and no bony changes.
the tarsusf enthesiophyte formation and 11. Tarsal osteoarthrosis - usually secondary to
dystrophic soft tissue mineralization. QC (QCD) or other underlying disease;

Figure 3.37 Chronic strain of the Achilles tendon: thickening
Figure 3.36 Chronic intertarsal subluxation with plantar of the tendon, dystrophic mineralization and calcaneal new
new bone and soft tissue m ineralization. bone.
80 Handbook of Small Animal Radiology and U ltrasound

radiographic changes may be milder than the intervening joint space similar to bone spavin
clinical signs suggest. Smooth spurs of new in horses are often an incidental finding in
bone on the dorsal aspect of the central and dogs but can sometimes be associated with
third tarsal bones and loss of clarity of the lameness.

Further reading
Techniques and normal anatomy fold osteochondrodysplasia. the canine shoulder. Vet. Radiol.
Kramer, M., Gerwing, M., Hach, V., Vet. Radiol. Ultrasound 45, Ultrasound 40, 372 379.
Schimke, E., 1997. Sonography of 582 585. McKee, M., Macias, C, 2004.
the musculoskeletal system in Rochat, M.C, 2005. Emerging causes Orthopaedic conditions of the
dogs and cats. Vet. Radiol. of canine lameness. Vet. Clin. shoulder in the dog. In Pract. 26,
Ultrasound 38, 139 149. North Am. Small Anim. Pract. 35, 118 129.
Meier, H.T., Biller, D.S., Lora 1233 1239. McKee, M., Macias, C, May, C,
Michiels, M., Hoskinson, J.J., 2001. Various authors, 1998. Scurrell, E.J., 2007. Ossification
Additional radiographic views of Osteochondrosis. Vet. Clin. North of the infraspinatus tendon
the thoracic limb in dogs. Am. Small Anim. Pract. 28 (1). bursa in 13 dogs. Vet. Rec. 161,
Compend. Contin. Educ. Pract. 846 852.
Veterinarian (Small Animal/ Scapula Muir, P., Johnson, K.A, 1994.
Exotics) 23, 818 824. Jerram, RM., Herron, M.R, 1998. Supraspinatus and biceps brachli
Meier, H.T., Biller, D.S., Lora Scapular fractures in dogs. tendinopathy in dogs. J. Small
Michiels, M., Hoskinson, J.J., 2001. Compend. Contin. Educ. Pract. Anim. Pract. 35, 239 243.
Additional radiographic views of Veterinarian (Small Animal) 20, Siems, J.L Breur, G.L Blevins, W.E.,
the pelvis and pelvic limb in dogs. 1254 1260. Cornelt K.K., 1998. Use of two
Compend. Contin. Educ. Pract. dimensional real time
Veterinarian (Small Animal/ Shoulder ultrasonography for diagnosing
Exotics) 23, 871 878. Anderson, A., Stead, A.C, contracture and strain of the
Muhumuza, L., Morgan, J.P., Coughlan, AR, 1993. Unusual infraspinatus muscle in a dog.
Miyabayashi, T., Atilola, AO., muscle and tendon disorders of J. Am. Anim. Hosp. Assoc. 212,
1988. Positive contrast the forelimb in the dog. J. Small 77 80.
arthrography a study of the Anim. Pract. 34, 313 318. Stobie, D., Wallace, L.L Lipowitz,
humeral joints in nonnal beagle Barthez, P.Y., Morgan, J.P., 1993. AL King, V., Lund, E.M., 1995.
dogs. Vet. Radiol. 29, 157 161. Bicipital tenosynovitis in the Chronic bicipital tenosynovitis in
Slocum, B., Devine, T.M., 1990. dog evaluation with positive dog" 29 cases (1985 1992).
Dorsal acetabular rim view for contrast arthrography. Vet. J. Am. Vet. Med. Assoc. 207,
evaluation of the canine hip. Radiol. Ultrasound 34, 325 330. 201 207.
J. Am. Anim. Hosp. Assoc. 26, Flo, G.L., :Middleton, D., 1990. van Bree, H., 1992. Vacuum
289 296. Mineralization of the phenomenon associated with
supraspinatus tendon in dogs. osteochondrosis of the
Congenital and developmental J. Am. Vet. Med. Assoc. 197, scapulohumeral joint in dogs: 100
diseases; d iseases of young animals 95 97. cases (1985 1991). j. Am. Vet.
Baines, E., 2006. Clinically significant Houlton, J.E.F., 1984. Med. Assoc. 201, 1916 1917.
developmental radiological Osteochondrosis of the shoulder Vandevelde, B., van Ryssen, B.,
changes in the skeletally and elbow joints in dogs. J. Small Saunders, J.H., Kramer, M., van
immature dog: 1. Long bones. Anim. Pract. 25, 399 413. Bree, H., 2006. Comparison of the
In Pract. 28, 188 199. Krieglieder, H., 1995. Mineralization ultrasonographic appearance of
Demko, L McLaughlin, R, 2005. of the supraspinatus tendon: osteochondrosis lesions in the
Developmental orthopedic clinical observations in 7 dogs. canine shoulder with
disease. Vet. Clin. North Am. Vet. Comp. Orthop. Traumatol. 8, radiography, arthrography and
Small Anim. Pract. 35, 1111 1135. 91 97. arthroscopy. Vet. Radiol.
Hubler, M., Volkert, M., Kaser Long, CD., Nyland, T.G., 1999. Ultrasound 47, 174 184.
Hotz, S., Arnold, S., 2004. Ultrasonographic evaluation of Wernham, B.G.L Jerram, RM.,
Palliative irradiation of Scottish Wannan, CG.A, 2008. Bicipital
Chapter 3 Appendicular skeleton 81

tenosynovitis in dogs. Compend. J. Am . Anim. Hosp. Assoc. 31, the abductor pollicis longus
Contin. Educ. Veterinarians 3D, 125 132. muscle in dogs. Vet. Comp.
537 552. Moores, A, 2006. Humeral condylar Orthop. Traumatol. 14, 95 100.
fractures and incomplete Guilliard, M.L 1998. Enthesiopathy
Elbow ossification of the humeral of the short radial collateral
Anderson, A., Stead, A.C, condyle in dogs. In Pract. 28, ligaments in racing greyhounds.
Coughlan, AR, 1993. Unusual 391 397. J. Small Anim. Pract. 39, 227 230.
muscle and tendon disorders of Murphy, S.T., Lewis, D.D., Johnson, K.A, 1987. Accessory carpal
the forelimb in the dog. J. Small Shiroma, J.T., Neuwirth, L.A, bone fractures in the racing
Anim. Pract. 34, 313 318. Parker, RB., Kubilis, PS., 1998. greyhound: classification and
Berry, CR, 1992. Radiology corner: Effect of radiographic positioning pathology. Vet. Surg. 16, 60 64.
Evaluation of the canine elbow for on interpretation of cubital joint U, A., Bennett, D., Gibbs, C,
fragmented medial coronoid congruity in dogs. Am. J. Vet. Res. Carmichaet N., Gibson, N.,
process. Vet. Radiol. Ultrasound 59, 1351 1357. Owen, M., et al., 2000. Radial
33, 273 276. Robins, G.M., 1980. Some aspects of carpal bone fractures in 15 dogs.
Houlton, J.E.F., 1984. the radiographical examination of J. Small Anim. Pract. 41, 74 79.
Osteochondrosis of the shoulder the canine elbow joint. J. Small Whitelock, R, 2001. Conditions of the
and elbow joints in dogs. J. Small Anim. Pract. 21, 417 428. carpus in the dog. In Pract. 23,
Anim. Pract. 25, 399 413. 2 13.
Kirberger, RM., Fourie, S., 1998. Radius and ulna
Elbow dysplasia in the dog: Clayton Jones, D.G., Vaughan, L.C, Metacarpus, metatarsus and
pathophysiology, diagnosis and 1970. Disturbance in the growth of phalanges
control. J S Afr. Vet. Assoc. 69, the radius in dogs. J. Small Anim. Cake, M.A, Read, RA, 1995. Canine
43 54. Pract. 11, 453 468. and human sesamoid disease: a
Lamb, CR, Wong, K., 2005. Ramadan, RO., Vaughan, L.C, 1978. review of conditions affecting the
Ultrasonographic anatomy of the Premature closure of the distal palmar metacarpal/metatarsal
canine elbow. Vet. Radiol. ulnar growth plate in dogs a sesamoid bones. Vet. Comp.
Ultrasound 46, 319 325. review of 58 cases. J. Small Anim. Orthop. Traumatol. 8, 70 75.
Lowry, J.E., Carpenter, L.G., Park, R Pract. 19, 647 667. Gottfried, S.D., Popovitch, CA,
D., Steyn, P.F., Schwarz, PD., Rossi, F., Vignoli, M., Terragni, R, Goldschmidt, M.H., Schelling. c.,
1993. Radiographic anatomy and Pozzi, L., hnpallomeni, C, 2000. Metastatic digital carcinoma
technique for arthrography of the Magnani, M., 2003. Bilateral in the cat: a retrospective study of
cubital joint in clinically normal elbow malformation in a cat 36 cats (1992 1998). j. Am. Anim.
dogs. J. Am. Vet. Med. Assoc. 203, caused by radio ulnar synostosis. Hosp. Assoc. 36, 501 509.
72 77. Vet. Radiol. Ultrasound 44, Homer, B.L., Ackerman, N.,
Mason, T.A, Lavelle, RB., Skipper, 283 286. Woody, B.L Green, RW., 1992.
S.c., Wrigley, W.R., 1980. Trangerud, C, Sande, RD., Intraosseous epidermoid cysts in
Osteochondrosis of the elbow Rorvik, AM., Indrebo, A, the distal phalanx of two dogs.
joint in young dogs. J. Small Grondalen, L 2005. A new type of Vet. Radiol. Ultrasound 33,
Anim. Pract. 21, 641 656. radiographic bone remodeling in 133 137.
May, C, Bennett, D., 1988. Medial the distal radial and ulnar Muir, P., Norris, J.L., 1997.
epicondylar spur associated with metaphysis in 54 Newfoundland Metacarpal and metatarsal
lameness in dogs. J. Small Anim. dogs. Vet. Radiol. Ultrasound 46, fractures in dogs. J. Small Anim.
Pract. 29, 797 803. 108 113. Pract. 38, 344 348.
Milton, J.L., Montgomery, RD., 1987. Read, RA, Black, AP., Armstrong,
Congenital elbow dislocations. Carpus S.L MacPherson, G.C, Peek,. L
Vet. Clin. North Am. Small Anim. Anderson, A, Stead, A.C, 1992. Incidence and clinical
Pract. 17, 873 888. Coughlan, AR, 1993. Unusual significance of sesamoid disease
Miyabayashi, T., Takiguchi, M., muscle and tendon disorders of in Rottweilers. Vet. Rec. 130,
Schrader, S.C, Biller, D.S., 1995. the forelimb in the dog. J. Small 533 535.
Radiographic anatomy of the Anim. Pract. 34, 313 318. Towle, H.A., Blevins, W.E., Tuer,
medial coronoid process of dogs. Grundmann, S., Montavon, P.M., L.R, Breur, G.L 2007. Syndactyly
2001. Stenosing tenosynovitis of
82 Handbook of Small Animal Radiology and U ltrasound

in a litter of cats. J. Small Anim. Breur, G.L Blevins, W.E., 1997. dogs. J. Small Anim. Pract. 45,
Pract. 48, 292 296. Traumatic injury of the iliopsoas 602 608.
Voges, AK., Neuwirth, L., muscle in 3 dogs. J. Am. Vet. Med. Nunamaker, D.M., Biery, D.N.,
Thompson, J.P., Ackennan, N., Assoc. 210, 1631 1634. Newton, C.D., 1973. Femoral neck
1996. Radiographic changes Craig, L.E., 2001. Physeal dysplasia anteversion in the dog: its
associated with digitat with slipped capital femoral radiographic appearance. J. Am.
metacarpal and metatarsal epiphysis in 13 cats. Vet. Pathol. Vet. Radiol. Soc. 14, 45 48.
tumors, and pododennatitis in the 38, 92 97. Perez Aparicio, F.L Fjeld, T.O., 1993.
dog. Vet. Radiol. Ultrasound 37, Dueland, RT., Wagner, S.D., Femoral neck fractures and
327 335. Parker, RB., 1990. von Willebrand capital epiphyseal separations in
heterotopic osteochondrofibrosis cats. J. Small Anim. Pract. 34,
Pelvis in Dobennan Pinschers: five cases 445 449.
Brumitt, J.W., Essman, S.c., (1980 1987). j. Am. Vet. Med. Queen, L Bennett, D., Cannichaet S.,
Komegay, J.N., Graham, J.P., Assoc. 197, 383 388. Gibson, N., Li, N., Payne
Weber, W.L Berry, C.R, 2006. Fluckiger, M.A., Freidrich, G.A, Johnson, c.E., et al., 1998.
Radiographic features of golden Binder, H., 1999. A radiographic Femoral neck metaphyseal
retriever muscular dystrophy. stress technique for evaluation of osteopathy in the cat. Vet. Rec.
Vet. Radiol. Ultrasound 47, of coxofemoral joint laxity in 142, 159 162.
574 580. dogs. Vet. Surg. 28, 1 9. Slocum, B., Devine, T.M., 1990.
Crawford, J.T., Manley, P.A, Gibbs, c., 1997. The BVA/KC scoring Dorsal acetabular rim
Adams, W.M., 2003. Comparison scheme for control of hip radiographic view for evaluation
of computed tomography, dysplasia: interpretation of of the canine hip. J. Am Anim.
.

tangential view radiography, and criteria. Vet. Rec. 141, 275 284. Hosp. Assoc. 26, 289 296.
conventional radiography in Hauptman, L Prieur, W.D., Smith, G.K., Biery, D.N., Gregor, T.P.,
evaluation of canine pelvic Butler, H.C., Guffy, M.M., 1979. 1990. New concepts of
trauma. Vet. Radiol. Ultrasound The angle of inclination of the coxofemoral joint stability and the
44, 619 628. canine femoral head and neck. development of a clinical stress
Dennis, R, Penderis, L 2002. Vet. Surg. 8, 74 77. radiographic method for
Radiology corner Anal sac gas. Johnson, A.L., 1985. Osteochondrosis quantitating hip joint laxity in the
Vet. Radiol. Ultrasound 43, dissecans of the femoral head of a dog. J. Am. Vet. Med. Assoc. 196,
552 553. Pekinese. J. Am. Vet. Med. Assoc. 59 70.
Knaus, I., Briet, S., Kunzet W., 2003. 187, 623 625.
Appearance of the sacroiliac Keller, G.G., Reed, AL., Lattimer, J.c., Slifle
joint in ventrodorsal radiographs Codey, E.A, 1999. Hip dysplasia: de Rooster, H., van Bree, H., 1999.
of the nonnal canine pelvis. a feline population study. Vet. Popliteal sesamoid displacement
Vet. Radiol. Ultrasound 44, Radiol. Ultrasound 40, 460 464. associated with cruciate rupture
148 154. McDonald, M., 1988. Osteochondritis in the dog. J. Small Anim. Pract.
Knaus, I., Briet, S., Kunzet W., dissecans of the femoral head: a 40, 316 318.
Mayrhofer, E., 2004. Appearance case report. J. Small Anim. Pract. de Rooster, H., van Bree, H., 1999.
and incidence of sacroiliac joint 29, 49 53. Use of compression stress
disease in ventrodorsal McNicholas, W.T., Wilkens, B.E., radiography for the detection of
radiographs of the canine pelvis. Blevins, W.E., Snyder, P.W., partial tears of the canine cranial
Vet. Radiol. Ultrasound 45, 1 9. McCabe, G.P., Applewhite, AA, cruciate ligament. J. Small Anim.
et al., 2002. Spontaneous femoral Pract. 40, 573 576.
Hip capital physeal fractures in adult de Rooster, H., Van Ryssen, B., van
Adams, W.M., Dueland, RT., cats: 26 cases (1996 2001). J. Am. Bree, H., 1998. Diagnosis of
Meinen, L O'Brien, RT., Anim. Hosp. Assoc. 221, cranial cruciate ligament injury in
Guiliano, E.K., Nordheim, E.K., 1731 1736. dogs by tibial compression
1998. Early detection of canine hip Moores, A.P., Owen, M.R, Fews, D., radiography. Vet. Rec. 142,
dysplasia: comparison of two Coe, RL Brown, P.L 366 368.
palpation and five radiographic Butterworth, S.L 2004. Slipped Ferguson, L 1997. Patellar luxation in
methods. J. Am Anim. Hosp.
. capital femoral epiphysis in the dog and cat. In Pract. 19,
Assoc. 34, 339 347. 174 184.
Chapter 3 Appendicular skeleton 83

Gnudi, G., Bertoni, G., 2001. Prior, J.E., 1994. Avulsion of the osteochondritis dissecans of the
Echographic examination of the lateral head of the gastrocnemius lateral ridge of the trochlea tali in
stifle joint affected by cranial muscle in a working dog. Vet. the dog. J. Small Anim. Pract. 31,
crudate ligament rupture in the Rec. 134, 382 383. 280 286.
dog. Vet. Radiol. Ultrasound 42, Read, RA, Robins, G.M., 1982. Dee, J.F., Dee, L Piermattei, D.L.,
266 270. Deformity of the proximal tibia in 1976. Classification, management
Kramer, M., Stenget H., dogs. Vet. Rec. 111, 295 298. and repair of central tarsal
Gerwin& M., Schimke, E., Reinke, L Mughannam, A, 1994. fractures in the racing greyhound.
Sheppard, C, 1999. Sonography Meniscal calcification and J. Am. Anim. Hosp. Assoc. 12,
of the canine stifle joint. ossification in six cats and two 398 405.
Vet. Radiol. Ultrasound 40, dogs. J. Am. Anim. Hosp. Assoc. Montgomery, RD., Hathcock, J.T.,
282 293. 30, 145 152. Milton, J.L., Fitch, RB., 1994.
Kramer, M., Gerwin& M., Michele, S., Robinson, A, 1999. Atraumatic Osteochondritis dissecans of the
Schimke, K, Kindler, S., 2001. bilateral avulsion of the origins of canine tarsal joint. Compend.
Ultrasonographic examination of the gastrocnemius muscle. Contin. Educ. Pract. Veterinarian
injuries to the Achilles tendon in J. Small Anim. Pract. 40, (Small Animal) 16, 835 845.
dogs and cats. J. Small Anim. 498 500. Mughannam, AL Reinke, L 1994.
Pract. 42, 531 535. Skelly, CM., McAllister, H., Avulsion of the gastrocnemius
Lamb, CR, Duvemois, A, 2005. Donnelly, W., 1997. Avulsion of tendon in three cats. J. Am . Anim.
Ultrasonographic anatomy of the the tibial tuberosity in a litter of Hosp. Assoc. 30, 550 556.
normal canine calcaneal tendon. greyhound puppies. J. Small Newelt S.M., Mahaffey, M.B.,
Vet. Radiol. Ultrasound 46, Anim. Pract. 38, 445 449. Aron, D.N., 1994. Fragmentation
326 330. Soderstrom, M.L Rochat, M.C, of the medial malleolus of dogs
L'Eplattenier, H., Montavon, P., 2002. Drost, W.T., 1998. Radiographic with and without tarsal
Patellar luxation in dogs and cats: diagnosis: Avulsion fracture of osteochondrosis. Vet. Radiol.
pathogenesis and diagnosis. the caudal cruciate ligament. Vet. Ultrasound 35, 5 9.
Compend. Contin. Educ. Pract. Radiol. Ultrasound 39, 536 538. Ost, P.C, Dee, J.F., Dee, L.G.,
Veterinarian (Small Animal) 24, Stork, CK., Petite, AF., Norrie, RA, Hohn, RB., 1987. Fractures of the
234 239. Polton, G.A, Rayward, RM., calcaneus in racing greyhounds.
Macpherson, G.C, Allan, G.S., 1993. 2009. Variation in position of the Vet. Surg. 16, 53 59.
Osteochondral lesion and medial tabella in West Highland Reinke, J.D., Mughannam, AL 1993.
cranial cruciate ligament white terriers and other dogs. Lateral luxation of the superficial
rupture in an immature dog J. Small Anim. Pract. 50, 236 240. digital flexor tendon in 12 dogs.
stifle. J. Small Anim. Pract. 34, Tanno, F., Weber, u., Lang, L J. Am. Anim. Hosp. Assoc. 29,
350 353. Simpson, D., 1996. Avulsion of the 303 309.
Montgomery, RD., Fitch, RB., popliteus muscle in a Malinois Reinke, J.D., Mughannam, AL
Hathcock, J.T., LaPrade, RF., dog. J. Small Anim. Pract. 37, Owens, J.M., 1993. Avulsion of the
Wilson, M.E., Garrett, P.D., 1995. 448 45l. gastrocnemius tendon in 11 dogs.
Radiographic imaging of the Williams, L Fitch, RB., Lemarie, RL J. Am. Anim. Hosp. Assoc. 29,
canine intercondylar fossa. 1997. Partial avulsion of the origin 410 418.
Vet. Radiol. Ultrasound 36, of the cranial cruciate ligament in Rivers, B.L Walter, P.A., Kramek, B.,
276 282. a four year old dog. Vet. Radiol. Wallace, L., 1997. Sonographic
Muir, P., Dueland, RT., 1994. Ultrasound 38, 380 383. findings in canine common
Avulsion of the origin of the calcaneal tendon injury. Vet.
medial head of the gastrocnemius Tarsus Comp. Orthop. Traumatol. 10,
muscle in a dog. Vet. Rec. 135, Carlisle, CH., Reynolds, K.M., 1990. 45 53.
359 360. Radiographic anatomy of the Sjostrom, L., Hakanson, N., 1994.
Park, RD., 1979. Radiographic tarsocrural joint of the dog. Traumatic injuries associated with
evaluation of the canine stifle J. Small Anim. Pract. 31, 273 279. the short lateral collateral
joint. Compend. Contin. Educ. Carlisle, CH., Robins, G.M., ligaments of the talocrural joint of
Pract. Veterinarian (Small Reynolds, K.M., 1990. the dog. J. Small Anim. Pract. 35,
Animal) I, 833 841. Radiographic signs of 163 168.
85

Chapter 4

Head and neck

4.1 6 Abnormalities of the temporomandibular
CHAPTER CONTENTS joint 94
4.1 Radiographic technique for the skull 86 Ear 95
4.2 Breed and conformational variations of
4.1 7 Abnormalities o f the external ear
the skull and pharynx 87 canal 95
Cranial cavity 88 4.1 8 Variations in the wall of the tympanic
4.3 Variations in shape of the cranial bulla 96
cavity 88 4.1 9 Increased radiopacity o f the tympanic

4.4 Variations in shape of the foramen bulla 96
magnum 88 4.20 Ultrasonography o f the tympanic

4.5 Variations in radiopacity of the cranium 88 bulla 97
4.6 Variations in thickness of the calvarial Nasal cavity 97
bones; calvarial masses 89 4.21 Variations i n shape of the nasal
4.7 Ultrasonography of the brain 90 cavity 97
Maxilla and premaxilla 90
4.22 Increased radiopacity of the nasal

4.8 Maxillary and premaxillary bony proliferation or
cavity 97
sclerosis 90 4.23 Decreased radiopacity of the nasal

4.9 Maxillary and premaxillary bony destruction
cavity 99
or rarefaction 91 Frontal sinuses 99
4.1 0 Mixed prol iferative-osteolytic maxillary 4.24 Variations in shape of the frontal
and premaxillary lesions 92 sinuses 1 00
Mandible 92
4.25 Increased radiopacity of the frontal

4.1 1 Mandibular bony proliferation or sclerosis 92 sinuses 1 00
4.1 2 Mandibular bony destruction or
4.26 Variations in thickness of the

rarefaction 92 frontal bones 1 00
4.1 3 Mandibular fracture 93 Teeth 1 01
4.1 4 Mixed prol iferative-osteolytic mandibular 4.27 Variations in the number of teeth 1 01
lesions 93 4.28 Variations in the shape o f teeth 1 02
4.29 Variations in structure or radiopacity
Temporomandibular joint 93 of the teeth 1 02
4.1 5 Temporomandibular joint not clearly seen 94 4.30 Periodontal radiolucency 1 02

© 2010 Els�yi�r Ltd.
86 Handbook of Small Animal Radiology and Ultrasound

ventral obliquef the skull is rotated about its
4.31 Displacement or abnormal location
long axis towards the DV positionf and for a
of teeth 1 02
left 30° ventral-right dorsal oblique or a right
Pharynx and larynx 1 03 30° ventral-left dorsal obliquef it is rotated
4.32 Variations in the pharynx 1 03 towards the VD position. Used to separate
4.33 Variations in the larynx 1 04 symmetrical head structures such as the jawsf
4.34 Ultrasonography of the larynx 1 04 dental arcadesf tympanic bullae and frontal
4.35 Changes in the hyoid apparatus 10 5 sinuses but requires two identically
positioned radiographsf one for each side. For
Soft tissues o f the head and neck 105
the teethf the mouth may be open to reduce
4.36 Thickening o f the soft tissues o f the head
superimposition.
and neck 1 05
4.37 Variations in radiopacity of the soft tissues
b. Sagittal oblique (left 20° rostral-right caudal
of the head and neck 1 05 oblique or a right 20° rostral-Ieft caudal
4.38 Contrast studies of the nasolacrimal duct
oblique)f in which the nose is tilted up from a
(dacryocystorhinography) 1 06 true lateral positionf each demonstrating the
4.39 Ultrasonography of the eye and orbit 1 06 dependent temporomandibular joint (TMJ)
4.40 Contrast studies of the salivary ducts
(Fig. 4.8).
and glands (sialography) 1 09 c. Rostrocaudal (RCd) closed mouth, to skyline the
4.41 Ultrasonography of the salivary glands 1 09 frontal sinuses or cranium or to demonstrate the
4.42 Ultrasonography of the thyroid and parathyroid nasal cavities end on. The animal lies in dorsal
glands 1 10 recumbency with the head flexedf and using a
4.43 Ultrasonography of the carotid artery vertical X-ray beamf the area of interest
and jugular vein 1 10 being profiled correctly using the light beam
4.44 Ultrasonography of lymph nodes of the diaphragm.
head and neck 1 10 d. Caudorostral (CdR) horizontal beam view for
4.45 Cervical oesophagus 111 frontal sinuses. The animal is in sternal
4.46 Nasal dermoid sinus cyst 111 recumbency with the head raised to profile the
frontal sinuses. This view may be used to
demonstrate fluid lines within the sinuses.
4.1 RADIOGRAPHIC TECHNIQUE FOR THE SKULL e. Rostro 30° ventral-dorsocaudal oblique with open
mouth and vertical head and X-ray beamf to
A basic radiographic examination of the head and
demonstrate the tympanic bullae (also known
neck should include laterolateral and dorsoventral
as Red open mouth; see Fig. 4.9).
(DV) and/or ventrodorsal (VD) views. The DV is
f. Special view for the feline tympanic bullae
usually easier to position than the VDf as facial
(Fig. 4.10).
landmarks can be seen. Great care should be taken
to achieve accurate positioningf and to facilitate g. Intraoral DV (occlusal) for the nasal cavity,
thisf general anaesthesia is usually required. maxilla and premaxilla. Requires non-screen
A high-definition film-screen system or digital film or a thinf flexible cassette.
algorithm should be usedf and a grid is not neces­ h. Open mouth VD (ventro 20° rostral-caudodorsal
sary. Positioning for views (c), (e) and (h) may be oblique) with open mouthf horizontal hard palate
achieved using soft ties or a perspex positioning and X-ray beam angled dorsocaudally
frame. for demonstration of the nasal cavity; an
Additional specialized views are used to high­ alternative to (g) but allowing more caudal
light specific areas of the head. structures such as the cribriform plate to be
included; especially useful in cats. Placing a
a. Lateral oblique viewf with rotation of the skull
sandbag under the neck may help in
about its long axis; for a left 30° dorsal-right
positioning (Fig. 4.12).
ventral oblique or a right 30° dorsal-left
Chapter 4 Head and neck 87

i. Intraoral VD (occlusal) for the mandible. Requires
non-screen film or a thinf flexible cassette.
j. Special views for teeth (see p. 01).
k. Lesion-oriented oblique view to skyline areas of
-

deformity such as swellings.

4.2 BREED AND CONFORMATIONAL
VARIATIONS OF THE SKULL AND PHARYNX
Breeds of dog can be divided into three groups:
1. dolichocephalic breeds, in which the nasal
cavity is longer than the cranium (e.g. Irish
Setter).
2. mesaticephalic breedsf in which the nasal cavity
and cranium are of approximately equal length
(e.g. Labrador).
3. brachycephalicf breeds in which the nasal cavity
length is greatly reduced (e.g. Bulldog).
There are marked conformational variations in the
skult particularly between different breeds of dog
but also to a lesser extent between different breeds
®
of cat (Fig. 4.1). Brachycephalic breeds have a short
maxillaf although the mandible may remain rela­
tively long. The nasal cavity is correspondingly
reduced in sizef and the teeth may be crowded
and displaced. The cranimn is more domedf and
the occipital protuberance and frontal sinuses are
less prominent than in the longer-nosed breeds.
The fontanelle and suture lines may remain open.
On eT or MRt many of these dogs are seen to have
ventriculomegalYf i.e. subclinical hydrocephalus.
Brachycephalic breeds of dog also show soft palate
©
thickeningf increased submandibular soft tissue Figure 4.1 Normal lateral skulls. (A) Dolichocephalic dog
mass and caudal displacement of the hyoid appa­ (AP, angular process of mandible; BM, body of mandible;
ratus. Skult facial and cranial indices have been C, cranium or calvariu m ; CP, condyloid or articular process
of mandible; E, ethmoturbinates; EOP, external occipital
described that express skull (facial or cranial)
protuberance; FS, frontal sinus; N, nasal cavity;
width as a percentage of length; brachycephalic
OC, occipital condyle; RM, ramus of mandible - its dorsal
dogs have higher indices than mesaticephalic and
part is the coronoid process; TB, tympanic bulla; TMJ,
dolichocephalic dogsf especially for the facial area.
temporomandibular joint; Z, zygomatic arch).
In catsf the cranium is relatively large and the
(B) Brachycephalic dog (C, domed cranium; FS, absent
tentorium osseum between the cerebral hemi­ or reduced frontal sinus; M, cu rved body of mandible;
spheres and cerebellum is prominent on the lateral N, reduced nasal cavity with crowding of teeth).
view. The tympanic bullae are large and contain (C) Cat (E, ethmoturbinates; T, tentorium osse u m ;
a characteristic inner bony shell that divides TB, large tympanic bulla with i n n e r bony shell).
the bulla into two portionsf ventromedial and
dorsolateral.
88 Handbook of Small Animal Radiology and U ltrasound

bones may have a more illliform radiopacity
CRAN IAl CAVITY than normat lacking the usual copper-beaten
appearancef and the fontanelle and suture lines
The cranial cavity is composed of the frontat pari­
are likely to remain open.
etat temporal and occipital bones; the cribriform
plate of the ethmoid bone; and the bones forming 3. Bony masses (see 4.6.3 and Fig. 4.3).
the base of the skull (the sphenoid and basioccipi­ 4. Trauma - usually flattening or concavity of the
tal bones). The roof of the cranial cavitYf formed calvarium seen on a lesion-oriented oblique
by the frontal and parietal bones and part of the view; fracture lines may be visible.
occipital bonef is known as the calvarium. 5. Thinning and caudal bulging of the occipital
bone is seen in Cavalier King Charles Spaniels
Views with caudal occipital malformation (Chiari
syndrome)f which is usually associated with
a. Laterolateral. syringohydromyeliaf diagnosed using MRI.
b. Dorsoventral or ventrodorsal. 6. Thickening and irregularity of the calvarium is
c. Lateral oblique. seen in idiopathic calvarial hyperostosis of
d. Rostrocaudal. Bullmastiffs (see 4.6.2).
e. Lesion-oriented oblique.
4.4 VARIATIONS I N SHAPE OF
Normal appearance T HE FORAMEN MAGN U M
The normal calvarium has slightly variable opacitYf 1. Abnormal dorsal extension (keyhole shape) seen in
giving a copper-beaten appearancef due to varia­ occipital dysplasias; usually toy and miniature
tions in its thickness as it conforms to cerebral sulci breeds of dog; may be associated with
and gyri. In smalt dome-headed breeds such as the hydrocephalus and/or atlantoaxial malformations.
Chihuahuaf the fontanelle and suture lines may Seen on a well-penetrated RCd view.
remain open throughout life.

4.5 VARIATIONS IN RADIOPACITY OF
4.3 VARIATIONS I N SHAPE O F THE THE CRANIU M
CRANIAL CAVITY
1. Decreased radiopacity of the cranium.
1. Breed-associated - brachycephalic breeds of dog a. Generalized.
and cat tend to have a domed calvarium; many - Hyperparathyroidism - most commonly
have ventriculomegaly (subclinical secondary to chronic renal disease but also
hydrocephalus). secondary to nutritional imbalance or
2. Congenital hydrocephalus (Fig. 4.2) - primary parathyroid disease (see 1.16.4
exaggeration of the domed shapef with thinning and 4.9.5 and Fig. 4.5).
of the bones of the calvarium. The calvarial b. Localized.
- Superimposed gas shadows in external ear
canals.
- Normal suture lines or vascular channels.
- Fracture lines.
- Neoplasia.
- Pnemnocephalus - usually ventricular.
2. Increased radiopacity of the cranium.
a. Localized.
- Trauma leading to periosteal new bone
formation; subperiosteal haematoma in the
nuchal crest areaf which then mineralizes.
Figure 4.2 Congenital hydrocephalus: domed cran ium with - Neoplasia - osteoma or multilobular
open fontanelle and suture lines. tumour of bone (MLTB - see 4.6.3 and
Chapter 4 Head and neck 89

Fig. 4.3; well-defined, dense bony masses); b. Hydrocephalus (congenital or arising at a
osteochondroma or multiple cartilaginous young age) - usually with a domed calvariumf
exostoses (in catsf often involve the skull; open suture lines and fontanelle and a
roundedf well-mineralized juxtacortical homogeneous fground glassf radiopacity. If
masses); osteosarcoma (often there are open suturesf it may be possible to
predominantly proliferative in the skull). examine the brain ultrasonographically (see
- Overlapping fracture fragments. 4.7). Acquired hydrocephalus is unlikely to
- Foreign body reaction. produce bony changes.
- Calcification of a meningioma or c. Erosion by an adjacent mass.
hyperostosis of overlying cranial bone 2. Increased thickness of the bones of the
(especially in cats). calvarium.
- Myelographic contrast in the ventricular a. Normal variant in some breeds (e.g. Pit Bull
system and subarachnoid space - Terrier).
characteristic pattern following brain sulci. b. Healed fracture.
b. Generalized. c. Craniomandibular osteopathy (may affect
- Increased radiopacity due to cranial bone parietat frontat occipital and temporal bones
thickening (see 4.6.2). as well as the mandible - see 4.11.1 and
- Craniomandibular osteopathy may cause Fig. 4.6).
calvarial thickening (see 4.11.1 and d. Hyperostosis (thickening and sclerosis) of
Fig. 4.6). the calvarium in young Bullmastiffs
- Osteopetrosis (see 1.13.15). approximately 6-9 months of age - usually
- Idiopathic calvarial hyperostosis of self-limiting and regresses at skeletal
Bullmastiffs (see 4.6.2). maturity; unknown aetiologYf although it has
3. Mixed or mottled radiopacity of the cranial some similarities to craniomandibular
bones - usually due to a mixture of bone osteopathy and human infantile cortical
production or soft tissue mineralization and hyperostosis. Affects mostly males but also
osteolysis. reported in females and there may be a
a. Neoplasia - primary bone and soft tissue familial component. Femoral periostitis was
hunours tend to have varying proportions of also described in one dog.
bone destruction and bone proliferation or soft e. Meningioma in cats - may cause localized
tissue mineralization. Examples are hyperostosis adjacent to the tumour; often
osteosarcomaf which tends to be predominantly best seen on a RCd view.
proliferative at this site but with some f. Acromegaly in cats.
destructionf and MLTB (osteochondrosarcoma)f g. Hypervitaminosis A in cats may give rise to
which is a dense mass with speckled occipital new bone (see 5.4.8).
mineralization and little osteolysis of underlying 3. Bony masses on the calvarium.
bonef most often involving the temporo­ a. Malignant neoplasiaf for example
occipital region (see 4.6.3 and Fig. 4.3). osteosarcomaf chondrosarcomaf MLTB (also
b. Osteomyelitis - especially following traumaf known as multilobular osteochondrosarcomaf
and may be associated with meningitis. chondroma rodens). Varying degrees of
- Bacterial. associated osteolysis. MLTB is an illlcornmon
- Fungal (e.g. cryptococcosis*) - canine tumour that arises ahnost exclusively
predominantly osteolytic. on the skult mainly on the calvariumf maxilla
and mandible. It is slow-growing and locally
4.6 VARIATIONS I N THICKNESS O F THE invasivef often recurring after excision.
CALVARIAL BONES; CALVARIAL MASSES Metastasis may occur. RadiographicallYf it
appears as a densef mineralized mass with a
1. Thinning of the bones of the calvarium. nodular or stippled pattern and a variable
a. Normal variant in smalt brachycephalic degree of underlying osteolysis (Fig. 4.3).
breeds of dogf possibly due to subclinical b. Benign neoplasia (e.g. osteoma) - rare in
hydrocephalus. small animals.
90 Handbook of Small Animal Radiology and U ltrasound

interpreting RI in animals tmder general anaesthe­
sia or with cardiovascular disease.
1. Increased size of the lateral ventricles.
a. Breed-associated; most brachycephalic breeds
of dog have larger lateral ventricles than non­
brachycephalic breeds.
b. Hydrocephalus.
- CongenitaL
- Acquired due to obstructive lesions such
as tumours causing increased production
Figure 4.3 Mu ltilobular tumour of bone (multilobular
of cerebrospinal fluid or preventing its
osteochondrosarcoma): a dense, mineralized mass with a
stippled, broccoli-like appearance arises from the calvarium. caudal flow.
2. Increased RI.
a. Hydrocephalus.
c. Osteochondroma (cartilaginous exostoses) - b. Intracranial mass lesions.
especially cats - (see 1.15.2). c. Intracranial bleeding.
d. Healing or healed trauma (e.g. fracturef
d. Brain oedema.
subperiosteal haematoma).
e. Inflammatory brain disease.
e. Severef localized osteomyelitis.
f. Raised systolic blood pressure.

4.7 U LTRASONOGRAPHY O F THE BRAIN
Ultrasonographic examination of the brain is possible MAXILLA A N D PREMAXILLA
if there is an open fontanellef and so can often be per­
formed in young dogs and sometimes in adults of Views
brachycephalic breeds. The brain itself appears
a. Laterolateral (right and left sides are
hypoechoic and loosely granular in texturef while
superimposed).
the interior of the cranial cavity is outlined by a
b. Lateral oblique.
well-defined echogenic line. It may be possible to
identify the lateral ventricles as small anechoic focif c. Intraoral DV.
usually bilaterally symmetrical in sizef shape and d. Intraoral DV with beam angled laterally for
position. MRI and CT arefhoweverf superior imaging maxillary teeth.
techniques for imaging of intracranial structures. e. Open mouth VD (ventro 10° rostral­
Blood flow in the basilar artery (located by col­ dorsocaudal oblique) (Fig. 4.12).
our Doppler) can be evaluated via the cisterna
magna. Flow in the ventrally located rostral or
middle cerebral arteries can also be measured if 4.8 MAXILLARY AND PREMAXI LLARY
there is an open fontanelle. Because absolute flows BONY PROLIFERATION OR SCLEROSIS
can be influenced by the angle between the inci­
1. Osteomyelitis - usually a mixture of bone
dent sound and the arteryf it is more usual to mea­
proliferation and destruction.
sure the resistive index (RI)f which is the ratio of
a. Secondary to dental disease.
the difference between peak systolic and end dia­
b. Secondary to chronic dacryocystitis and may
stolic velocities (Vs and Vdf respectively) and the
peak systolic velocity: be associated with cystic dilation of the
nasolacrimal duct; dacryocystorhinography is
V, - Vd indicated (see 4.38).
RI =
V,. c. BacteriaL
The normal RI in the basilar artery in dogs is d. Fungal.
0.56-0.75. RI correlates strongly with intracranial 2. Neoplasia - more often predominantly
pressuref hence increased RI reflects raised intra­ osteolytic (see below) but can be proliferative;
cranial pressure. Care should be taken in some are exclusively proliferativef for example
Chapter 4 Head and neck 91

MLTB (see 4.6.3 and Fig. 4.3). Nasal cavity a . Acanthomatous ameloblastoma
neoplasia may produce apparent increase in (acanthomatous epulisf basal cell carcinomaf
radiopacity of the maxilla on the lateral adamantinoma) - dogs only.
radiograph. b. Ameloblastoma.
3. Healing or healed maxillary or premaxillary c. Amyloid-producing odontogenic tumour.
fracture. d. Complex and compound odontoma -
include organized or disorganized dental
tissue (see 4.12.2. and Fig. 4.7).
4.9 MAXI LLARY AND PREMAXI LLARY e. Other rare odontogenic tumours.
BONY DESTRUCTION OR RAREFACTION 3. Dentigerous or non-eruption cyst - expansilef
radiolucent lesion containing tooth elements.
1. Malignant neoplasia - all types may show 4. Periodontal disease and dental abscessation -
some degree of bone proliferation but some are radiolucent halo of osteolysis around the
predominantly osteolytic. The osteolysis varies affeeled tooth root(s) (see 4.30.1 and 4.30.2 and
from localized and sharply marginated in Fig. 4.17).
appearance to diffuse; teeth in the area may be 5. Renal secondary hyperparathyroidism (rubber
displacedf eroded or lost. The histological jaw, osteodystrophia fibrosa) (Fig. 4.5) -
nature of the mass cannot be predicted from osteopenia secondary to chronic renal diseasef
the radiographs. especially renal dysplasia in young animals.
a. Squamous cell carcinoma (Fig. 4.4); The skull is affected primarilYf and bones
commonest oral tumour in cats. become osteopenic with a lace-like trabecular
b. Malignant melanoma; commonest oral pattern and prominence of the nasal turbinates
tumour in dogs. and soft tissue structures such as the soft
c. Fibrosarcoma. palate. Bone mineral loss is especially marked
d. Primary bone tumoursf primarily around the teethf with ill-defined haloes of
osteosarcoma. rarefaction giving the impression of floating
e. Other oral sarcomas (e.g. leiomyosarcoma). teeth. RarelYf primary or nutritional secondary
f. Nasal cavity neoplasia eroding the hyperparathyroidism in adult animals may
surrounding bony case. cause the same signs.
2. Non-malignantf odontogenic tumours - these 6. Nasolacrimal duct cysts - discrete
do not metastasize but are locally invasive and radiolucency with a finef sclerotic marginf
therefore often radiographically communicating with the nasolacrimal duct on
indistinguishable from malignant tumours. dacryocystorhinography (see 4.38).

Figure 4.4 Squamous cell carcinoma of the premaxilla: Figure 4.5 Renal secondary hyperparathyroidism:
mainly osteolytic with displacement, loss and erosion rarefaction of bone produces ill-defined radiolucent haloes
of teeth. around the teeth, giving the impression of floating teeth.
92 Handbook of Small Animal Radiology and U ltrasound

7. Maxillary cholesterol granuloma - identical 4.1 1 MAN D I B U LAR BONY PROLIFERATION
in appearance to nasolacrimal duct cyst OR SCLEROSIS
but no communication with the nasolacrimal
duct. 1. Craniomandibular osteopathy (Fig. 4.6) -
S. Maxillary bone epithelial cyst - discrete florid periosteal new bone that remodels with
osteolytic lesionf seen mainly in young dogs time; immature dogsf primarily small breeds
and not communicating with the nasolacrimal such as the West Highland White Terrierf
duct. Cairn Terrier and Scottish Terrier but
9. Maxillary giant cell granuloma - discrete occasionally large breeds; usually involves the
osteolytic lesionf seen mainly in young dogs mandible and/ or the tympanic bullae but also
and not communicating with the nasolacrimal sometimes the calvarium and frontal bones. The
duct. new bone is mainly palisading in appearance (see
10. Fractures - check involvement of teethf 1.6.1)f and osteolysis is absent. Clinical signs often
especially permanent tooth germs in young wax and wanef with bouts of pyrexia as well as
animals. swelling of the affected mandible(s); difficulty
eating if the new bone encroaches on the ThIJs.
2. Osteomyelitis - usually a mixture of bone
4.1 0 M IXED PROLIFERATIVE-OSTEOLYTIC proliferation and destruction.
MAXILLARY AND PREMAXILLARY LESIONS a. Secondary to dental disease or fracture.
b. Bacterial.
1. Periodontal disease and dental abscessation ­ c. Fungal.
radiolucent halo of osteolysis around tooth root(s) 3. Neoplasia - more often predominantly
and surrounding sclerosis. osteolytic (see below) but can be proliferative;
2. Neoplasia - mixed osteolysis and new bone some are exclusively proliferative (e.g. osteoma).
production; tumours of dental origin also For MLTB, see 4.6.3 and Figure 4.3.
contain highly opaque dental tissue. 4. Healing or healed mandibular fracture.
S. Canine leucocyte adhesion deficiency - young
Irish Setters (see 1.24.9).
6. Acromegaly (cats).
MAN D IBLE

Views 4.1 2 MAN D I B U LAR BONY DESTRUCTION
OR RAREFACTION
a. Laterolateral (mandibles are superimposed over
each other). 1. Malignant neoplasia - as in maxilla (see 4.9.1
b. Dorsoventral or ventrodorsal (partly obscured and Fig. 4.4).
by maxillae). 2. Non-malignantf odontogenic tumours (see 4.9.2)
c. Lateral oblique. (Fig. 4.7).
d. Intraoral VD. 3. Dentigerous or non-eruption cyst; especially
e. Intraoral DV with beam angled laterally for affecting PMt with focal areas of mandibular
mandibular teeth. osteolysis seen unilaterally or bilaterally; Boxers
may be predisposed.

Normal appearance
The mandibles of brachycephalic breeds are
markedly curved when seen on the lateral viewf
suggesting an attempt at shortening in order
for the incisor teeth to approach those of the pre­
maxilla (Fig. 4.1b). In elderly cats, the mandibular
symphysis appears irregular on the intraoral Figure 4.6 Craniomandibular osteopathy: florid periosteal
view. new bone affecting the mandible and tympanic bulla.
Chapter 4 Head and neck 93

b. Osteolytic tumourf for example squamous
cell carcinomaf melanomaf lymphoma
(especially cats).
c. Renal secondary hyperparathyroidism.

4.1 4 M IXED PROLIFERATIVE-OSTEOLYTIC
MANDIBULAR LESIONS
See 4.10. In cats especiallYf it is difficult to differen­
tiate mandibular osteomyelitis from neoplasiaf as
both may produce osteolysis (sometimes with
pathological fracture)f sclerosisf periosteal new
bone and erosion of teeth.
Figure 4.7 Tumour of dental origin: a complex odontoma in
a young dog, seen as an expansile osteolytic bone lesion
containing material of dental radiopacity.
TEMPOROMAN D I B ULAR JOINT

4. Periodontal disease and dental abscessation - The ThIJ is a transversely elongated condylar syno­
radiolucent halo of osteolysis around the vial joint formed between the condylar process of
affected root(s) (see 4.30.1 and Fig. 4.17). In the mandible and the mandibular fossa of the tem­
severe cases may lead to pathological poral bone. The fossa has a caudoventral extensionf
mandibular fracture. the retroarticular processf which prevents caudal
S. Renal secondary hyperparathyroidism (rubber
luxation of the joint. The TMJ does not lie truly
jaw) - osteopenia secondary to chronic renal transversely but is angled slightly in a caudolateral
disease (see 4.9.5 and Fig. 4.5). to rostromedial direction. There is considerable
variation in the precise orientation of the ThIJ
6. Mandibular giant cell granuloma - discrete
between breeds and individualsf with the joint
osteolytic lesion seen mainly in young dogs.
lying more obliquely in brachycephalic animals.
Accurate radiographic demonstration of the joint
4.1 3 MAN D I B U LAR FRACTURE can be challenging due to these anatomical varia­
tions and to superimposition by other structures.
1. Trauma.
a. Symphyseal injury - most common in the cat;
Views
high rise syndrome (falling from a height)
typically results in symphyseal separation a. Sagittal oblique (with mouth open and closedf
and splitting of the hard palate, in Fig. 4.8). An angle of 10-30° in mesaticephalic
conjunction with limb and soft tissue injuries. and dolichocephalic breeds and an angle of
b. Fractures of the body of the mandible - check 20-30° in brachycephalic breeds have been
involvement of teethf especially permanent found to be optimal. Slight lateral rotation of
tooth germs in young animals. about 100 may also help to prevent
c. Fractures of the ramus (alsof depressed superimposition over the base of the skull.
factures of the zygomatic arch may impinge on b. Ventrodorsal or DV.
the ramusf causing problems opening the
mouth).
d. Fractures involving the ThIJ; may cause Normal appearance
subsequent ThIJ ankylosisf especially in cats. On the sagittal oblique viewsf the mandibular con­
2. Pathological fracture. dyle should be smoothly rounded, fitting closely
a. Through an area of severe periodontal disease into the glenoid (the smooth concavity in the
or a dental abscessf especially in toy breeds of petrous temporal bone)f immediately rostral to
dog. the tympanic bulla.
94 Handbook of Small Animal Radiology and U ltrasound

A

o ®
Figure 4.8 (A) Positioning for the sagittal oblique view of temporomandibular joint (TMJ): from a true lateral position, the nose
is tilted u pwards 1 0-30° depending on conformation (more tilt in brachycephalic breeds). (8) Normal appearance of the TMJ on
a sagittal oblique view (A, angular process of mandible; C, condyle; G, glenoid or mandibular fossa of temporal bone; R,
retroarticular process).

4.1 5 TEMPOROMAN DI BULAR JOINT NOT 4. 1 6 ABNORMALITIES OF THE
CLEARLY SEEN TEMPOROMAND IB U LAR JOINT
1. Incorrect positioningf especially use of the 1. Irregular articular surfaces.
lateral oblique view (as for tympanic bullae) a. Trauma.
rather than the sagittal oblique viewf as the X­ - Fracture; may lead to ankylosis secondary to
ray beam does not pass through the joint space. haemarthrosis or callusf especially in cats.
2. Technical factors. - Luxation or subluxation; usually unilaterat
a. Underexposure. with condyle displaced rostrally and
b. Underdevelopment. deviation of the mandible to the contralateral
3. Trauma. side; rarelYf fracture of the retroarticular
a. Fracture. process allows caudal luxation.
b. Osteoarthritis - narrowing of joint space and
b. Luxation or subluxation.
periarticular osteophytes may also be seen.
4. Periarticular new bone. c. Infection - may extend from infection of the
a. Healing or healed fracture. external or middle ear or from a para-aural
b. Osteoarthritis. abscess or wound.
c. Ankylosis following trauma - especially cats d. Neoplasia - primary bone tumour or
after mandibular trauma; may be bilateral. invading soft tissue tumour; variable
Pseudoankylosis without radiographic amounts of new bone too.
changes can occur due to fibrosis as a result 2. Temporomandibular joint dysplasia -
of haemarthrosis. flattening ± abnormal angulation of the
d. Craniomandibular osteopathy (see 4.11.1 and articular surfaces and absence of the
Fig. 4.6); changes usually most marked along retroarticular process are seen in some cases;
the mandibular ramus and on the tympanic especially the Basset Hound and Irish Setter.
bullae, but the TMJs may be involved May be clinically silent in some dogsf especially
secondarily. the Cavalier King Charles Spaniel. On an open
e. Canine leucocyte adhesion deficiency (young mouth VD viewf the coronoid process of the
Irish Setters - see 1 .23.7). mandible may be seen to impinge on the
5. Destruction of articular surfaces. zygomatic archf resulting in open mouth jaw
a. Infection - may extend from infection of the locking. If the condition is unilaterat the
external or middle ear or from a para-aural impinging coronoid process is on the side
abscess or wound. contralateral to the TMJ dysplasia. Subluxation
b. Neoplasia - primary bone tumour or of the mandibular condyle may sometimes be
invading soft tissue tumour; variable seen by comparing open and closed mouth
amounts of new bone too. sagittal oblique radiographs.
Chapter 4 Head and neck 95

EAR Normal appearance
The normal external ear canals are seen as bands of
Views gas lucency lateral to the tympanic bullae. The
external ear canals and the pinnae may create con­
a. Dorsoventral or VDf for external ear canals and fusing shadows on lateral and oblique radio­
tympanic bullae (the DV is usually easier to graphs. The walls of the tympanic bullae are seen
position symmetricallYf as facial landmarks can as thin and regular bony structuresf the cat also
be seen). The petrous temporal bones and having an inner bony septum that divides the bulla
cranium are superiInposed over the bullaef but incompletely into ventromedial and dorsolateral
comparison between right and left sides is compartInents.
possible.
b. Lateral oblique, skylining the dependent
tympanic bulla. Positive contrast canalography
c. Open mouth Red for tympanic bullae (Fig. 4.9). The use of positive contrast medium has been
d. In the catf a special viewf the rostro 100 ventral­ described for assessment of the integrity of the
dorsocaudal obliquef has been described for the tympanic membrane and for evaluation of stenotic
tympanic bullae (Fig. 4.10) and is technically ear canals. A small amount of non-ionic contrast
easier than the RCd open mouth view used in medium such as iohexol is instilled into the ear
dogs. canal and massaged. Presence of contrast medimn
in the bulla indicates rupture of the tympanic
membranef although false negative results may
arise due to plugging of the ear canal with inflam­
matory debris.

Fistulography
If a para-aural abscess with discharging tracts is
presentf fistulography may be used to look for con­
nection with the ear.

Figure 4.9 Positioning for the open mouth rostrocaudal view
4.1 7 ABNORMALITIES OF THE EXTERNAL
for the tympanic bullae. The hard palate lies about 30°
EAR CANAL
beyond the vertical, but the precise position depends on
1. External ear canal not visible.
the skull conformation. The endotracheal tube is usually
removed for the exposure. Positioning aids are not shown.
a. Overexposuref overdevelopment or severe
fogging of the fihn.
b. Congenital absence of the ear canal (atresia).
c. Occlusion of the canal by waxf debris or
, r
purulent material.
�r
10' d. Traumatic separation of the ear canat usually
between the annular and auricular cartilages;
may give rise to otitis media and para-aural
abscessation ± discharging sinuses.
e. Previous surgical ablation of the canal.
f. Occlusion of the canal by a soft tissue mass
within or outside the canal.
- Neoplasm.
- Inflammatory polyp.
Figure 4.1 0 Positioning for the special view of the feline - Para-aural abscess.
tympanic bullae. 2. Narrowing of the external ear canal.
96 Handbook of Small Animal Radiology and U ltrasound

a. Hypertrophy and/or inflammation of the 2. Thinning or destruction of the wall of the
lining of the canal - due to acute or chronic tympanic bulla.
otitis externa. a. Neoplasia.
b. Compression of the canal by a para-aural - Squamous cell carcinoma.
mass or swelling. - Adenocarcinoma.
3. Calcification of the external ear canal. - Lymphoma.
a. Normal - a small amount of orderly b. Severe otitis media with osteomyelitis.
calcification of the cartilages encircling the c. Trapped ceruminous debris secondary to
canal may be normal in older dogs. external auditory canal atresia.
b. Sequel to chronic otitis externa. d. Previous bulla osteotomy.
c. Sequel to auditory canal atresia; may be
associated with para-aural abscessation and
draining sinuses. 4.1 9 INCREASED RADIOPACITY OF THE
d. Sequel to tramnatic separation of the ear TYMPAN IC B U LLA
canal; may be associated with para-aural
abscessation and draining sinuses. 1. Artefactual due to poor positioning on the open
mouth RCd viewf or superimposition of the
tongue.
4.1 8 VARIATIONS IN THE WALL O F 2. Increased radiopacity of the bulla - may be due
THE TYM PANIC BU LLA to obliteration of air within the bulla and/or
thickening of the bulla wall.
1. Thickening of the wall of the tympanic bulla.
a. Accumulation of fluid in the bulla is a
a. Normal variant in some brachycephalic
common finding in brachycephalic dogs on
breedsf for example Cavalier King Charles
MRIf although radiographic findings in such
Spaniet which has small bullae with
cases have not been described.
relatively thickened walls.
b. Accumulation of fluid in the bulla may also
b. Otitis media (middle ear disease; Fig. 4.11).
be the result of auditory tube dysfunction
c. Inflammatory polyp - check for (e.g. with trigeminal neuropathy or palatine
nasopharyngeal polyp toof especially in cats. defects).
d. Craniomandibular osteopathy (see 4.11.1 and c. Otitis mediaf usually with thickening of the
Fig. 4.6). bulla wall.
e. Neoplasia (usually with osteolysis too). d. Inflammatory polyp, often with thickening of
- Squamous cell carcinoma. the bulla wall; may extend into the external
- Adenocarcinoma. ear canal or nasopharynx.
f. Canine leucocyte adhesion deficiency (young e. Neoplasia (see above).
Irish Setters - see 1 .24.9). f. Trapped ceruminous debris secondary to
auditory canal atresia.
g. Cholesterol granuloma.
h. Cholesteatoma.
i. Otolithiasis - discretef mineralized opacities
within the bulla lumen probably due to
mineralization of necrotic material due to
current or previous otitis media; may be an
incidental finding.
3. Increased radiopacity due to thickening of the
bony bulla wall (see 4.18.1 and Fig. 4.11).
Note that radiography is relatively insensitive for
Figure 4.1 1 Otitis media: thickening of the bulla wall and detection of middle ear diseasef and normal radio­
increased radiopacity of the bulla lumen, seen here on an graphs do not rule out the diagnosis. MRI (gold
open mouth rostrocaudal radiograph. standard) and CT are preferred techniques.
Chapter 4 Head and neck 97

4.20 ULTRASONOGRAPHY OF but not widely used. MRI and eT are far superior
THE TYM PANIC B ULLA techniquesf if available.

Ultrasonography can be used to detect fluid within Normal appearance
the bulla and is more sensitive and specific than
radiography in this respect. When fluid is presentf The turbinate (conchal) pattern should be clearly deli­
the bulla lumen appears anechoic and the deep neatedf and broadly symmetrical when comparing
wall of the bulla is visiblef but when the bulla con­ the right and left nasal cavities. In the rostral third
tains airf sound is reflected from the bone-air inter­ of the nasal cavityf the turbinate pattern should con­
face at the superficial bulla wall and the lumen is sist of a fine linear pattern. In the middle thirdf the
not visible due to reverberation artefact. Saline pattern becomes woven into an irregular honeycomb
may be infused into the ear canal to act as an and the ovoid maxillary recesses can be seen laterally.
acoustic window for visualization of the tympanic In the caudal thirdf the pattern returns to a linear
membrane. form. The bony part of the nasal septum (the vomer)
divides the right and left nasal cavities. It is not
unusual for the vomer and nasal septum to be curved
NASAL CAVITY or deviated in brachycephalic breeds and in cats.
RostrallYf the paired palatine fissures are seen. On
Views radiographs taken using a low exposuref the soft
tissues of the nostrils can also be assessed.
a. Intraoral DV (occlusal). Nasal radiographs may be highly suggestive of
b. Open mouth ventro 200 rostral-dorsocaudal a specific disease in dogs but tend to be non­
oblique (open mouth VD) (Fig. 4.12). specific in catsf and biopsy is usually required.
c. Dorsoventral or ventrodorsal (the mandibles are Nasal diseasef especially nasal neoplasiaf may be
superimposed over the lateral parts of the nasal accompanied by changes in one or both frontal
cavity). sinusesf and therefore the radiographic protocol
d. Laterolateral (the right and left sides are should include appropriate frontal sinus views.
superimposed over each otherf but this view is
useful for seeing changes in the overlying nasal
4.2 1 VARIATIONS IN SHAPE OF
bones and frontal sinuses).
THE NASAL CAVITY
e. Lateral oblique.
f. Rostrocaudal centred on nares. 1. Breed variation.
2. Congenital deformity.
Positive contrast rhilwgraphy using barium sulphate
or iodinated contrast medium has been described 3. Trauma.
4. Mucopolysaccharidosis - inherited condition of
the Domestic Short-haired catf Siamese and
Siamese crosses; broadf short maxillaf reduced
X-ray beam or absent frontal sinusesf abnormal nasal
conchaef hypoplasia of the hyoid apparatus (see
also 1.22.11 and 5.4.9).

4.22 INCREASED RADIOPACITY OF
T HE NASAL CAVITY
1. Increased radiopacity with retention of the
illlderlying turbinate pattern - usually bilaterat
occasionally unilateral (Fig. 4.13).
Figure 4.1 2 Positioning for the open mouth ventrodorsal
view for the nasal cavity. The X-ray beam is angled about 200
a. Underexposure.
from the vertical. It is not usually necessary to remove the b. Underdevelopment.
endotracheal tube. Positioning aids are not shown. c. Recent nasal flushing.
98 Handbook of Small Animal Radiology and U ltrasound

A N Figure 4.1 4 Nasal neoplasia: destruction of turbinate bones
Figure 4.1 3 Unilateral rhinitis: the turbinate pattern is by a soft tissue radiopacity, with deviation and interruption
blu rred compared with the normal side, and there is an of the nasal septum or vomer shadow; osteolysis of
overall increase in radiopacity. Confident diagnosis is harder surrou nding bones (maxilla, nasal bones and palate) may
if the changes are bilateral. A, affected side; N, normal also occur.
nasal cavity.
unilaterally (there may also be destruction of the
d. Inflammatory rhinitis (e.g. vomer and/or surrounding bones). Note that
lymphoplasmacyticf eosinophilicf inability to identify a turbinate pattern does not
neutrophilic, foreign body), although normal necessarily mean that lysis has occurred; intact
radiographs do not rule out rhinitis. turbinates may be obscured by adjacent tissuef
e. Hyperplastic rhinitis. especially in cats with nasal lymphoma.
a. Neoplasia (Fig. 4.14) - carcinoma most
f. Rhinitis-bronchopneumonia syndrome in
common; also sarcomasf including
Irish Wolfhounds - aetiology unknown; may
chondrosarcoma and lymphoma (especially
be immune-mediated or a primary ciliary
cats). Nasal lymphoma in cats may be
defect and appears to be heritable. Most
associated with renal lymphoma. Neoplasia
affected dogs show transient to persistent
may also extend into the nasal cavity from the
mucoid to mucopurulent nasal discharge of
frontal sinus or orbit. Nasal tumours are
varying severity from birthf with bouts of
usually seen in middle-aged and older
bronchopneumonia.
aniInals and are much less common
g. Rhinitis associated with dental disease (see
in brachycephalic than mesati- or
4.28-4.30).
dolichocephalic dogs. They usually arise in
h. Nasal haemorrhage (coagulopathYf traumaf
immune-mediated disease). the caudal or mid-third of the nasal cavityf
often near the carnassial tooth. Initially
i. Small or recent nasal foreign body
unilateral but often extend into the
(unila teral).
contralateral nasal cavity with interruption of
j. Kartagenees syndrome (or immotile cilia
the intervening vomer or nasal septum. Nasal
syndrome; often associated with situs
neoplasia is often associated with frontal
inversus and evidence of bronchitis or
bronchiectasis - see 6.12.8). sinus opacification due to trapped secretionsf
k. Primary ciliary dyskinesia (see 6.12.7). whereas this is unusual with rhinitis. Erosion
of surrounding bones (nasat maxillaf palate)
1. Cryptococcosis* - especially cats.
occurs in severe cases.
m.Capillariasis* - may rarely cause rhinitis. b. Nasal polyp - cats > dogs. In catsf also
n. Pneunwnyssus caninum* - nasal mite. known as ethmoturbinate polypsf as they are
o. Fibrous osteodystrophy secondary to inflammatory polyps arising from the nasal
hyperparathyroidism (see 1.16.4). ethmoturbinates; they usually follow a
2. Increased radiopacity with loss of the preceding upper respiratory infection and
underlying turbinate pattern - usually begins are mainly seen in cats 6-24 months old.
Chapter 4 Head and neck 99

Unilateral or bilateral nasal cavity
involvement. Most reported cases are from
Italy.
c. Filllgal rhinitisf especially aspergillosis*f
usually overall decreased opacity but see
patchy increased opacity if there is marked
retention of necrotic material or a hmgal
granuloma - see below. Unilateral or
bilaterat with variable involvement of the
nasal septum or vomer and frontal sinusesf
and osteomyelitis of surrounding bones in
severe cases.
d. Other inflammatory rhinitides (e.g.
lymphoplasmacytic rhinitis) may cause mild Figure 4.1 5 Destructive rhinitis (aspergillosis): loss of the
turbinate pattern, with ill-defined and patchy increase in
to moderate turbinate destruction; unilateral
radiopacity rather than diffuse nasal opacification.
or bilateral.
e. Chronic nasal foreign body; unilateral.
Nasal septum or vomer shadow may or may
f. Fibrous dysplasia; bilateral.
not be interrupted. In some casesf frontal
3. Mineralization within the nasal cavity. sinus changes due to osteomyelitis or fungal
a. Mineralization of neoplasia (e.g. granuloma may be seen.
osteosarcomaf chondrosarcoma). b. Viral rhinitisf leading to chronicf destructive
b. Mineralization of a hmgal granuloma. bacterial rhinitis (cats).
c. Mineralized foreign body. c. Lymphoplasmacytic rhinitis.
d. Displaced tooth - congenitat tramnatic. d. Nasal foreign body.
e. Destruction of the supporting palatine or
maxillary bone if nasal neoplasia is eroding
4.23 DECREASED RADIOPACITY OF the surrounding bones; may be smalt
THE NASAL CAVITY punctuate lucencies or larger areas.
f. Congenital defect of the hard palate.
1. Decreased radiopacity with retention of the
g. Previous rhinotomy.
illlderlying turbinate pattern - bilateral.
h. Nasal tumour that has fragmented and been
a. Overexposure.
sneezed out or displaced by nasal flushing.
b. Overdevelopment.
c. Severe fogging of the film.
2. Decreased radiopacity with destruction of the FRONTAL S IN USES
illlderlying turbinate pattern - unilateral or
bilateral; may be interspersed with ill-defined Views
patches of increased opacity. An ill-definedf
rostrally directed lucent tract may be seen a. Rostrocaudal (vertical X-ray beam) or
adjacent to the nasal septum; this is due to caudorostral (horizontal X-ray beam).
widening of the common nasal meatus as b. Lateral oblique.
conchae are destroyed. c. Laterolateral (right and left frontal sinuses are
a. Fungal rhinitis (Fig. 4.15) - especially superimposed).
Aspergillus* spp. but also Penicillium, d. Dorsoventral or ventrodorsal (frontal sinuses are
Cryptococcus* and other species; may also be partially superimposed by the caudal nasal
present with a foreign body. Mainly young cavity and rostral calvarium).
dogs of dolichocephalic and mesaticephalic
breeds; less common in cats and in
Normal appearance
brachycephalic dogs. Unilateral or bilateral
and usually starts in the rostral part of the The frontal sinuses should be filled with airf
nasal cavityf sparing the etlunoturbinates. which outlines the smooth bony folds of the
1 00 Handbook of Small Animal Radiology and U ltrasound

walls. The frontal sinuses are more prominent in b. Fungal - especially Aspergillus* spp.; some
larger breeds of dog and in cats than in smaller cases develop frontal bone osteomyelitisf
breeds of dog; they may be absent in some which produces a mottled opacity to the
brachycephalic breeds. They are small at birthf bone; fungal granuloma may also occur.
enlarging with age. The sinuses are lined by Nasal cavity changes usually predominate
mucoperiosteum. (see 4.23.2 and Fig. 4.15).
Frontal sinus changes may arise secondary to c. Associated with rhinitis (e.g. idiopathic
nasal diseasef and the radiographic protocol will lymphoplasmacytic rhinitis).
usually need to include both areas. d. Allergic.
e. Subsequent to viral respiratory disease.
4.24 VARIATIONS I N SHAPE OF f. Kartagener's syndrome (see 6.12.8).
THE FRONTAL SINUSES 2. Occlusion of drainage of the frontal sinusesf
leading to mucus retention.
1. Breed and conformational variations - the a. Trauma - occlusion of the frontonasal
frontal sinuses may be extremely large and ostium due to a fracturef leading to
prominent in some giant breeds of dogf such as accumulation of secretions and a frontal sinus
the St. Bernardf and small or absent in mucocele.
brachycephalic breeds. b. Mass in the caudal nasal cavitYf usually
2. Trauma. neoplastic (see 4.22.2 and Fig. 4.14).
a. Fracture of the walls of the sinusf usually a 3. Neoplasia (note that neoplastic tissue and
depressed fracture leading to concavity of the trapped fluid cannot be distinguished on
sinus. radiographsf and both will cause increase in
b. Occlusion of drainage due to a nasofrontal sinus opacity).
fracturef leading to accumulation of frontal a. Extension of nasal or orbital neoplasia into
sinus secretions and an expanded sinus with the frontal sinuses.
thinning of the overlying frontal bones b. Soft tissue or bone neoplasia arising within
(frontal sinus mucocele). the frontal bone or sinus.
3. Neoplasm involving the frontal bones; osteolysis - Carcinoma - soft tissue radiopacity;
and/ or new bone productionf usually with osteolytic.
marked overlying soft tissue swelling. - Osteosarcoma - mixed bone lesion.
4. Osteomyelitis involving the frontal bones; - Osteoma or MLTB; mainly proliferative
usually less severe than changes due to (see 4.6.3 and Fig. 4.3).
neoplasia; may produce a mottled radiopacity.
4. Haemorrhage following trauma (usually with
Most often secondary to aspergillosis (see 4.23.2
bony changes as well).
and Fig. 4.15). 5. Craniomandibular osteopathy - thickening of
5. Craniomandibular osteopathy may affect the the frontal bones and reduction of sinus
frontal bonef causing reduction in sinus volume volume may occurf usually in conjunction
internally and distortion externallYf possibly
with new bone in other typical locations
leading to exophthahnos (see 4.11.1 and
(see 4.11.1 and Fig. 4.6) but occasionally in
Fig. 4.6).
isolation.
6. Aplasia - mucopolysaccharidosis in cats.
6. Canine leucocyte adhesion deficiency - young
Irish Setters (see 1.24.9).
4.25 INCREASED RADIOPACITY O F
THE FRONTAL SINUSES
4.26 VARIATIONS IN THICKNESS OF
Increased radiopacity of the frontal sinuses may be
T HE FRONTAL BONES
due to the presence of fluid or soft tissue within the
sinus or to the superimposition of new bone or soft 1. Increase in thickness of the frontal bones or
tissue swelling. bony mass.
1. Sinusitis. a. Healing or healed fracture.
a. Bacterial. b. Secondary to fungal sinusitis.
Chapter 4 Head and neck 1 01

c. Neoplasm involving the frontal bones (see of the tooth consists of dentinf with a covering
above). of enamel over the crown and cementum over the
d. Craniomandibular osteopathy (see 4.11.1 and root. Blood vessels and nerves lie in the inner
Fig. 4.6). pulp cavity. Enamet dentin and cementum are
e. Calvarial hyperostosis of Bullmastiffs (see radiopaquef while the inner pulp cavity is rela­
4.6.2). tively radiolucent. OccasionallYf the enamel is seen
f. Canine leucocyte adhesion deficiency (young to be more radiopaque than the underlying dentin.
Irish Setters - see 1.24.9). In the immature animat the pulp cavity is wide
g. Acromegaly (cats). with an open apical foramen; in the mature animat
2. Decrease in thickness or osteolysis of the frontal the pulp cavity narrows and the apical foramina
bones. close. The tooth roots are embedded in the alveolar
a. Neoplasm involving the frontal bones (see bone of the mandiblef maxilla or premaxilla. They
above). are surrounded by a radiolucent zone created
b. Osteomyelitis involving the frontal bones. by the periodontal membrane and outlined by a
c. Erosion by an adjacent mass. thinf radiopaque line - the lamina dura. Some
permanent tooth germs already start forming in
d. Secondary to a frontal sinus mucocele - likely
utero.
to be expansile.
The normal dental formulae for the dog and cat
3. Bony masses - see 4.6.3 (cranial bony masses)f as
are given below.
the principles of interpretation are the same.
Immature (deciduous teeth)
- Dog: 2 x I 3/ C ' / PM 3/3 = 28
3 1
- Cat: 2 x I 3/ C 1 h PM 3h = 26
TEETH 3
Mature
Views - Dog: 2 x 1 3/ C ' / PM 4 /4 M 2/ = 42
3 1 3
- Cat: 2 x I 3 h C 1 h PM 3 h M 1 h = 30
a. Lateral oblique.
The modified Triadan system for numbering
b. Intraoral DV and VD views of the maxilla and teeth allows each tooth to be identified by a num­
mandiblef respectively. ber: the right (pre)maxillary teeth being prefixed
c. Bisecting angle technique (incisorsf canines and 1, left teeth (pre)maxillary 2, left mandibular 3
upper premolars and molars). and right mandibular 4; for examplef left maxillary
d. Intraoral parallel technique (mandibular PM4 in the adult dog is 208.
premolars and molars).
e. Near-parallel view for carnassial teeth (108, 208)
in cats.
4.27 VARIATIONS IN THE N U M BER
OF TEETH
Normal appearance 1. Decrease in the number of teeth (hypodontia).
Each normal tooth has a well-defined crown and a. Congenital.
one or more clearly defined roots (Fig. 4.16). Most - Anodontia (total absence of teeth) - very
rare.

1
- Isolated hypodontia (oligodontia) -
Crown r---- IPullp cavity reduction in the number of teeth; may be
symmetrical or asymmetrical; common in
Kerry Bluef Bull Terrier breedsf Labrador
/f--- Pericdontal and Golden Retriever.
Root membrane - Ectodermal dysplasia - breeds deficient
/f---- Lamiina dura in structures that originate from ectoderm
(e.g. Mexican Hairless dogf Chinese
Crested).
AlveokJs b. Acquired.
Figure 4.1 6 Anatomy of a normal tooth. - Previous tooth extraction.
1 02 Handbook of Small Animal Radiology and U ltrasound

Tooth loss due to severe periodontal - Secondary to fracture of the tooth.
disease or destructive neoplasia. - Secondary to periodontal disease.
- Fusion of teeth. Associated with a dental abscess.
2. Increase in the number of teeth (hyperdontia). 4. Dentinogenesis imperfecta - thinning of dentine
a. Retained temporary teeth layer leading to multiple fractures; sometimes
(pseudopolydontia). seen with osteogenesis imperfecta (see 1.16.13).
b. Congenital polydontia - usually unilateral and
more common in the upper jaw than in the
lower; mainly extra incisors or premolars; true 4.30 PERIODONTAL RAD IOLUCENCY
extra teethf referred to as supernmnerary teeth. 1. Periodontal disease - destruction of alveolar
c. Germination - incomplete splitting of a tooth bone and resorption of the alveolar crest
into two teeth may produce a single tooth between the tooth and its neighbours; may
with a double crownf which may be mistaken extend to form a radiolucent halo around the
for two separate teeth. tooth rootf which in the mandible may result in
pathological bone fracture.
4.28 VARIATIONS I N THE SHAPE O F TEETH 2. Apical tooth root abscess - pulp necrosis causes
inflammation and/or infection aroillld the root
1. Change in shape of the crown. apex (Fig. 4.17).
a. Fracture of the crown. 3. Neoplasia (see 4.9.1 and 4.9.2 and Figs 4.4 and
b. Abnormal wear of the crown (e.g. stone 4.7).
chewing)f resulting in flattening of the tooth 4. Primary or secondary hyperparathyroidism
tip. (generalized loss of bone radiopacitYf although
c. Crown removed; one or more roots retained. changes due to renal secondary
d. Gemination and/ or fusion may create a tooth hyperparathyroidism are often most severe
with an abnormal crown (see 4.27.2). around tooth roots - see 4.9.5 and Fig. 4.5).
e. Supernumerary mandibular fourth premolars
may have a conical crown instead of the
normal triangular shape. 4.31 D ISPLACEMENT OR ABNORMAL
LOCATION OF TEETH
2. Change in shape of the root.
a. Periodontal disease leading to deformity 1. Normal crowding of premaxillary and maxillary
or erosion of the rootf especially feline teeth in brachycephalic animals - as the maxilla
odontoclastic resorptive lesionsf which cause shortensf the premolars rotate in order to
circumferential erosion just beneath the gum occupy less space; PM3 is affected first.
line that may lead to fracture of the crown. 2. Supernumerary teeth may lie in an abnormal
b. Deformation or displacement by an adjacent location (e.g. an extra incisor tooth on the palate).
mass.
3. Developmental - dentigerous or dental cysts;
c. Lysis due to adjacent malignant tmnour.
normal or slightly deformed tooth in an
d. Dilaceration - the root shows a sudden
change in directionf usually of about 90°.

4.29 VARIATIONS IN STRUCTURE
OR RADIOPACITY OF THE TEETH
1. Fracture of the tooth.
2. Caries - radiolucent defects in the crown.
3. Wide pulp cavity. Figure 4.1 7 Apical tooth root abscess: radiolucent halo
a. Immature tooth (all teeth appear similar). around the affected tooth (the carnassial tooth, upper PM4),
b. Dead tooth (other live teeth have a narrower with irregularity of one of the tooth roots. Dental
pulp cavity). abscessation at this site is sometimes called malar abscess,
c. Inflammation of the pulp cavity. and there may be facial swelling ± a discharging sinus.
Chapter 4 Head and neck 1 03

abnormal location; may be surrounded by a usually begins at 2-3 years of age (or earlier in
radiolucent cystic area. large or chondrodystrophic breeds).
4. Fibromatous epulis of periodontal ligament
origin - dogsf rare in cats; mainly around canine 4.32 VARIATIONS IN THE PHARYNX
and carnassial teeth in brachycephalic dogs.
Tooth displacement but no osteolysis. 1. Reduction or obliteration of the air-filled
5. Neoplasia - teeth displaced by tumour mass; nasopharynx.
osteolysis is present and there may be tooth loss a. Soft tissue mass in the nasopharynx.
(see 4.9.1. and Fig. 4.4). Subtle displacement of - Nasopharyngeal polyp (inflammatory, so
tooth roots may be an early sign of jaw may be associated with radiological
neoplasia. evidence of otitis mediaf i.e. increased
6. Trauma (e.g. in the upper jawf a tooth may be radiopacity of the bulla lumen and
impacted into the nasal cavity). thickening of the bulla wall) (Fig. 4.19).
Neoplasia (most commonly carcinoma in
dogs and lymphoma in cats).
PHARYNX AND LARYNX Abscess or foreign body reaction.
- Granuloma.
Views - Cyst - nasopharyngeal epidermoid cyst or
cystic remnant of Rathke's pouch (may
a. Laterolateral. A true lateral viewf without an have mineralized wall).
endotracheal tube in placef is essential for b. Thickening of the soft palate.
evaluation of the pharynx. - Part of brachycephalic obstructive airway
b. Ventrodorsal or dorsoventral: of limited value syndrome.
due to superimposition of the skull and spine. - Palatine mass - tumourf cyst or
granuloma.
c. Excessive pharyngeal tissue - part of the
Normal appearance brachycephalic obstructive airway syndrome.
The pharynx is divided into the oro- and nasophar­ d. Foreign body in the nasopharynx - will be
ynx by the soft palate, which should extend to the outlined by air.
tip of the epiglottis, and the area of the pharynx e. Retropharyngeal swelling.
above the larynx is the laryngopharynx (Fig. 4.18). - Enlarged retropharyngeal lymph nodes
The larynx normally lies the length of C3 ventral (e.g. lymphoma).
to the cervical spine. Mineralization of the laryn­ - Retropharyngeal abscess.
geal cartilages in the dog is quite normal and - Retropharyngeal tumour (e.g. of thyroid
gland).
f. Nasopharyngeal stenosis; membranes or
fibrotic web.

/

/
"

TR
Figure 4.1 8 Normal lateral pharynx. AfT, arytenoid and
thyroid cartilages of the larynx; C, cricoid cartilage of the Figure 4.1 9 Nasopharyngeal polyp in a cat: a soft tissue
larynx; E, epiglottis; H, hyoid apparatus; NP, nasopharynx; mass is seen in the nasopharynx, depressing the soft palate.
OP, oropharynx; SP, soft palate; TR, tracheal rings. Bony changes are present in one of the tympanic bullae.
1 04 Handbook of Small Animal Radiology and U ltrasound

- Congenital stenosisf usually affecting e. Cellulitisf abscessation or foreign body
the rostral nasopharynx (e.g. choanal affecting the retropharyngeal tissues.
atresia). f. Neoplasia involving the retropharyngeal
- Stenotic nasopharyngeal dysgenesis - tissues.
especially Dachshunds; congenital 2. Caudal displacement of the larynx and proximal
thickening of the palatopharyngeal trachea.
muscles reducing the intrapharyngeal a. Normal in brachycephalic dogs.
ostium to a narrow slit. Lateral b. Extreme dyspnoea.
radiographs show a thick band of soft c. Laryngeal paralysis.
tissue extending from the terminal soft
d. Disruption of the hyoid apparatus or of the
palate region to the caudodorsal
muscles between hyoid and larynx due to
laryngopharynx.
trauma (e.g. bite woundsf choke chain injury)
- Acquiredf secondary to trauma or to
or neoplasia.
previous upper respiratory tract disease in
3. Mineralization of laryngeal cartilages.
cats; strand-like soft tissue opacity or slight
dorsal deviation of the soft palate may be a. Normal ageing changes.
seen. b. Secondary to laryngeal neoplasia
g. Obesity. (mineralization is usually more extensive and
less ordered).
2. Ballooning of the pharynx.
c. Secondary to laryngeal chondritis.
a. Pharyngeal paralysis.
4. Reduction or obliteration of the laryngeal
b. Respiratory obstruction or air hunger.
airway.
c. Pharyngeal diverticulumf presumably
a. Neoplasia - may show a discrete soft tissue
associated with trauma.
opacity or reduction in margination of
3. Radiopacities within the pharynx. laryngeal structures.
a. Superimposed ear canal and pinna shadows. - Carcinoma is most common in the dog.
b. Hyoid bones (see 4.35 and Fig. 4.18). - Lymphoma is most common in the cat.
c. Mineralization of laryngeal cartilages (see b. Inflammation.
4.33.3 and Fig. 4.18). c. Lymphoid hyperplasia.
d. Radiopaque foreign body.
d. Haemorrhage (e.g. trauma).
e. Dystrophic calcification within a mass.
e. Foreign body.
f. Ossification within a mass.
f. Laryngeal cyst.
g. Superimposed salivary calculi.
g. Laryngeal granuloma.
4. Miscellaneous.
a. Abscessation of the tongue in dogs has been
reportedf with soft tissue swelling of the root 4.34 U LTRASONOGRAPHY OF THE LARYNX
of the tongue ± gas-filled centre on Examination from the ventral aspect of the larynx
radiographYf and a fluid-filled cavity seen on shows the thyroid and cricoid cartilagesf with a
ultrasonography. central stream of reverberations from the air col­
urrm within. The vocal folds and the cuneiform
processes abduct and adduct during respiration.
4.33 VARIATIONS I N THE LARYNX 1. Absence of motion of the cuneiform processes.
a. Breathing at rest.
1. Ventral displacement of the larynx and proximal
trachea. b. Laryngeal paralysis (bilateral).
a. Normal in brachycephalic dogs. 2. Asymmetry of motion of the cuneiform
b. Flexion of the head and neck during processes.
radiography. a. Asymmetrical plane of section.
c. Enlargement of one or both retropharyngeal b. Laryngeal paralysis (unilateral).
lymph nodes. 3. Distortion or displacement of the central air
d. Enlargement of one or both thyroid glands. column.
Chapter 4 Head and neck 1 05

a. Laryngeal tumour. d. Haematoma.
b. Laryngeal cyst. e. Granuloma.
c. Laryngeal collapse due to trauma or secondary f. Cyst.
to severe obstructive airway disease. g. Recent administration of subcutaneous fluids
4. Thickening of the soft tissues of the larynx. into the neck area.
a. Laryngeal tumour. 2. Diffuse thickening of the soft tissues of the head
b. Laryngeal cyst. and neck.
c. Inflammation. a. Obesity (fat is more radiolucent than other
d. Oedema. soft tissues).
b. Cellulitis.
c. Oedema.
4.35 CHANGES I N THE HYO I D APPARATUS d. Diffuse neoplasia.
1. Artefactual appearance of subluxation between
hyoid bones due to positioning for radiography.
4.37 VARIATIONS IN RADIOPACITY
2. Caudal displacement of the hyoid apparatus by
a soft tissue mass is normal in brachycephalic
OF THE SOFT TISSUES OF THE HEAD
breeds (e.g. Bulldog and Pug), the mass being
AND NECK
prominent masseter muscles. 1. Decreased radiopacity of soft tissues.
3. Fracture - choke chain injuries or other direct
a. Gas within soft tissues.
trmuna.
- Oesophageal gas; a small amount of gas is
4. Disruption of relationship between individual
commonly seen in the proximal
hyoid bones - hanging injuries.
oesophagusf especially if the animal is
5. Bone proliferation and/or destruction.
llllder general anaesthesia or is dyspnoeic.
a. Osteomyelitis.
- Secondary to pharyngeal or oesophageal
b. Neoplasia (e.g. thyroid carcinoma). perforation.
6. Hyoid hypoplasia - mucopolysaccharidosis; - Secondary to tracheal perforation.
mainly cats (see 5.4.9 and Fig. 5.8). - Discharging sinus or fistulous tract; most
likely to be associated with a foreign body
such as a stick. Geometricf linear gas
SOFT TISS U ES OF THE H EA D A N D N E CK shadows may outline the foreign body.
Further investigation may include
4.3 6 THICKENING O F THE SOFT TISSUES fistulography using water-soluble
O F THE HEAD AND NECK iodinated contrast medium and/or
Abnormality may be recognized by displacement of ultrasonography. Chronic cases may give
normal structures (e.g. trachea) or by displacement rise to periosteal new bone or osteomyelitis
affecting adjacent vertebrae.
or loss of fascial planes. A barium swallow may be
- Secondary to pneumomediastinum (gas
helpful to show the location of the oesophagus. If an
area of swelling is identifiedf further information about tracks cranially along cervical fascial
its nature may be obtained using ultrasonographYf and planes from the thorax).
this will also allow ultrasolllld-guided fine needle - Abscess cavity.
aspiration or biopsYf avoiding vascular structures. - Pllllcture or laceration of skin leading to
subcutaneous emphysema.
1. Focal thickening of the soft tissues of the head
b. Fat within soft tissues.
and neck.
- Normal subcutaneous and fascial plane fat.
a. Sialocele.
- Obesity.
b. Soft tissue tumour; injection site sarcoma is
seen in cats. - Lipoma or liposarcoma.
c. Abscessf sometimes secondary to foreign 2. Increased radiopacity of soft tissues.
body penetration; bony changes may be seen a. Artefactual (e.g. wet hair, dirty coat).
on adjacent vertebrae. b. Mineralization.
1 06 Handbook of Small Animal Radiology and U ltrasound

- Calcinosis circmnscripta (rounded - Inadequate volume of contrast medimn
deposits of amorphous mineralization) (see used.
12.2.2 and Fig. 12.1). Mainly young dogs of b. Nasolacrimal duct not patent.
large breedsf especially the German - Aplasia of a segment of the nasolacrimal
Shepherd dog. duct.
- Calcinosis cutis (secondary to Occlusion of the nasolacrimal duct by
hyperadrenocorticism; linear streaks in foreign materiat mucusf purulent materiat
fascial planes or granular deposits near inflammationf stricture formation or
skin surface). neoplasia.
- Dystrophic calcification in a tumourf 2. Irregular contrast colurrm in the nasolacrimal
haematomaf abscessf granuloma or at the duct.
site of a previous depot injection. a. Contrast mixing with mucus or purulent
c. Radiopaque foreign body in oesophagus or material.
soft tissues. b. Contrast outlining foreign material in the
d. Sialolithiasisf if in a location consistent with a nasolacrimal duct.
salivary gland or duct. c. Inflammation of the nasolacrimal duct.
e. Microchip - characteristic appearance. d. Neoplasia involving the nasolacrimal duct.
f. Leakage of barium sulphate into soft tissues
3. Leakage of contrast medium from the
through a pharyngeal or oesophageal tear.
nasolacrimal duct.
a. Rupture of the nasolacrimal duct.
4.38 CONTRAST STU DIES O F b. Entry into a nasolacrimal duct cyst.
THE NASOLACRIMAL DUCT c. Contrast exiting the rostral opening of the
(DACRYOCYSTORHINOGRAPHY) nasolacrimal duct may leak back into the
nasal cavityf outlining the turbinates and
Dacryocystorhinography is not often performed
mimicking rupture of the duct; this may be
but may be used to demonstrate occlusion of the
avoided by keeping the nose lower than the
nasolacrimal duct in animals with chronic epi­
caudal aspect of the head.
phoraf to detect leakage from the ductf and to eval­
uate whether a known lesion is connected to or has
an effect on the duct. Survey radiographs should 4.39 U LTRASONOGRAPHY OF THE EYE
be taken prior to the contrast studYf with the AND ORBIT
patient anaesthetized. A fine catheter is then
Radiography of the eye is of limited valuef so ultra­
placed within either the upper or the lower punc­
sound is increasingly used to image this region
tum of the eyelid Sf and while digital pressure and
when visual inspection is impairedf for example
a swab are used to occlude the other punctumf
by eyelid swellingf opacity of the cornea or lensf
1-1.5 mL of a water-solublef iodinated contrast
or intra ocular haemorrhage. It is usually best per­
medium is slowly injected into the duct. Injection
formed in the conscious animat in which the eye
may also be made in a retrograde fashion from
is in a normal position; illlder anaesthesiaf it often
the rostral opening of the ductf caudal to the nares.
may retract and rotate ventrally. A high-frequency
A radiograph is then taken immediatelYf usually
(2:: 7.5 MHz) sector or curvilinear transducer is
with the patient in lateral recumbency. The normal
placed directly on the cornea or nictitating mem­
opacified nasolacrimal duct is seen on a lateral
brane following topical anaesthesia and using vis­
radiograph as a narrowf slightly illldulating line
cous contact gel. A stand-off is useful when
crossing the maxilla approximately halfway
examining the cornea and anterior chamber. The
between the hard palate and the dorsum of the
eye should be examined in both dorsal (horizontal)
nose. On a DV intraoral viewf it lies immediately
and sagittal (vertical) planesf taking care to sweep
medial to the cheek teeth.
through the whole volume of the globe and the ret­
1. Contrast colurrm does not fill the duct. robulbar structures. Images obtained through
a. Poor technique. closed eyelids are very inferior. Images may also
- Leakage of contrast from one or both be obtained in the transverse plane relative to the
pilllcta. eye by scanning from the lateral aspect near the
Chapter 4 Head and neck 1 07

from exophthahnosf which may appear similar
clinically).
a. Breed-associated (bilaterally symmetrical).
b. Glaucoma - hydrophthahnos.
2. Decreased size of the globe.
a. Breed-associated (bilaterally symmetrical)f for
example Rough Collie.
b. Congenital microphthalmos.
c. Phthisis bulbi.
- Following trauma.
Figure 4.20 Normal ocular ultrasonogram. C, front and back
- Following inflammatory disease.
of cornea; CB, ciliary body; L(B), back of lens; L(F), front of
lens. - End-stage glaucoma.
3. Thickening of the wall of the globe.
a. Generalized thickening.
orbital ligament after clipping the hair (temporal - Scleritis.
approach). - Chorioretinitis.
The globe of the eye is approximately spherical b. Localized thickening.
and roughly 2 cm in diameterf with a smoothf thinf - Tumour.
well-defined wall (Fig. 4.20). The aqueous and vit­ - Sub retinal haemorrhage.
reous humours in the chambers of the eye are nor­ - Granuloma (see below).
mally anechoic. With a stand-oft the front and - Optic neuritis - protrusion of the optic
back of the cornea are seen as a pair of shortf paral­ nerve head at the optic disc.
let echogenic lines. Separate layers of the scleraf
4. Echogenicities within the chambers of the eye.
retina and choroid are not normally recognized.
a. Generalized increase in echogenicity.
A small depression or elevation may be seen at
the back of the globef representing the optic disc. - Gain settings inappropriately high.
The anterior and posterior surfaces of the lens are - Vitreal syneresis - degeneration that
identified as shortf curvilinear structures only at results in pockets of liquefaction and may
those points where the incident sound beam is per­ be seen to move or swirl with eye motion;
pendicular to the lens surface; at other pointsf the occurs as a natural ageing process in some
smooth curve of the lens surface scatters echoes dogs.
away from the transducer. The substance of the - Haemorrhage (secondary to traumaf
lens is anechoic. The hyperechoic ciliary body and neoplasiaf coagulopathYf hypertensionf
iris may be visible on either side of the lens. chronic glaucoma).
Radiographic changes of orbital disease are seen - Inflammatory exudate (endophthalmitis).
only in cases of radiopaque foreign body and - Vitreous ffloatersf.
where orbital neoplasia is extensive and involving - Asteroid hyalosis (calcium phospholipid
the nasal cavity and/or frontal sinus (see 4.22.2 particles suspended in relatively solid
and 4.25.3). Orbital ultrasonography is therefore a vitreous).
valuable techniquef especially if MRI or CT is not - Synchysis scintillans (cholesterol particles
readily available. Scanning is performed through suspended in liquefied vitreous).
the globef which acts as an acoustic window. The b. Localized mass effect.
retrobulbar tissues form an orderly cone behind - Blood clot.
the eye; retrobulbar muscles are hypoechoicf while - Sediment of inflammatory cells.
the retrobulbar fat is hyperechoic. A temporal - Intraocular tumour - melanoma (usually
approach caudal to the orbital ligament can also arise from ciliary body); ciliary body
be used to examine the retrobulbar structuresf adenoma or adenocarcinoma; lymphoma
including the optic nerve. (often bilaterat may be associated with
1. Increased size of the globe (ultrasonography is intra ocular haemorrhage); metastatic
helpful for differentiating increased globe size tumour.
1 08 Handbook of Small Animal Radiology and U ltrasound

- Intraocular granuloma - blastomycosis* b. Hereditary predisposition.
(usually choroidal in origin); c. Displaced by an adjacent mass.
coccidioidomycosis*; cryptococcosis*; d. Glaucoma.
histoplasmosis*; feline infectious
6. Increased echogenicity of the lens due to
peritonitis; toxoplasmosis*.
cataract formation. Increased echogenicity may
- Subretinal haemorrhage.
be generalized or focat and may be capsular
- Iris cysts - attached to iris or free-floating; and/ or within the body of the lens.
anechoic centre. a. Primary hereditary - many breedsf the
- Retinal detaclunent - occasionally gives appearance and age of onset being
rise to a mass effect but more often characteristic for the breed.
produces curvilinear echogenicities (see b. Secondary to another eye diseasef which may
below). be hereditary.
- Intraocular foreign body - there may be Uveitis - various causes.
acoustic shadowingf or if metallicf may see
- Progressive retinal atrophy.
comet tail artefact.
- Retinal dysplasia.
c. Linear or curvilinear echogenicities.
- Glaucoma.
- Retinal detachment (Fig. 4.21) - when
completef appears as fseaguWs wingsff - Lens luxation.
with attachments at optic disc and ciliary - Persistent hyaloid artery and persistent
body. Partial detachments may also be hyperplastic primary vitreous.
visible as linear or curvilinear echoes - Multilocular defects.
within the vitreous. Retinal detachments c. Other causes.
often move with eye motion. - Senile (age-related).
- Posterior vitreous detachment - similar in Trauma.
appearance to detached retina but not - Diabetes mellitus.
attached at the optic disc. - Toxins.
- Vitreous membranes or traction bands -
- Radiation.
fibrous strands that sometimes develop
secondary to clot formation; can lead to 7. Enlargement of the ciliary body.
tractional retinal detachment. a. Inflammation.
- Inflammatory tract from foreign body b. Neoplasia.
penetration. - Melanoma.
- Persistent hyperplastic primary vitreous - Adenoma.
linear structure nmning from posterior - Adenocarcinoma.
pole of lens to the optic nerve head; colour
- Lymphoma - especially cats; may be
Doppler useful to detect patency of
bilateral.
hyaloid artery.
S. Changes in the retrobulbar tissues.
S. Change in position of the lens - luxation or
a. Diffuse disturbance - heterogeneous in
subluxation. The lens may move anteriorly or
echogenicity and echotexture.
posteriorly.
- Cellulitis.
a. Trauma.
- Extensive or diffuse neoplasia.
b. Solid mass - varying echogenicity but usually
hypoechoicf often deforming the back of the
globe.
- Neoplasia (lymphoma - often bilateral;
other primary and metastatic neoplasms;
extension from nasal or frontal sinus
tumour).
- Myositis of the extraocular musclesf
especially medial rectus muscle.
Figure 4.21 Total retinal detachment on ultrasonography. - Zygomatic sialadenitis.
Chapter 4 Head and neck 1 09

c. Cavitary mass. b. Occlusion of the salivary duct.
- Retrobulbar abscess (bacteriat fungat - Sialolith; may be visible on a survey
parasiticf secondary to foreign body). radiograph as a mineralized opacitYf and
- Myxosarcoma - may produce pockets of sialography confirms its location within a
viscous fluid that grossly mimic saliva. salivary gland or duct.
- Zygomatic mucocele. - Stricture.
d. Focal echogenicity (or echogenicities) ± - Foreign body.
acoustic shadowing. - Compression of the salivary duct by an
- Retrobulbar foreign body (NB: a metallic adjacent mass.
foreign body may give rise to a comet tail 2. Extravasation of contrast medium into
artefact). surrounding soft tissues.
- Dystrophic calcification. a. Rupture of the salivary duct.
- Bone proliferation arising from the bones b. Salivary mucocele.
of the orbitf suggesting aggressive
3. Irregular filling of the salivary duct.
neoplasia extending beyond the orbit.
a. Inflammation.
e. Enlargement of the optic nerve ± protruding
optic disc. b. Neoplasia.
- Optic neuritis (numerous causes including c. Sialolith.
granulomatous meningoencephalitisf d. Foreign material.
toxoplasmosis*f cryptococcosis*f canine 4. Uneven filling of the salivary gland.
distemperf blastomycosis*f feline infectious a. Insufficient contrast medimn used.
peritonitisf trauma). b. Abscessation of the salivary gland.
c. Neoplasia of the salivary gland (e.g.
adenocarcinoma).
4.40 CONTRAST STU DIES OF d. Salivary gland cyst.
THE SALIVARY D UCTS AND GLANDS e. Infarction of the salivary gland.
(SIALOGRAPHY)
f. Compression of the salivary gland by an
Sialography is occasionally undertaken to charac­ adjacent mass.
terize further the nature of swellings around the
head and neck. A fine cannula is introduced into 4.41 ULTRASONOGRAPHY OF
the appropriate duct opening: THE SALIVARY GLANDS
- parotid (on the mucosal ridge opposite the
The mandibular salivary gland is the only salivary
caudal margin of the upper fourth premolar
gland that can be imaged consistently. It is located
tooth)
superficiallYf caudal to the angle of the mandible.
- zygomatic (about 1 cm caudal to the parotid
UltrasonographicallYf it appears well definedf oval
opening)
and hypoechoic with a more echogenic capsule.
- mandibular (lateral surface of the lingual There may be thin echogenic streaks within the
caruncle at the frenum linguae) substance of the gland.
- sublingual (may be common with the
1. Hypoechoic or anechoic foci in the salivary
mandibular opening or 1-2 mm caudal to it).
gland.
Between 1 and 2 mL of water-soluble iodinated a. Salivary gland cyst.
contrast medium is injected carefullYf taking care b. Salivary gland abscess.
to avoid leakage back around the cannulaf and c. Neoplasm.
radiographs of the appropriate region of the head 2. Echogenic foci in the salivary gland - sialolith
and neck are taken immediately. (often with acoustic shadowing).
1. Salivary duct not filled. 3. Heterogeneous foci in the salivary gland.
a. Inadequate technique. a. Neoplasm.
- Too little contrast medimn used. Benign papillomatous tumour.
- Leakage of contrast back around cannula. - Carcinoma.
110 Handbook of Small Animal Radiology and U ltrasound

b. Salivary gland abscess. a. Acquired hypothyroidism; may be
c. Foreign body reaction (e.g. grass seed in associated with a decrease in echogenicityf
salivary duct). irregular capsule delineation and abnormal
shape.

4.42 U LTRASONOGRAPHY OF THE THYROI D
AND PARATHYRO I D GLANDS 4.43 U LTRASONOGRAPHY OF THE CAROTID
ARTERY AND JU GU LAR VEIN
A high-frequency transducer is required. The two
lobes of the thyroid gland may be identified lying The external jugular veins lie in a groove on the ventro­
dorsolateral to each side of the tracheaf caudal to lateral aspect of the neck. The common carotid arteries
the larynx and medial to the ipsilateral common lie deep to the jugular veinsf bifurcating near the head
carotid artery. OccasionallYf especially in brachy­ into external and internal carotid arteries. The vein is
cephalic dogsf there is a narrow connection or thin-walled and compressiblef with anechoic contentsf
isthmus between the caudal aspects of the two while the arteries have thicker walls and are less com­
lobesf running ventral to the trachea. The lobes pressible. Doppler ultrasoillld may be used to confirm
should be smoothf well defined and finely granu­ the arterial or venous nature of the blood flow.
lar in texture. They are fusiform to elliptical in the 1. Intraluminal mass in the carotid artery or
longitudinal plane and roundf oval or triangular jugular vein.
in the transverse plane. They are usually hyper­ a. Thrombus.
echoic to surrounding muscle but may also be iso­ b. Invasion by adjacent tumour.
echoic or hypoechoic. Each lobe of the normal
2. Multiple abnormal vessels associated with the
thyroid gland in a medium-sized dog is around
carotid artery or jugular vein.
2.5-3 cm long and 0.4-0.6 cm wide and correlates
a. Collateral vessels.
with body weight and surface area. In the catf
the normal dimensions are about 2 cm long and - Secondary to obstruction of normal
vessels.
0.2-0.3 cm wide. The normal parathyroids are
- Supplying an abnormal mass.
sometimes seen as hypoechoic or anechoic foci
2--4.6 mm in diameter; there are two parathyroids b. Arteriovenous malformation.
within each thyroid gland, although they may not - Secondary to trauma.
all be visible. - Secondary to neoplasia.
1. Nodules within the thyroid gland - may be of - Congenital malformation.
variable echogenicity.
a. Thyroid tumour. 4.44 U LTRASONOGRAPHY OF LYM PH
- Adenoma. NODES OF THE HEAD AND N ECK
- Carcinoma.
Most lymph nodes in the head and neck of the dog
b. Parathyroid tumour. and cat are small « 5 mm diameter) and are not
- Adenoma. consistently seen ultrasonographically. Based on
- Carcinoma. work in humansf lymph nodes in the head and
c. Parathyroid hyperplasia. neck are considered enlarged if they exceed 1 cm
d. Thyroid cyst (irregularly marginated cysts in diameter. Enlarged lymph nodes usually remain
with hyperechoic septations may be seen in hypoechoic but may become heterogeneousf espe­
hyperthyroid cats). cially if cavitation occurs. In humansf reactive
2. Enlargement of the thyroid gland. lymph nodes tend to retain their oval or flat shapef
a. Well marginatedf low echogenicity - thyroid while neoplastic lymph nodes are more likely to
adenoma. become round. It is not clear whether this applies
b. Poorly marginatedf heterogeneous mass - to small animals.
thyroid carcinoma; may see invasion 1. Enlarged lymph nodes.
of common carotid artery and/or jugular a. Reactive.
veinf and involvement of regional lymph b. Neoplasia.
nodes. - Lymphoma.
3. Decrease in size of the thyroid gland. - Metastases.
Chapter 4 Head and neck 111

4.45 CERVICAL OESOPHAGUS tube during embryonic development. In dogsf der­
moid sinuses are typical in the cervical and dorsal
Disease of the cervical oesophagus is less common
midlinef and the Rhodesian Ridgeback is predis­
than that of the thoracic oesophagusf but the same
posed. Nasal dermoid sinuses have recently been
principles of interpretation apply - see Chapter 8.
recognizedf with extension into the nasal cavity
from a midline dorsal opening. Plain radiographs
4.46 NASAL DERMOID SINUS CYST are usually unremarkablef but the sinus tract can
be demonstrated with sinographYf allowing surgi­
A dermoid sinus is a neural tube defect resulting
cal planning.
from incomplete separation of the skin and neural

Further reading
General McConnell, J.F., Hayes, AM., Platt, S. Craniomandibular osteopathy in
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F., Powers, B.E., LaRue, S.M., hyperostosis syndrome in two Pract. Veterinarian (Small
Withrow, S.J., 1998. Multilobular bullmastiffs. Vet. Radiol. Animal) 17. 911 921.
osteochondrosarcoma in 39 dogs: Ultrasound 47, 72 77.
1979 1993. j. Am . Anim. Hosp. Muir, P., Dubielzig, RR, Johnson, K Temporomandibular joint
Assoc. 34, 11 18. A, Shelton, D.G., 1996. Gemmill, T., 2008. Conditions of
Gibbs, c., 1976. Radiological Hypertrophic osteodystrophy and the temporomandibular joint
refresher: The head part I calvarial hyperostosis. Compend. in dogs and cats. In Pract. 30,
Traumatic lesions of the skull. Contin. Educ. Pract. Veterinarian 36 43.
J. Small Anim. Pract. 17, 551 554. (Small Animal) 18. 143 151. Lane, J.G., 1982. Disorders of the
Johnston, G.R, Feeney, D.A, 1980. Pastor, K.F., Boulay, J.P., Schelling, S. canine temporomandibular joint.
Radiology in ophthalmic H., Carpenter, J.L., 2000. Vet. Ann. 22. 175 187.
diagnosis. Vet. Clin. North Am. Idiopathic hyperostosis of the Meomartino, L., Fatone, G., Brunetti, A.,
Small. Anim. Pract. 10, 317 337. calvaria in five young Lamagna, F., Potena, A., 1999.
Konde, L.}., Thralt MA., Gasper, P., bullmastiffs. J. Am. Anim. Hosp. Temporomandibular ankylosis in
Dial, S.M., McBiles, K, Colgan, S., Assoc. 36, 439 445. the cat: a review of seven cases. J.
et al., 1987. Radiographically Spaulding. K.A.. Sharp. N.j.H 1990.
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associated with mucopoly lateral cerebral ventricles in the mandibular ankylosis in the cat. J.
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28. 223 228.
Maxilla and premaxilla Ear
Cranial cavity Featherstone, H., Llabres Diaz, F., Benigni, 1., Lamb, C, 2006.
Garosi, L.S., Penderis, J.P., Brearley, M. 2003. Maxillary bone epithelial Diagnostic imaging of ear disease
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Intraventricular tension Frew, D.G., Dobson, J.M., 1992. BischofC M.G., Kneller, S.K., 2004.
pneumocephalus as a complication Radiological assessment of 50 cases Diagnostic imaging of the canine
of transfrontal craniectomy: of incisive or maxillary neoplasia in and feline ear. Vet. Clin. North
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Ultrasonographic anatomy of the Gibbs, C, 1977. Radiological the external ear canal in dogs. Vet.
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Chapter 4 Head and neck 1 13

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Solano, M., Penninck, D.G., 1996. Ultrasonography of the thyroid Dacryocystorhinography in the
Ultrasonography of the canine, and para thyroid glands. Vet. dog. J. Am . Vet. Med. Assoc. 159,
feline and equine tongue: normal elin. North Am. Small. Anim. 1417 1421.
finding and case history reports. Pract. 28, 973 992.
115

Chapter 5

Spi n e

5.20 Changes on plain radiographs that are unlikely
CHAPTER CONTENTS to be significant 1 40
5.1 Radiographic technique for the spine 115 5.21 Neurological deficits involving the spinal

5.2 Variations in vertebral number 116 cord or proximal nerve roots with normal plain

5.3 Variations in vertebral size and shape: radiographs and myelogram 1 40
congenital or developmental 117
5.4 Variations in vertebral size and shape:
acquired 1 19
5.5 Variations in vertebral alignment 1 22 5 .1 RADIOGRAPHIC TECHNIQUE FOR THE SPINE
5.6 Diffuse changes in vertebral opacity 1 24 Optimal radiographs are obtained with the patient
5.7 Localized changes in vertebral opacity 1 24 under sedation or general anaesthesia to minimize
5.8 Abnormalities of the intervertebral motion blur and allow accurate positioning.
disc space 1 26 True lateral and ventrodorsal (VD) positioning
5.9 Irregularity of the vertebral endplates 12 7 should be ensured by the use of positioning aids
5. 1 0 Abnormalities of the intervertebral (Fig. S.lA-D). At the lumbosacral junction, a VD
foramen 1 28 radiograph obtained with the area flexed may also
5. 1 1 Abnormalities of the articular facets 1 29 be helpful. In the cervical spinef oblique views
5. 1 2 Lesions in the paravertebral soft increase the visibility of the intervertebral foraminaf
tissues 1 30 the dens (odontoid peg) and the occipital condyles.
5. 1 3 Ultrasonography of paravertebral soft Horizontal VD views are desirable when severe
tissues 1 30 instability or spinal fractures are suspected to avoid
5. 1 4 Spinal contrast studies: technique and additional injury on manipulation of the patient.
normal appearance 131 Detail intensifying screens are preferredf and a grid
5. 1 5 Technical errors during myelography 1 33 should be used if the tissue thickness is greater than
5. 1 6 Extradural spinal cord compression on 10 cm. Close collimation will also improve image
myelography 1 34 definition by reducing the production of scattered
5. 1 7 Intradural-extramedullary spinal cord radiation. If neurological deficits are present or if
compression on myelography 1 37 disc disease is suspectedf the primary beam must
5. 1 8 Intramedullary spinal cord enlargement be centred at the level of the suspected lesion.
on myelography 1 38 Myelography used to be the most commonly
5. 1 9 Miscellaneous myelographic findings 13 9 used contrast medium technique for the evaluation
of the spinal cord or cauda equina but in many

© 2010 Els�yi�r Ltd.
116 Handbook of Small Animal Radiology and U ltrasound

Incorrect

CA) CC)

Correct

®
Figure 5.1 Achieving accu rate positioning with the use of foam wedges.

establishments is being replaced by cross-sectional 5.2 VARIATIONS IN VERTEBRAL N U M B E R
imaging techniques. Myelography is discussed fur­
The normal vertebral formula in the dog and cat is
ther in Section 5.14. Epidurography, discography
7 cervicat 13 thoracicf 7 lumbarf 3 sacral and a
and lumbar sinus venography are additional tech­
variable number of caudal vertebrae. Nmnerical
niques that are sometimes still used to evaluate the
alterations may be genuine or may be accompanied
cauda equina but that are also becoming obsolete.
by other congenital vertebral abnormalitiesf which
Linear tomography is useful in the thoracic and
may result in apparent vertebral number altera­
hunbosacral regions to eliminate superimposition
tions (transitional vertebrae - see 5.3.2).
of the ribs and ilial wingsf respectively. Cross­
sectional images can be obtained by means of CT 1. Six or eight lumbar vertebrae (especially
and MRI; CT provides better definition of bone Dachshund).
and joint abnormalitiesf whereas MRI provides high 2. Four sacral vertebrae - vestigial disc spaces may
soft tissue contrast and is ideal for cases with no be visible.
survey film abnormalitiesf such as spinal hunoursf 3. Twelve thoracic vertebrae.
early infection and ligamentous pathology. CT mye­ a. Twelve genuine thoracic vertebrae and seven
lography can be performed to increase the informa­ lumbar vertebrae.
tion given about changes in cord size. Scintigraphy b. T13 lacks ribsf giving the appearance of 12
is occasionally used to identify the location of thoracic and 8 lmnbar vertebrae.
inflammatory or neoplastic processes but gives little 4. Fourteen thoracic vertebrae - usually due to the
anatomical detaiL presence of rib-like structures on L1 rather than
Optimal interpretation of spinal radiographs a genuine increase in nmnber.
requires a systematic evaluation that involves 5. Inherited short tail (brachyury) in the Manx
assessing radiographic quality and techniquef cat Cstumpiesf) and certain dog breedsf
extravertebral soft tissue structuresf osseous verte­ including the Pembroke Welsh Corgif Brittany
bral structuresf disc spaces and adjacent vertebral Spaniet Bouvier des Flandresf Swedish
endplatesf intervertebral foramina and articular Vallhund and Polish Lowland Sheepdog. In
facets. Each vertebraf disc space and intervertebral the Manx catf other spinal deformities are
foramen should be compared with those adjacent often associated.
to them. Disc spaces normally appear narrower 6. Inherited taillessness (anury); especially the
towards the periphery of the film due to diver­ Manx cat Crumpiesf)f and associated with other
gence of the primary X-ray beam. spinal deformities (see 5.3.20).
Vertebral physes should be closed by 38 weeks, 7. Perosomus elumbis - rare neuroskeletal
with cranial physes closing before caudal physes. congenital defect in which there is agenesis of
The apex and body of the dens (odontoid peg) have the lumbosacral spinal cord and vertebraef with
separate ossification centres and are completely associated pelvic limb deformities; mainly cattle
ossified by 25 weeks. but has been reported in dogs.
Chapter 5 Spine 117

5.3 VARIATIONS I N VERTEBRAL SIZE AND
SHAPE : CONGENITAL OR DEVELOPMENTAL
More than one abnormality may be present.
1. Normal variants.
a. The neural arch of Cl is often short in toy
breeds of dog.
b. C7 and L7 may be shorter than the adjacent
vertebrae.
c. The ventral margins of L3 and L4 vertebral
bodies are often poorly defined due to bony
roughening a t the origins of the
diaphragmatic crura.
2. Transitional vertebrae - these are vertebrae
that have anatomical features of two adjacent
regions. They are commonly seen and may
accompany numerical abnormalitiesf but other
than those at the lumbosacral junction they are
not usually clinically significant. The
transitional segment may show illlilateral or
bilateral changes.
a. Sacralization of the last lumbar vertebra
(Fig. 5.2A) - one or both transverse
processes fuse to the wing of the sacrum and
may also articulate with the ilimn.
Asymmetrical and symmetrical transitional
vertebrae have roughly equal incidence. ®
This may predispose to lumbosacral
Figure 5.2 Transitional vertebrae: (A) at the lum bosacral
instability and disc degeneration with junction, with a transverse process at one side and
secondary cauda equina syndrome. If articulation with the ilium on the other; (8) at the
rotational malalignment is presentf it may thoracolumbar junction, with one rib and one transverse
also predispose to unilateral hip dysplasia process.
and result in an inability to obtain pelvic
symmetry during positioning for hip
dysplasia radiographs; this is more likely d. Transitional T13 vertebra (Fig. 5.2B) - a rib
to occur with unilateral sacralization. develops into a transverse process; a
Common in the German Shepherd dog vestigial rib may be seen as a mineralized
but also in the Dobermannf Rhodesian line in the soft tissues.
Ridgebackf Greater Swiss Mountain dog e. Transitional Ll vertebra - a transverse
and Brittany Spaniel. process elongates and develops into a
b. Lumbarization of SI vertebraf which fails to rib-like structure; also common in cats.
fuse to the rest of the sacrum (Fig. 5.2A); f. Transitional C7 vertebra - a transverse
appears similar to the above process elongates and develops into a
radiographically and may be differentiated rib-like structure.
only by counting the number of normal g. Occipitalization of the atlas.
adjacent vertebral segments. 3. Hemivertebrae (Fig. 5.3) - malformation of the
c. Partial or complete fusion of S3 to Cdl; also vertebral body; a common abnormality in
common in catsf particularly Burmese. the thoracic and tail regionsf particularly in
Pseudoarticulation of the transverse screw-tailed breeds and the German Short­
processes may be present. Often seen with haired Pointer. Rare in cats. Multiple vertebrae
(b) in an attempt to restore three sacral are often affected. Clinical signs (neurological
segments. deficits due to spinal cord compression) are
118 Handbook of Small Animal Radiology and U ltrasound

to partial sagittal cleavage of the vertebral
body.
6. Incomplete fusion of sacral segments.
7. C2 - dens (odontoid peg) abnormalities.
a. Agenesisf hypoplasia or non-fusion leading
to atlantoaxial instability (see 5.5.5).
b. Dorsal angulation of the dens.
c. Cats - aplasiaf hypoplasia or irregular
ossification may occur in
Figure 5.3 Typical m id-thoracic hemivertebra: a wedge­
mucopolysaccharidosis (see 5.4.9).
shaped vertebral body resulting in kyphosis and narrowing of
the vertebral canal.
8. Cervical spondylopathy (wobbler syndrome; see
5.4.20 and Fig. 5.5) - especially Dobermann.
uncommon and usually occur in the first year Malformed caudal cervical vertebraef often with
of life during the growth phase. a plough-share appearance of the centrum and
a. Dorsal hemivertebra - ventral half did not wedge-shaped disc spaces; the neural arch may
develop, producing kyphosis. also be angled cranioventrallYf and both of these
b. Lateral hemivertebra - left or right half did result in vertebral canal stenosis. Spinal cord
not developf producing scoliosis. compression may be worsened on flexion of the
c. Ventral hemivertebra - dorsal half did not neck due to vertebral instabilitYf creating a
developf producing lordosis. dynamic lesion. Howeverf neurological signs are
4. Block or fused vertebrae - usually only two seen in young animals only when stenosis is
and rarely three segments are fused - reduced severe. See 5.4.14 for description of acquired
or absent disc space with vertebrae of normal changes.
9. Narrowed vertebral canal (spinal stenosis) -
length. The degree of fusion varies. The
increased stress on adjacent disc spaces needs myelography or MRI to demonstrate the
predisposes to subsequent disc herniation. degree of cord compression.
Differential diagnoses are old traumaf healed a. Secondary to hemivertebrae or block
discospondylitis. vertebrae.
a. Lumbar region. b. Cervical spondylopathy (wobbler
syndrome; Fig. 5.5).
b. Cervical region.
c. Thoracic stenosis.
5. Butterfly vertebrae (Fig. 5.4) - particularly
- T3-6 usually with no cord compression -
brachycephalic breeds of dog; rare in cats.
Dobermann.
Unlikely to cause clinical signs. Seen on the - Individual thoracic vertebrae - Bulldog.
VD viewf particularly in the caudal thoracic
and caudal lumbar regions as a cleft of the
cranial and caudal vertebral endplates due

Figure 5.5 Typical vertebral malformation seen with cervical
spondylopathy (wobbler syndrome): deformity and u pward
tilting of the vertebral body and low position of the neural
arch resu lting in vertebral canal stenosis. Subluxation may
Figure 5.4 Butterfly vertebrae seen on the ventrodorsal view. occu r with neck flexion.
Chapter 5 Spine 1 19

d. Congenital lumbosacral stenosis in small 16. Other occasional complex vertebral anomaliesf
and medium-sized dogs. especially in the cervical area.
10. Sacral osteochondrosis - clinical signs not 17. Articular facet aplasia.
usually apparent until skeletally mature (see a. Cervical.
5.4.16 and Fig. 5.8). b. Thoracolumbarf often with hyperplasia of
11. Congenital metabolic disease affecting the adjacent facet.
vertebrae at a young age. 18. Idiopathic multifocal osteopathy of the Scottish
a. Pituitary dwarfism - especially German Terrier (see 1.18.7); absence of parts of
Shepherd dog; proportionate dwarfism ± vertebrae may occurf particularly dorsally in
epiphyseal dysgenesis. the cervical spine.
b. Congenital hypothyroidism - especially 19. Perocormus - severe shortening of the
Boxer; disproportionate dwarfism with vertebral colurrm.
epiphyseal dysgenesis leading in the spine 20. Cats - sacrococcygeal (sacrocaudal)
to delayed vertebral endplate ossification dysgenesis; varies from spina bifida to
and growth plate closure; endplates may complete sacrococcygeal agenesis. Especially
show characteristic ventral spikes. in Manx catsf in which it may be accompanied
Pathological fracture through an illlfused by other anomalies such as shortened cervical
growth plate has been reported. Long bone vertebraef butterfly vertebraef fusion of hunbar
changes also occur (see 1.22.9). vertebrae and meningo(myelo)cele.
12. Fused dorsal spinous processes. 21. Cats - mucopolysaccharidosis - congenital
13. Spina bifida - results in a split or absent dorsal lysosomal storage diseasef although signs may
spinous process or absent laminaf most cmnmon not manifest until later in life (see 5.4.9).
in the caudal hunbar region; especially the
Bulldog and rare in cats. A widened vertebral
5.4 VARIATIONS IN VERTEBRAL SIZE AND
canal may be seen on the lateral view. May be
SHAPE : ACQU IRED
accompanied by spinal dysraphismf a defective
closure of the neural tube. Myelography is For articular facet variationsf see 5.11.
required to assess soft tissue changes.
a. Spina bifida occulta - normal spinal cord and Increased vertebral size
intact skin. Common in short-tailed breeds.
b. Meningocele - herniated meningesf skin 1. Spondylosis deformans - varying sizes of
intact. ventral and lateral bony spurs that may
c. Myelomeningocele - herniated spinal cord bridge the disc space (Fig. 5.6). Usually
and meningesf skin intact. clinically insignificant unless so extensive as
d. Spina bifida manifesta - herniated spinal to result in nerve root involvement; at the
cord and meninges exposed to the exterior. lumbosacral junction it may be associated
e. Spina bifida cystica - herniated spinal with other pathology and cauda equina
cord and meninges elevated above syndrome.
the skin. a. Initiated by degeneration of annulus
14. Dermoid (pilonidal) sinus - occasionally fibrosus - an incidental finding that may
associated with defects in the dorsal spinous start as young as 2 yearsf is very common
process or neural archf if the sinus tract and increases in incidence with age; less
extends to the dura (see 5.7.4). common and generally milder in cats.
15. Occipitoatlantoaxial malformations -
combinations of abnormalities including
occipital dysplasiaf fusion of the occiput to the
atlasf short atlas neural archf deformities of
the dens and atlantoaxial subluxation; clinical
signs depend on the degree of resulting cord
compressionf and some may be clinically Figure 5.6 Varying degrees of spondylosis: small spurs of
silent. new bone progressing to ankylosis.
1 20 Handbook of Small Animal Radiology and U ltrasound

Ll LJ LJ
b. Secondary to:
- chronic disc herniation
- cervical spondylopathy (wobbler
syndrome)
- disc fenestration
- discospondylitis 000
- hemivertebrae
® CC)
- fracture or luxation injuries.
Figure 5.7 New bone on the ventral margins of vertebral
c. Syndesmitis ossificans - extensive bodies due to local neoplasia (usually L5-7) or spondylitis
ossification of the ventral longitudinal (usually L1-3). The new bone may be brushlike (A), lamellar
ligament - young Boxers. (8) or solid (C). See 1.6 for further description of periosteal
2. Fracture and enlarged vertebra due to callus reactions.
formation.
a. Trauma.
b. Pathological fracture (extensive callus 4. Spondylitis (Fig. 5.7) - usually characterized by
unlikely). vertebral body periosteal reactionsf
- Nutritional secondary particularly ventrallYf and may progress to
hyperparathyroidism Guvenile osteomyelitis of the vertebral body.
osteoporosis - see 1.16.4). ConverselYf osteomyelitis may also originate
- Osteolytic tumour (e.g. plasma cell haematogenously within the vertebra and
myeloma). extend peripherally. Note that the ventral
- Bone cyst (see 1.19.2 and 3). margins of L3 and L4 are often poorly defined
3. Neoplasia. due to bony roughening at the origins of the
diaphragmatic cruraf and this should not be
a. Benign neoplasia or disorder of skeletal
mistaken for spondylitis.
development.
a. Bacterial.
- Single osteochondroma or multiple
cartilaginous exostosesf often producing - Migrating plant material - especially
expansile lesions of the dorsal spinous ventral to Ll-3 (T13-L4). Medium and
processes in young animals. Growth large-sized dogs are thought to aspirate
ceases at skeletal maturity in dogsf but vegetation such as grass awnsf which
lesions may continue to grow after the migrate through the lung and diaphragm
active growth phase in cats (see 1.15.2). to the origin of the crura at L3 and L4;
Malignant transformation to osteosarcoma an alternative proposed route is via
or chondrosarcoma has been reported. penetration of the gastrointestinal tract.
b. Malignant neoplasia. May be associated with para spinal
abscessationf and such changes may be
- Osteosarcoma.
visible with ultrasonography (see 5.13).
- Other primary or metastatic tumours.
- Other foreign bodies.
c. Hindquarter soft tissue tumours resulting
- Haematogenous infection.
in ventral periosteal reaction on caudal
- Bite wounds.
lumbar and sacral vertebrae (Fig. 5.7;
differential diagnosis is spondylitis - see - Iatrogenic due to surgical complications.
belowf but neoplastic changes are usually b. Parasitic.
more caudal). The new bone is not - Spirocerca lupi'" - spondylitis of mid­
necessarily neoplastic but is a reaction to thoracic vertebrae (T5-11); with caudal
local malignancy. mediastinal (oesophageal) mass (see 8.19.5).
- Prostatic tumour - the most common c. Fungal.
cause of such new bone. - Actinomycosis"'.
- Bladder or urethral tumour. Coccidiodomycosis"'.
- Perianal tmnour. Aspergillosisf'" especially German
- Mammary tumour. Shepherd dogs.
Chapter 5 Spine 121

d. Protozoal. b . Pathological fracture.
- Hepatozoonosis* - there may be extensive - Nutritional secondary
new bone formationf including other hyperparathyroidism Guvenile
bones of the body (see 1.14.2). osteoporosis) (see 1.16.4).
5. Disseminated (diffuse) idiopathic skeletal - Osteolytic tumour (e.g. plasma cell
hyperostosis - similar to the disease of the same myeloma); may be subtlef so compare
name in humans and seen in large and giant with adjacent vertebrae.
dogs; the main changes are in the spinef with - Severe spondylitis.
extensivef flowing new bone formation along 11. Discospondylitis - osteolysis of vertebral
the ventral and lateral margins of the vertebral endplates eventually results in a shortened
bodies and at sites of ligamentous attachments; vertebral bodYf with secondary spondylosis
also extremital periarticular new bone and deformans and even fusion in the later stages
enthesiophyte formation. Aetiology unknown (see 5.9.1 and Fig. 5.10).
but appears to represent an exaggerated 12. Indented vertebral endplates.
response to stimuli that would normally induce a. Intravertebral disc herniation (Schmorrs
littlef if anYf new bone formation and may be node) - particularly L7 and/or Sl; medium
considered to be an ossifying diathesis. and large breedsf especially German
6. Baastrup's disease - bony proliferation Shepherd dog.
between dorsal spinous processes. Larger dog b. Nutritional secondary hyperparathyroidism
breeds, especially Boxer. Guvenile osteoporosis) - the central part of
7. Aneurysmal bone cyst (see 1.19.3). the endplate is indented by the nucleus
8. Cats - hypervitaminosis A; extensive new bone pulposus while the bones are soft and then
formation on cervical and cranial thoracic remains for life.
vertebrae and rarely further caudally. Mainly 13. Mucopolysaccharidosis; the vertebrae may be
ventrallYf mimicking severe spondylosisf but shortened or misshapen because dwarfism and
may also involve the sides and dorsum of the epiphyseal dysplasia may be a feature (see
vertebrae. Long bone joints may also be affected 5.4.9).
at sites of soft tissue attaclunentsf especially the
elbow and stifle. Ankylosis of the spine and
affected limb joints may occur. Usually 2- to Altered vertebral shape
9-year-old cats on raw liver diets; differential
diagnosis is mucopolysaccharidosis. 14. Cervical spondylopathy (wobbler syndrome) -
9. Mucopolysaccharidosis; lysosomal storage congenitally malformed ± unstable cervical
vertebrae that may be accompanied at a later
diseases causing new bone on the vertebraef
age by acquired changes such as remodelling
which may lead to spinal fusionf and endplate
of the centrumf endplate sclerosisf spondylosis
dysplasia; also dwarfismf facial deformitYf
and secondary disc herniation. Especially
pectus excavatumf hip dysplasia and
Dobermann (see 5.3.8 and Fig. 5.5). Most cases
epiphyseal dysplasia leading to
present in middle age due to secondary disc
osteoarthrosis. More common in catsf
herniationf although in cases of severe
especially those with Siamese ancestry; rare in
deformity neurological signs are evident at a
the dog; differential diagnosis is
younger age. If MRI is not availablef
hypervitaminosis A. Mucopolysaccharidosis
myelography is required to demonstrate
type VII has been reported to cause shortened
acquired soft tissue changes and to quantify
vertebral bodies and irregular vertebral
the degree of cord compressionf which may be
epiphyses as well as disproportionate
due to primary bony deformity or to secondary
dwarfism in a German Shepherd dog.
disc herniationf facet arthrosis or ligamentum
Decreased vertebral size flavum hypertrophy or redundancy (see also
5.16.3-5, 5.16.7 and 5.16.8).
10. Fractures - may result in shortened vertebra 15. Fractures - the vertebrae may be misshapen
due to compression. due to malunion or asymmetric compression.
a. Trauma. a. Trauma.
1 22 Handbook of Small Animal Radiology and U ltrasound

- VD view; medially deviating pedicles of
the caudal vertebral canat particularly in
the Great Dane and Boerboel.
b. Expansile or healing lesions of adjacent bone.
c. Lumbosacral stenosis.
d. Calcium phosphate deposition disease in
Figure 5.8 Sacral osteochondrosis: there is remodelling and Great Dane pups - dorsal displacement of
sclerosis of the craniodorsal aspect of the sacral end plate C7 accompanied by deformation of the
with an overlying osteochondral fragment. articular facets.

b. Pathological fracture.
- Nutritional secondary hyperparathyroidism
5 .5 VARIATIONS IN VERTEBRAL
ALIGNM ENT
Guvenile osteoporosis).
- Osteolytic tumour (e.g. plasma cell The floor of the vertebral canal of adjacent verteb­
myeloma). rae should form a continuous straight to gently
- Bone cyst (see 1.19.2 and 1.19.3). curved line. Malalignment may be constant and
- Vertebral physitis. visible on survey radiographsf or intermittent and
16. Sacral osteochondrosis (Fig. 5.8) - require radiographs made while the region is
remodelling (angulation, lipping, bone defect, flexed or extended (stress radiography) to demon­
subchondral sclerosis) of the craniodorsal strate instability.
aspect of SI and rarely the caudodorsal aspect 1. Scoliosis (lateral curvature).
of L7 ± an osteochondral fragment; mainly a. Muscular spasm.
young male German Shepherd dogs but also b. Congenital vertebral abnormalitiesf for
Boxers and Rottweilers. On the VD viewf example hemivertebrae (see 5.3.3 and Fig. 5.3).
seen to be paramedian or bilateral rather than c. Pathological fracture.
midline. Myelography may show deviation d. Spinal cord abnormalities leading to
or compression of the dural sac. Although a functional scoliosis.
developmental diseasef clinical signs are - Dandy-Walker syndrome.
not usually seen until > 18 months of age.
- Spinal dysraphism - Weimaraner.
17. Neoplasia (see 5.4.3).
- Syringohydromyelia; especially Cavalier
18. Mucopolysaccharidosis (see 5.4.9).
King Charles Spaniel.
2. Lordosis (ventral curvature).
Vertebral canal changes
a. Normal conformational variant.
19. Widened vertebral canal. b. Muscular spasm.
a. Normal at the level of the cervical (C5-T2) c. Congenital vertebral abnormalitiesf for
and lumbar (L2-5) intumescentia. example hemivertebrae (see 5.3.3 and
b. Enlarged spinal cord due to chronic Fig. 5.3), although kyphosis is more common.
pathology. d. Loss of fibrotic vertebral support - old and
- Tumour (e.g. slow-growing astrocytomaf heavy dogs.
ependymomaf meningioma). e. Pathological fracture.
- Syringohydromyelia, especially at the f. Nutritional secondary hyperparathyroidism
level of C2; common in the Cavalier King Guvenile osteoporosis)f especially caudal
Charles Spaniel. lumbar spine (see 1.16.4).
c. Spinal arachnoid pseudocyst. 3. Kyphosis (dorsal curvature).
20. Narrowed vertebral canal. a. Normal conformational variant.
a. Cervical spondylopathy (wobbler syndrome). b. Muscular spasm.
- Lateral view; dorsoventral narrowing c. Congenital vertebral abnormalitiesf for
at the cranial end of the affected example hemivertebrae (see 5.3.3 and
vertebra. Fig. 5.3).
Chapter 5 Spine 1 23

d. Thoracolumbar disc disease.
e. Discospondylitis.
f. Pathological fracture.
g. Nutritional secondary hyperparathyroidism
Guvenile osteoporosis) (see 1.16.4).
4. Trauma: a three-compartment model may be
used to assess the stability of spinal fractures.
Each vertebra is divided into a dorsal
compartment (articular processesf spinous
processesf laminaef pediclesf supporting soft
tissues)f a middle compartment (dorsal
longitudinal ligamentf dorsal part of annulus
fibrosusf dorsal aspect of vertebral body) and a
ventral compartment (remainder of vertebral
body and annulus fibrosusf nucleus pulposusf
ventral longitudinal ligament). If two of the
three compartments are damagedf the fracture
is considered to be unstable. eT is more
®
reliable than radiography for determination of Figure 5.9 Atlantoaxial subluxation. (A) In the lateral view
the extent of spinal fractures. Remember that of a normal spine, the spinous process of C2 overhangs the
arch of Cl, producing a comma-shaped intervertebral
bony displacement at the time of injury may
foramen*; no sign ificant alteration is seen on flexion. (8) In
have been greater than is recognized
cases of atlantoaxial instability, abnormal flexion occurs at
radiographicallYf having been reduced again
this joint and the intervertebral foramen is wide. I n the case
by muscle spasm. Subsequent callus formation
shown here, C2 lacks a dens.
may cause worsening of neurological deficits
some time after the injury. Small chip fractures
may also be seen due to avulsion of soft tissue pain and varying degrees of motor dysfunction
attachments. result.
a. Fracture. a. Congenital atlantoaxial instability - younger
b. Subluxation. miniature and toy breeds (especially
Yorkshire Terrierf Toy Poodlef Chihuahuaf
c. Luxation.
Pomeranian and Maltese)f rarely large-breed
d. Salter-Harris type I or 11 fracture through
dogs. May present clinically at a later age due
vertebral physis in immature animat with
to superimposed minor trauma.
displacement of the epiphysis.
- Aplastic dens.
5. Atlantoaxial subluxation (Fig. 5.9) - abnormal
- Hypoplastic dens.
alignment of C2 (axis) relative to Cl (atlas),
- Non-fusion of the dens to C2 (fusion
which results in widening of the intervertebral
normally completed at 6 months).
space between the neural arch of Cl and the
- Absence of the dens ligaments.
cranioventral aspect of the spine of C2f
exacerbated by mild neck flexion (note that - Cats - dens agenesis resulting from
subtle widening of this space occurs in normal mucopolysaccharidosis (see 5.4.9).
subjects on flexion). Dorsal subluxation of C2 b. Acquired.
may also occur. Marked flexion must be - Fracture of the dens or cranial part of CL
avoidedf as it may cause spinal cord damage in - Rupture of the transverse ligament of the
the presence of instability. Usually due to atlas, which normally holds the dens
defects of the dens (odontoid peg), evaluation of against the floor of that vertebra.
which is best achieved on oblique or VD views 6. Cervical spondylopathy (wobbler syndrome)
of the neck. The rostrocaudal open mouth view (see 5.3.8 and Fig. 5.5) - mainly Dobermann.
has been described for evaluation of the dens a. Static - malformed caudal cervical vertebrae
but in the presence of instability is likely to with craniodorsal subluxation (tipping)
cause spinal cord damage. Clinical signs of neck of one or more vertebrae and a
1 24 Handbook of Small Animal Radiology and U ltrasound

dorsoventrally narrowed cranial vertebral g. Pseudohyperparathyroidism;
canal opening. Often accompanied by hypercalcaemia of malignancy.
wedge-shaped or narrowed disc spaces and h. Osteogenesis imperfecta - long bone
spondylosis. changes usually predominate.
b. Dynamic - malalignment worsens with 3. Senile osteoporosis - especially aged cats.
ventroflexion of the neck. 4. Neoplastic.
7. Lumbosacral instability - step formation a. Plasma cell myeloma (multiple myeloma) -
between the last lumbar and first sacral genuine osteopenia as well as multiple
vertebrae. May be seen only on stress osteolytic lesions (see 1.18.2).
radiography of the region. Common in the 5. Cats - hypervitaminosis A (raw liver diets);
German Shepherd dogf in which transitional although proliferative bony changes
lumbosacral vertebrae may predispose to predominate and mask the osteopenia (see
instability; may progress to degenerative 5.4.8).
lumbosacral stenosis and cauda equina 6. Cats - mucopolysaccharidosis; likewise (see
syndrome (see 5.16.6 and Fig. 5.17). 5.4.9).
S. Calcimn phosphate deposition disease in Great
Dane pups - dorsal displacement of C7
accompanied by deformation of the articular
Generalized increase in radiopacity of the
vertebrae (see also 1 . 1 3, Increased
facets.
radiopacity within bone)

5.6 DIFFUSE CHANGES I N VERTEBRAL 7. Artefactual generalized increase in vertebral
O PACITY radiopacity.
a. Underexposure.
Generalized decrease in radiopacity of the b. Underdevelopment.
vertebrae (see also 1 . 1 6, Osteopenia)
S. Osteopetrosis-osteosclerosis complex -
1. Artefactual generalized decrease in vertebral hereditary in the Basenji.
radiopacity. 9. Fluorosis.
a. Overexposure. 10. Cats - feline leukaemia virus-associated
b. Long-scale exposure techniques (high kV, medullary sclerosis.
low mAs).
c. Obese or large patients creating large 5.7 LOCALIZED CHANGES IN VERTEBRAL
amounts of scattered radiationf especially if OPACITY
a grid was not used or with inadequate
collimation. Localized decrease in radiopacity of one or
d. Overdevelopment. more vertebrae (see also 1 . 1 B, Osteolytic
e. Fogging of the film (numerous causes). lesions and 1 . 1 9, Expansile osteolytic
lesions)
2. Metabolic bone disease.
a. Secondary hyperparathyroidism. 1. Artefactual localized decrease in vertebral
b. Primary hyperparathyroidism. radiopacity.
c. Corticosteroid excess. a. Superimposed skin defectf bowel or lung air
- Hyperadrenocorticism - Cushingf s on rotated lateral or VD views.
disease. b. Superimposed subcutaneous gas.
- Iatrogenic - long-term corticosteroid 2. Decreased radiopacity of the vertebral endplate.
administration. a. Discospondylitis - endplate also irregularf
d. Hyperthyroidism. and sclerotic in chronic cases (see 5.9.1 and
e. Diabetes mellitus. Fig. 5.10).
f. Congenital hypothyroidism - especially b. Neoplasia (see below).
Boxer; delayed closure of vertebral physes c. Intravertebral disc herniation (Schmorrs
and dysgenesis of endplates. node) - particularly at L7 and/or 51;
Chapter 5 Spine 1 25

medium and large breedsf especially g. Dermoid or epidermoid cyst.
German Shepherd dog. h. Post surgery (e.g. hemilaminectomy bone
3. Irregular or discrete radiolucencies - single or defect).
multiple radiolucent areas involving single or 4. Linear radiolucencies.
multiple vertebrae and that may be a. Fractures.
accompanied by bone production. Pathological b. Widened vertebral physis.
fracture may occur.
- Salter-Harris growth plate fractures
a. Primary tumour - usually only one vertebra
in skeletally immature animals.
involved; less common than neoplasia in the
- Vertebral physitis - haematogenous
appendicular skeleton; often primarily
infection in yOilllg dogsf affecting
osteolytic.
mainly caudal lumbar physesf where
- Osteosarcoma.
blood flow is sluggish; may be
- Fibrosarcoma. associated with portosystemic shunts.
- Chondrosarcoma. Congenital hypothyroidism - delayed
- Haemangiosarcoma. closure of vertebral physes with
- Solitary plasma cell myeloma - dysgenesis of endplates; especially Boxer
characteristic punched-out appearance (see 1 .22.9 and 5.3.11).
with little surrounding reaction. c. Dermoid (pilonidal) sinus extending from
- Others. the dorsal midline usually to cervical or
b. Metastatic or multifocal tmnours - may cranial thoracic vertebrae; especially
involve multiple vertebrae or other bones; in young Rhodesian Ridgebacksf in which it
often primarily osteolytic. shows autosomal recessive inheritance;
- Multiple myeloma (plasma cell sporadic in other breeds. Variable depthf in
myeloma). some cases extending to the dural sac either
- Lymphoma. through the interarcuate space or via a
- Histiocytic sarcoma (malignant neural arch defectf the latter appearing as a
histiocytosis) - especially Rottweilerf linear radiolucency. Clinical signs occur if
Bernese Mountain dogf Golden Retrieverf the sinus involves the meninges and/or
Flat-coated Retriever. becomes infected. Sinography using non­
- Metastases fromf for examplef prostaticf ionic contrast medium may be used to detect
mammaryf thyroid carcinomas; the depth of the sinus.
osteosarcoma.
c. Infiltrative soft tissue tumours - may Localized increase in radiopacity of one or
involve more than one vertebraf or a more vertebrae
vertebra and adjacent bone (ribf pelvis);
5. Artefactual localized increase in vertebral
an adjacent soft tissue mass may be
radiopacity.
evident.
a. Superimposed structures (e.g. extrudedf
- Haemangiosarcoma.
mineralized disc material superimposed
- Lymphoma.
over neural arch).
- Fibrosarcoma. b. Underexposure of thicker areas of tissue.
- Rhabdomyosarcoma.
6. Inflammation or osteomyelitis - it may not
- Others. be possible to differentiate periosteal new
d. Benign hrrnours - osteochondroma or bone superimposed over the vertebra from
multiple cartilaginous exostoses may increased density of the bone itself (sclerosis).
produce expansile osteolytic lesions a. Spondylosis.
(see 1.15.2). b. Discospondylitis.
e. Severe spondylitis - osteolysis and
c. Spondylitis.
pathological fracture are reported with
systemic aspergillosis*. 7. Neoplasia - although osteolysis usually
f. Aneurysmal bone cyst. predominatesf areas of increased radiopacity
1 26 Handbook of Small Animal Radiology and U ltrasound

may also be visible and some tumours are 5.8 ABNORMALITIES OF THE
genuinely sclerotic. INTERVERTEBRAL DISC SPACE
a. Osteogenic osteosarcoma.
b. Chondrosarcoma. 1. Disc space widened.
c. Osteochondroma or multiple cartilaginous a. Normal variants.
exostoses (see 1.15.2). - Lumbar disc spaces are wider than
d. Chordoma has been reported as an thoracic disc spaces.
intramedullarYf mineralized spinal cord - The lumbosacral disc space may be wider
mass that mimicked disc extrusion on plain than adjacent lumbar disc spaces.
radiographs. b. Artefactual widening - traction during stress
8. Fractures. radiography.
a. Compression fracture. c. Apparent widening due to vertebral endplate
erosion.
b. Healed fracture.
- Oiscospondylitis (see 5.9.1 and Fig. 5.10).
9. Vertebral endplate sclerosis. - Osteolytic tumour of adjacent vertebral
a. With collapsed disc space. body.
- Old disc herniationf especially at the Intravertebral disc herniation (Schmorrs
lumbosacral junction. node) - particularly at 1.7 and/or 51;
- Old surgically fenestrated disc. medium and large breedsf especially
b. Relative sclerosis compared with osteopenic German Shepherd dog.
vertebra (see 1.16 for causes). d. Trauma.
c. Chronic discospondylitis (see 5.9.1 and - Subluxation.
Fig. 5.10). - Luxation.
d. Hemivertebra. e. Adjacent to hemivertebra.
e. Adjacent to sacral osteochondrosis; f. Congenital hypothyroidism due to
especially German Shepherd dog (see 5.4.16 epiphyseal dysgenesis; especially Boxer
and Fig. 5.8). (see 5.3.11 and 1.22.9).
10. Ossifying pachymeningitis (dural osseous g. Cats - mucopolysaccharidosis due to
metaplasia - see 5.10.1 and Fig. 5.110). shortened vertebral bodies (see 5.4.9).
11. Vertebral angiomatosis - cats 1-2 years old in 2. Disc space narrowed or of irregular width.
thoracic vertebrae; rare condition in which a
a. Normal at T10-11 (anticlinal junction; Tll is
vascular malformation causes expansion and
usually the anticlinal vertebra).
sclerosis of the pedicles.
b. Artefactual narrowing.
12. Lead poisoning - metaphyseal sclerosis.
- Disc spaces appear to narrow towards the
13. Mineral radiopacity in vertebrae.
periphery of a radiograph due to
a. Bullets and air gun pellets. divergence of the primary X-ray beam.
b. Incorrect microchip placement. - Spine not positioned parallel to cassette as
c. Surgical implants. result of muscular spasm or incorrect
positioning; especially in the mid-cervical
region due to sagging of this area when in
Mixed radiopacity of one or more vertebrae lateral recumbency if not correctly
14. Neoplasia. supported with radiolucent foam wedges
beneath (see Fig. 5.1A and B).
a. Primary.
- On VD viewsf where the disc space is
b. Metastatic.
not parallel to primary beam (e.g. cervical
c. Infiltration from adjacent soft tissue disc spaces and at the lumbosacral
tumour. junction).
15. Osteomyelitis or spondylitis. c. Ageing change in cats - multiple narrowed
a. Bacterial. disc spaces and minor spondylosis often seenf
b. Fungal. especially in the thoracic spine.
Chapter 5 Spine 1 27

d. Herniated disc - spondylosis may be seen k. Narrowf vestigial disc space within a block or
with chronic lesions (note that survey fused vertebra (see 5.3.4).
radiography is unreliable for accurate 1. Adjacent to hemivertebra.
localization of significant disc diseasef as false m. Intravertebral disc herniation (Schmorrs
positives and negatives are common and node) - particularly L7 and/or 51; medium
clinical signs may lateralize to the side and large breedsf especially German
contralateral to the compressive lesion; Shepherd dog.
myelographYf eT or MRI is required prior to 3. Increased radiopacity of the disc space.
surgery). a. Artefactual increased radiopacity.
- Hansen type I disc disease - nucleus
- Superimposed rib or transverse process on
pulposus degeneration of chondroid
lateral radiographs.
metaplasia with calcification occurring in
- Vertebral endplate seen obliquely.
middle-aged chondrodystrophic dogs,
b. Mineralization of the nucleus pulposus in
especially the Dachshund; spinal pain or
chondrodystrophic breedsf sometimes
neurological signs tend to have an acute
beginning at less than 1 year of age and
onset due to rupture of the annulus
mainly around the thoracohunbar jllllction;
fibrosus and extrusion of calcified disc
less often in older dogs of other breeds
material into the vertebral canal. Rare
(usually an incidental findingf especially if
in cats.
in situ with a rounded dorsal margin).
- Hansen type 11 disc disease - nucleus
c. Contrast medium deposition during a
pulposus degeneration of fibrous
discogram.
metaplasia in older dogs of other breeds;
clinical signs are often gradual in onset 4. Increased radiolucency of the disc space.
due to progressive hypertrophy and dorsal a. Gas due to vacuum phenomenon - indicative
protrusion of the annulus fibrosus ± of disc degeneration.
hypertrophy of the dorsal longitudinal - May be consistently present.
ligament. A common incidental finding in - May be present only during traction.
older cats on post-mortem examinationf
although not usually associated with
clinical signs. 5.9 IRREGULARITY OF THE VERTEBRAL
- Combined typef in which a protruding END PLATES
annulus weakens and nuclear material
1. Discospondylitis (Fig. 5.10) - infection or
then extrudes.
inflammation of the intervertebral disc and
- Trauma - acute onset; usually extrusion of
adjacent vertebral endplatesf sometimes with
varying amounts of non-degenerate disc
adjacent soft tissue swelling due to cellulitis or
material.
abscessation; dogs more than cats; especially
e. Cervical spondylopathy (wobbler syndrome)
male large breeds. Infection is usually
with malformed caudal cervical vertebrae;
haematogenousf and a source of infection
disc space cranial to the malformed vertebra
should be sought (e.g. cystitisf prostatitis or
is usually wedge-shapedf apex ventrally.
vegetative endocarditis). Vertebral endplate
f. After surgical fenestration.
osteolysis creates irregular margination of the
g. Associated with advanced spondylosis.
disc spacef which may be either narrowed or
h. Subluxation due to trauma (orthogonal view widenedf and mild subluxation may occur.
may show greater displacement). In the early stagesf the endplates may show
i. Discospondylitis - (see 5.9.1 and Fig. 5.10). decreased radiopacity but later become
- Early phase before vertebral endplate sclerotic with surrounding spondylosis. At the
osteolysis. lumbosacral junctionf early discospondylitis
- Healing phase. must be distinguished from intravertebral disc
j. Collapse of disc space due to adjacent herniation (Schmorl's nodes, see 5.9.6). Survey
vertebral neoplasm. lateral radiographs of the rest of the spine
1 28 Handbook of Small Animal Radiology and U ltrasound

Much less common in dogsf due to thicker
subchondral bone; mainly at the lumbosacral
junction. Seen as a sharply defined indentation
of the vertebral endplatef sometimes with a
sclerotic margin and vacuum phenomenon
in the disc space (see 2.2.13). Speculatively
a cause for fibrocartilaginous embolism.
Not reported in cats but possibly the cause
of 5.9.2 above. Differential diagnosis is
discospondylitisf but more focal and well
defined.
7. Remodelled vertebrae following nutritional
secondary hyperparathyroidism.
8. Sacral osteochondrosis (see 5.4.16 and Fig. 5.8) -
Figure 5.1 0 Discospondylitis: irregularity of the disc space
irregularity of craniodorsal sacral endplate.
due to erosion of adjacent vertebral endplates; secondary
spondylotic new bone and facet arthropathy.
5 . 1 0 ABNORMALITIES OF THE
INTERVERTEBRAL FORAM EN
should be obtainedf as multiple disc spaces may
be involved. Mild spinal cord compression is The lumbar intervertebral foramina are readily
sometiInes presentf demonstrable by seen on the lateral viewsf although the thoracic
myelography or MR!. In severef healed casesf ones are mostly obscured by the ribs. The cervical
adjacent vertebrae may fuse together. intervertebral foramina open ventrolaterally and
a. Bacterial - Staphylococcus aureus most are not seen on the routine lateral view except to
commonly; also S. intermediusf Escherichia colif a limited extent at C2-3. They are best evaluated
Corymbacterium diphtheria, Pasteurella by making a VD radiograph and tilting the spine
multocida, Brucella canis (mainly USA), 45° to the left and right sides.
Streptococcus SPP .f Nocardia asteroides. May be 1. Opacified intervertebral foramen.
secondary to transient immunosuppression a. Normal - superimposition of accessory
with canine parvovirus infection. processes in the thoracolumbar region
b. Fungal - especially Aspergillus* spp. in (Fig. 5.11A).
immilllocompromised German Shepherd dogs. b. Artefactual.
c. Iatrogenic - complication of intervertebral - Superimposed bony rib nodules in the
disc surgery or discogram. thoracic spine.
2. Old cats - indentation of multiple endplates - Superimposed skin opacities.
is commonly seenf especially in the thoracic c. Extrusion of mineralized disc material
spine. (Fig. 5.11B).
3. Congenital hypothyroidism - vertebral - Dorsally into the vertebral canal and
epiphyseal dysgenesis with characteristic therefore superiInposed over the foramen
ventral spikes of bone; especially Boxers on lateral radiographs but difficult to see
(see 1.22.9). on the VD.
4. Mucopolysaccharidosis due to epiphyseal - Laterally into the foramen itselt
dysplasia; especially cats (see 5.4.9). compressing the nerve roots; seen in the
5. Compression fractures. foramen on a VD radiograph.
a. Trauma. d. Dorsally bulging calcified annulus fibrosus
b. Nutritional secondary hyperparathyroidism (Fig. 5.11C).
Guvenile osteoporosis) (see 1.16.4). e. Osteochondral fragment from
6. Sclunorrs nodes - herniation of intervertebral osteochondrosis dissecans at the lumbosacral
disc material into the adjacent vertebral junction (see 5.4.16 and Fig. 5.8).
endplate; well recognized in humansf causing f. Ossifying pachymeningitis (dural osseous
lower back pain rather than neurological signs. metaplasia) - finef horizontal linear opacity
Chapter 5 Spine 1 29

Figure 5.1 1 Intervertebral foramen abnormalities: (A) normal foramen with accessory process*; (8) extruded mineralized
nucleus pulposus in or overlying the foramen; (C) dorsally bulging m ineralized annulus fibrosus; (D) ossifying pachymeningitis;
(E) enlarged foramen due to nerve root neoplasia: (F) small foramen secondary to disc herniation and collapse of disc space.

ventrally or dorsallYf best seen over disc - Callus of a healing or healed vertebral
spaces; an incidental findingf usually older fracture.
dogs of larger breeds (Fig. 5.110). f. Block vertebra (see 5.3.4).
g. Proliferative bony lesions of adjacent
vertebrae (e.g. dorsolateral spondylesf facet 5 .1 1 ABNORMALITIES OF THE ARTICULAR
joint osteoarthrosis). FACETS
h. Calcinosis circumscripta dorsal to the spinal
1. Widened joint space.
cord at Cl-2 and at 1'2-3 has been described
in young dogs (see 12.2.2 and Fig. 12.1). a. Normal with ventroflexion of spine.
i. Bulletsf air gun pellets or other missiles. b. Subluxation.
2. Enlarged intervertebral foramen. c. Joint effusion.
a. Neoplasia of nerve root (Fig. 5.11E). d. Severe kyphosis.
- Neurofibrosarcoma. e. Aplasia of the facets (see below).
- Schwannoma. 2. Narrowed joint space.
- Meningioma. a. Associated with narrowed disc space and
b. After surgery. intervertebral foramen.
- Disc herniation.
- Foraminotomy or pediculectomy.
- Trauma with (sub)luxation.
c. Trauma.
b. Spondylarthrosis (see below).
- Fracture of adjacent vertebra.
- Vertebral subluxation. 3. Irregular joint space.
d. Atlantoaxial subluxation (see 5.5.5 and a. Facet joint osteoarthrosis (spondylarthrosis) -
Fig. 5.9) - widening of the normal comma­ degenerative changes of the facetal synovial
shaped foramen between Cl and C2. joint with osteophyte formationf subchondral
e. Vascular anomalies resulting in sclerosis and occasionally bridging;
compensatory increased vertebral artery associated synovial cysts have been reported.
blood flowf which enlarges the foramen. Most commonly seen in the thoracolumbar
regionf occasionally cervical. Bony changes
3. Reduced intervertebral foramen size.
are easily seen on lateral radiographsf but the
a. Artefactual due to opacification (see 5.10.1).
VD view is needed to show whether one or
b. Disc herniation with associated narrowing of both sides are affected. Associated soft tissue
the disc space (Fig. 5.11F). hypertrophy is not seen on plain radiographs.
c. Bony proliferative tmnour of adjacent May cause pain due to arthropathy or nerve
vertebra. root compression; severe cases show
d. Facet joint osteoarthrosis (see 5.11.3). neurological deficits with cord compression
e. Trauma. evident on myelography, MRI or eT.
- Fracture of adjacent vertebra. Idiopathic - single or multiple joints in
- Subluxation. older dogs.
1 30 Handbook of Small Animal Radiology and U ltrasound

- Cervical spondylopathy (wobbler - Osseous.
syndrome) - in young Great Danesf - Soft tissue.
Boerboels and Mastiffs due to malformed c. Abscess.
and malpositioned articular facetsf which d. Granuloma.
often show secondary arthrosis.
e. Haematoma.
- Familial in young Shiloh Shepherd dogs
T11-L2; Scottish Deerhounds C2-3. 4. Mineralization in the paravertebral soft tissues.
b. Secondary to trauma - usually a single joint. a. Dystrophic mineralization in a tumour.
c. Infection - irregularity of facets is seen in b. Calcinosis circumscripta - in soft tissues at
some cases of discospondylitis. the level of Cl-2 and C5-6 regions and
d. Mucopolysaccharidosis - especially cats. occasionally elsewhere near the spine.
Fusion of the facets may eventually occur (see Especially affects young German Shepherd
5.4.9). dogs (see 12.2.2 and Fig. 12.1).
4. Enlarged and/or sclerotic facets - osteoarthrosis
(see above).
S. Absent articular facets. 5 .1 3 U LTRASONOGRAPHY OF
a. Articular facet aplasia.
PARAVE RTEBRAL SOFT TISSUES
- Cervical. Ultrasonographic examination of the paravertebral
- Thoracolumbar - absence of caudal soft tissues is most readily performed from a
articular facets with compensatory dorsal or lateral approach. The ventral aspects of
hypertrophy of the adjacent cranial facets the vertebral bodies in the cervical and lumbar
and ligamentum flavumf secondary regions can be visualized if the transducer is
arthrosis and compressive myelopathy placed laterallYf just below the ventral margin of
have been reported; German Shepherd the sublumbar musculaturef and angled dorsallYf
dogs possibly predisposed. Facet or via a transabdominal approach. Ultrasound
hypoplasia may also occur and may be guidance may be used to aspirate the caudal lum­
clinically silent. bar disc spaces if affected by discospondylitis.
b. After spinal surgery. 1. Irregularity of the margins of the vertebral
bodies.
a. Spondylosis (see 5.4.1).
5 . 1 2 LESIONS IN THE PARAVERTEBRAL b. Spondylitis (see 5.4.4).
SOFT TISSUES c. Neoplasia (see 5.4.3).
Soft tissue changes i n the tissues surrounding d. Healed or healing bony tramna.
the spine may be indicative of traumaf neoplastic e. Bone discontinuity associated with recent
or infectious changes that could involve the bony tramna.
spine. f. Disseminated skeletal hyperostosis
(see 5.4.5).
1. Gas accumulation in paravertebral soft tissues.
g. Hypervitaminosis A (especially cats - see
a. Trauma with an open wound. 5.4.8).
b. Gas-producing bacterial infection. h. Mucopolysaccharidosis (see 5.4.9).
2. Metallic foreign bodies. 2. Disturbances of the normal fibre alignment of
a. Microchip. the paravertebral muscles.
b. Bulletsf air gilll pellets and other missiles. a. Trauma with contusion and/or muscle fibre
c. Needles etc. that may have been ingested and tearing (e.g. iliopsoas strain).
exited the gut. b. Previous surgery.
3. Swelling of paravertebral soft tissues - more c. Cellulitis and/or abscess formationf often
likely in the sublumbar and lumbosacral regionf suspected to be due to migrating foreign
often displacing the descending colon ventrally. body.
a. Reactive lymph nodes. d. Neoplasia.
b. Neoplasia. 3. Echogenic foci within paravertebral soft tissues.
Chapter 5 Spine 131

a. Foreign body (often surrounded by a small Obtaining lateral radiographs in both right and
amount of fluid). left lateral recumbency may also be beneficial for
b. Bone fragments. lateralized lesionsf which may be better outlined
c. Mineralization within paravertebral soft by contrast medium when dependent. In the cervi­
tissues. cothoracic areaf the DV view is preferred to the VD
- Within a focus of chronic inflammation. in order to encourage contrast medium to pool in
- Within a neoplasm. the area rather than flowing away. In lateral
- Secondary to tramna. recumbencYf elevation of the body cranial and
caudal to a lesion will likewise encourage pooling
- Calcinosis cutis (see 12.2.2).
of contrast in the area of interest. Stressed views
- Calcinosis circumscripta (see 12.2.2).
(flexedf extended and traction) of the cervical and
d. Gas. lumbosacral areas may assist in recognizing
- Subcutaneous emphysema. dynamic lesionsf although care should be taken if
- Within a sinus tract. the stressed position may worsen neurological
4. Fluid accumulation within paravertebral soft compression.
tissues. Cervical (cisterna magna) myelography
a. Haematoma. An assistant holds the dogfs head at right angles to
b. Abscess ± foreign body. the neckf with the median plane of the nose and
c. Retroperitoneal fluidf usually inflammatorYf skull parallel to the table. The spinal needle must
blood or urine. penetrate the skin at a point in the midline midway
d. Ventral disc space in discospondylitis. between the levels of the external occipital protu­
5. Sub lumbar lymph nodesf especially medial iliac berance of the skull and the cranial edges of the
and hypogastric. wings of the atlasf these landmarks being palpated.
In small dogs and catsf a 4- to S-cm 22-gauge
spinal needle is used; once the skin has been pene­
tratedf the stylet should be removed and the needle
5 . 1 4 SPINAL CONTRAST STU DIES:
advanced slowly. In larger dogsf a 6- to 9-cm nee­
TECHNIQUE AND NORMAL APPEARANCE
dle is requiredf and the stylet is left in the needle
Myelography until the resistance offered by the strong dorsal
atlanto-occipital ligament is felt or illltil the liga­
Myelography involves injection of non-ionicf iodi­
ment has been perforated. "When the needle enters
nated contrast medimn into the subarachnoid
the subarachnoid space, CSF will begin to flow
spacef and may be performed either via the cervi­
from the needle and may be collected for analysis.
cal or the lumbar route. The latter is regarded
The needle should be held firmly at its point of
as safer for the patient but is more difficult to
entrance through the skin to prevent movement
perform. Reliability of results can be improved by
of the needle when the syringe is attached. The
injecting the contrast medimn at the site closer to
contrast medium is injected slowly over about
the suspected lesion.
1 min.
The patient is anaesthetized and the site
prepared for aseptic injection. The normal dosage Lumbar myelography
rate is 0.3 mL/kg of iopamidol or iohexol at a con­ Injection may be made with the patient in lateral or
centration of 300 mg/mLf with a minimum of 2 mL sternal recumbencYf and many operators prefer the
for cats and small dogs. Cerebrospinal fluid (CSF) spine to be flexed to widen the interarcuate space
may be collected prior to injecting the contrast through which the needle enters the vertebral
medium. The contrast medium should be warmed canal. The site of injection is normally LS-6 in dogs
to reduce its viscosity. and L6-7 in cats (Fig. 5.12). The dorsal spinous pro­
Following contrast medium injectionf lateral and cess of the caudal vertebra is located just cranial to
VD radiographs are obtained routinely following a line through the wings of the iliumf and the spi­
the contrast medium along the spine; if any alter­ nal needle is introduced flush against its cranial
ation in the contrast colurrm is identifiedf oblique edge in a direction perpendicular to the long axis
views should also be obtainedf as these will skyline of the spine and parallel or vertical to the table
areas dorsolateral and ventrolateral to the cord. top (depending on the patientfs position) until
1 32 Handbook of Small Animal Radiology and U ltrasound

pointed or blunted. The location of its termination
is variable between dogs; in most dogsf the dural
sac crosses the lumbosacral disc space and enters
the sacrumf but in some it terminates more crani­
ally. In catsf the spinal cord and dural sac extend
more caudally than in dogs.
Figure 5.1 2 Normal lumbar myelogram with correct needle Changes in the contrast colurrms include thin­
placement at LS-6. ningf interruptionf obstructionf outward or inward
displacementf dilation and splitting.

Complications of myelography
solid resistance by the bony vertebral canal floor is
felt. The spinal cord is deliberately penetrated to 1. Seizuresf especially if contrast medium enters
reach the more voluminous ventral subarachnoid the cranial cavity.
space. Penetration of the cauda equina often results 2. Aggravation of clinical signs may occur within
in a hindquarter jerk or anal twitchf indicating cor­ the first day - these are related to manipulation
rect needle placement. If the needle will not enter during positioning.
the vertebral canat it must be redirected slightly. 3. Apnoea can occur if the injection is given too
The stylet is removed when the needle tip is the rapidly via the cisternal route.
vertebral canal. Free flow of CSF confirms correct 4. Penetrating the spinal cord or brainstem with
needle positionf although the amount of CSF the needle during cisternal myelography - may
obtained is usually much less than with cervical result in death.
puncturef and lack of CSF flow does not necessar­ S. Penetrating the cerebellar vermis with the
ily indicate wrong placement of the needle.
needle during cisternal myelography in dogs
If severe spinal cord compression or swelling is
with caudal occipital malformation (Chiari-type
suspectedf the contrast medium must be injected
abnormality; mainly Cavalier King Charles
rapidly over 10 s and exposures made immediately Spaniels).
and again after 30 s. The first exposure will show
6. Injection into the central canal of the spinal cord
the caudal edge of the lesion to best advantage
may cause severe paresis or paralysisf
and the slightly delayed one the cranial end.
depending on the quantity of contrast medium
Normal myelographic appearance injected. Such injections usually occur when
On the lateral radiographf dorsal and ventral con­ lumbar puncture is performed cranial to LS-6
trast colurrms are visible; on the VD or DV viewf (Fig. 5.14).
the lateral colmnns are seen. The colurrms are of 7. Haematoma has been reported after lumbar
even width along the vertebral canal except crani­ pllllcturef presumably due to damage to the
ally, within Cl and C2, where they are dilated vertebral venous sinuses.
due to the cisterna magna. The dorsal contrast col­
urrm is often slightly wider than the ventral col­
Epidurography
urrm. The ventral contrast colurrm is often slightly
indented over the disc spaces (especially C2-3)f Epidurography is used mainly to investigate cauda
without effect on the diameter of the spinal cord. equina syndrome. The dog may be positioned in
The spinal cord creates a non-opacified band sternal or lateral recumbency. A spinal needle is
between the colurrmsf with mild diffuse enlarge­ introduced into the epidural space via the sacro­
ment at the brachial (CS-7) and lumbar (L3-4) intu­ caudal junction or between caudal vertebrae 1
mescentia. The cord is relatively large compared and 2 or 2 and 3. The lumbosacral junction should
with the size of the vertebral canal in small dogs normally be avoidedf as pathology is often located
and catsf and appears relatively smaller in large at this site. In large-breed dogsf about 4-8 mL of
breeds of dog. From the mid-lumbar areaf the contrast medium is injected and immediate lateral
spinal cord tapers and is surrounded by the nerves and DV or VD radiographs are made.
forming the cauda equinaf creating a convergingf The normal epidurogram creates an undulating
striated appearance. The shape of the caudal end or scalloped appearancef with the ventral contrast
of the dural sac is variable and may be sharply colurrm elevated over each disc space and draped
Chapter 5 Spine 1 33

more ventrally in between. It is much more diffi­ Cervical myelogra m : Technical errors
cult to interpret than a myelogram.
3. Poor distribution of contrast medium in the
Discography subarachnoid space resulting in an uneven or
bizarre myelographic appearance; differential
Discography is occasionally performed at the lum­
diagnoses are severe meningitisf diffuse
bosacral junction in order to detect disc degenera­
neoplasia (e.g. lymphoma).
tion. The normal nucleus pulposus is difficult to
a. Inadequate subarachnoid volume of contrast
injectf while degenerate discs accommodate more
medium.
contrast medium and may show dorsal leakage.
- Initial vohune too small.
Needle placement is facilitated by the use of fluoros­
copy with image intensification. Howeverf discogra­ - Marked extradural injection or leakage
phy is being superseded by the use of eT and MRI. (see below).
b. Contrast medium not warmed to body
temperature; poor mixing with CSF may
5 . 1 5 TECHN ICAL ERRORS DURING contribute.
MYELOGRAPHY c. Injecting too slowly may contribute.
4. Subdural contrast medimn injection or leakage
General myelography: Technical errors
- contrast medium lies mainly dorsallYf is very
(Figs 5. 1 3 and 5. 1 4)
dense and has an undulatingf scalloped inner
1. Single or multiple 1-3 mm diameter margin and a knife-shaped distal termination;
radiolucent filling defects - air bubbles due to differential diagnosis is spinal arachnoid
air in syringe during injection. pseudocyst.
2. Contrast medimn in soft tissues dorsal to 5. Contrast medimn in the central canaL
injection site - leakage of contrast medium up a. Central canal > 2 mm wide.
the needle tract. - Inadvertent injection into
syringohydromyelic cord. Unlikely
to result in additional neurological
effects.
b. Central canal 0.5-2 mm wide.
Reflux into the canal if the spinal
needle accidentally penetrated the
spinal cord and passed through or
close to the canaL
Figure 5.1 3 Cervical myelogram showing technical errors: 6. Contrast medium accidentally injected into the
(A) air bubbles in the contrast medium; (8) subdural contrast spinal cord parenchyma - the prognosis for
medium injection. patient survival is volume-dependent.
7. Contrast medium does not pass an obstructive
lesion (may enter cranium instead) - try
elevating head and neck further to gravitate
the contrast medium past the obstructive site.
a. Lack of pressure of cisterna magna injection
does not allow contrast medium to force
its way past lesions totally obstructing
the subarachnoid space. An additional
lumbar puncture myelogram should be
performed.
b. Inadequate volume of contrast medium.
Figure 5.1 4 Lumbar myelogram showing technical errors: c. If contrast medimn does not outline the
(A) epidural leakage of contrast medium; (8) contrast caudal cervical region on a VD radiographf
medium in the central canal of the spinal cord; and (C) obtain a DV radiograph to encourage
leakage of contrast medium into blood vessels. pooling of contrast medium in this area.
1 34 Handbook of Small Animal Radiology and U ltrasound

Lumbar myelogra m : tech nical errors
8. Scalloped appearance of contrast medium.
a. Epidural injection.
- Needle tip too deep when in the ventral

,
part of the vertebral canal.
- Multiple dural punctures with contrast .....-,... -. �
leaking out of the subarachnoid space.
- Needle tip in an extradural mass lesion.
9. Subdural contrast medium injection or leakage ­
less common than with cisterna magna ® ©
puncture. Figure 5.1 5 Schematic representation of an extradural
10. Contrast medium pooling in the intervertebral lesion: (A) mass position, lying outside the meninges;
foramina and around nerve roots - epidural (8) myelogram view tangential to the lesion shows spinal
injection. cord compression; and (C) the orthogonal view shows
11. Contrast medium in subhunbar vasculaturef apparent spinal cord widening.
lymphatics and lymph nodes following
epidural injection.
12. Contrast medium in the central canal - more compression is seen with neoplasiaf disc material
likely to occur with needle placement cranial to or haematomaf which may encircle the cord. Focal
the recommended L5-6 interarcuate space. extradural compressions may occasionally create
a. Central canal 0.5-2 mm wide. the impression of contrast colurrm splitting when
- Reflux into the canal if the spinal needle imaged tangentiallYf and this can give an errone­
passed through or close to the canal. ous diagnosis of an intradural lesion.
- Aberrant communication between the 1. Normal variants - slight compression of the
subarachnoid space and the central canal subarachnoid spacef with no attenuation of the
due to tumourf herniated disc or malacic opposite contrast medium colurrm or spinal cord.
cord. a. Ventral contrast colurrm over C2-3 disc
b. Central canal > 2 mm wide. space.
- Iatrogenic distension of the central canal b. Dorsal contrast colurrm at the C3--4-5-6-7
due to direct injection. Depending on the articulations.
extentf the dog may go into respiratory c. Ventral contrast colurrm over other disc
or cardiac arrest and will develop spacesf especially in large breeds of dog.
neurological deficits that may or may 2. Artefactual - contrast medium in the
not improve over time. ventral epidural space following lumbar
- Syringohydromyelia - usually with puncture; produces a thickf wavy line that
Chiari-like malformation in Cavalier King is elevated over each disc space (see Fig. 5.14).
Charles Spaniels; inadvertent canalogram 3. Disc extrusion (Hansen type I disc disease;
may occur during cisterna magna Fig. 5.16). Spinal cord compression may be
injection. from any direction and may not necessarily be
13. Contrast medium injected into the spinal cord at the level of a disc space.
parenchyma; differential diagnosis is leakage
into an area of myelomalacia. a

5 . 1 6 EXTRADURAL SPINAL CORD
COMPRESSION ON MYELOGRAPHY
Normal Type I Type 11
The spinal cord is usually narrowed on one view extrusion protrusion
and widened on the orthogonal view (Fig. 5.15). Figure 5.1 6 Normal disc (a, annulus fibrosus; n, nucleus
The contrast colurrms are deviated and thinned pulposus), type I disc disease (extrusion) and type 11 disc
or interrupted. OccasionallYf an hourglass disease (protrusion).
Chapter 5 Spine 1 35

a. Thoracolumbar region (T11-L3), especially a. Common in dogsf mainly caudal cervical
in chondrodystrophic breeds; more caudal and thoracolumbar spine in large breeds;
hunbar disc spaces are less often affected. may be multiple. Commonly found in older
Extruded disc materiat and thus spinal cats on post-mortem examination but rarely
compressionf may be ventrat ventrolaterat cause clinical signs.
laterat dorsolateral and occasionally b. Cervical spondylopathy (wobbler syndrome)
dorsallYf or in combinations of these - caudal cervical regionf large-breed dogsf
locations. Oblique views are helpful to especially Dobermarmf Rottweiler and
localize disc materiat which is usually Dalmatian. Traction or ventroflexion of the
located at or cranial to the affected disc neck may reduce the compression by
space. Disc lesions TI-IO are unusual flattening the bulging soft tissue.
due to the presence of the intercapital c. Cauda equina syndromef especially larger
ligament between the heads of the ribs. breeds such as the German Shepherd dog
Rare in cats. (Fig. 5.17). Stressed views are helpful, as the
b. Cervical region (C2-7) in any breed of degree of dural sac compression is often
dog, mainly smaller breeds. C2-3 is the worse in extension than in flexionf reflecting
commonest site in small breeds and C6-7 the clinical signsf in which discomfort is
in larger breeds. The major clinical sign is more severe when the lumbosacral joint is
often neck pain rather than a neurological extended.
deficit. The disc material usually lies 5. Hypertrophied or redillldant ligamentum
ventrally or ventrolaterally. Rare in cats. flavum (interarcuate ligament) - dorsal
c. Cervical spondylopathy (wobbler syndrome) ­ compression of the spinal cord or cauda
caudal cervical region in large-breed dogsf equina.
especially Dobermarm and Rottweiler. a. Cervical spondylopathy (wobbler syndrome) ­
Mainly ventrally. Traction or ventroflexion large-breed dogs. Ventroflexion of the neck
of the neck has minimal effect on the reduces the compression; dorsoflexion of the
compression. Howeverf disc lesions secondary neck aggravates the compression. Especially
to caudal cervical vertebral malformation are CS-7 Great Danef C2-3 Rottweiler; associated
more often protrusions than extrusions (see with other lesions of caudal cervical vertebral
below). malformation.
d. Lumbosacral disc diseasef especially larger b. Lumbosacral instability; degenerative
breeds such as the German Shepherd dog lumbosacral stenosis.
(Fig. 5.17). Predisposed to by lumbosacral 6. Instability between adjacent vertebrae.
transitional vertebra. Disc material lies a. Atlantoaxial subluxation (see 5.5.5 and Fig. 5.9).
within the ventral part of the vertebral canat
b. Caudal cervical spinef especially C6-7f in
causing compression of the cauda equina.
cervical spondylopathy (wobbler syndrome)
Againf disc protrusions are more common
(see 5.3.8 and Fig. 5.5).
than extrusions.
c. Lumbosacral junctionf predisposing to
e. Adjacent to deformed vertebrae or rigid
degenerative lumbosacral stenosis and
sections of the spine (e.g. hemivertebraef
cauda equina syndrome (Fig. 5.17).
block vertebra and areas of ankylosed
d. Trauma and spinal fracture or subluxation.
spondylosis).
7. Extradural neoplasia with or without bony
4. Hypertrophied annulus fibrosus or disc
changes.
protrusion ± hypertrophy of the dorsal
a. Primary or metastatic tumour in surrounding
longitudinal ligament (Hansen type 11 disc
bone - often osteolytic lesions and may be
disease; Fig. 5.16) - ventral or ventrolateral
accompanied by pathological fractures.
compression of the spinal cord (chronic
- Various histological types in adultsf for
compression may lead to spinal cord atrophYf
example osteosarcomaf histiocytic
seen on myelography as reduced cord
sarcoma (especially Bernese Mountain
diameter with visible surrounding
dog and Rottweiler)f articular facet
subarachnoid space and no evidence of current
myxosarcoma.
compression).
1 36 Handbook of Small Animal Radiology and U ltrasound

- Dorsal compression from vertebral canal
stenosis - cranial cervical spine;
especially Bassett Hound.
- Dorsolateral compression - malformation
of articular facetsf mainly caudal cervical
spine; especially Great Danef Boerboet
Mastiff.
Figure 5.1 7 Compression of the cauda equ ina (cauda - Lateral compression from medially
equina syndrome) on myelography: various combinations of converging caudal cervical pediclesf
l u mbosacral instability, disc disease, bony stenosis and dorsal visible only on VD view; especially Great
soft tissue hypertrophy causing degenerative lumbosacral Danef BoerboeL
stenosis. e. Lumbosacral malalignment or instability.
f. Lumbosacral osteochondrosis; usually the
craniodorsal margin of 51; especially
- In young animalsf consider German Shepherd dogs (see 5.4.16 and
osteochondroma or multiple cartilaginous Fig. 5.8).
exostoses (see 1.15.2). g. Cats - hypervitaminosis A - occasionally
- Osteosarcoma in older cats. causes spinal cord compression (see 5.4.8).
b. Originating from soft tissues within the 9. Articular facet lesions (see 5.11.3) - lateral or
vertebral canaL dorsolateral compressionf best seen on VD or
- Neurofibroma. oblique views.
- Myxoma or myxosarcoma. a. Cervical spondylopathy (wobbler syndrome) ­
enlargementf malpositioning and arthrosis of
- Meningioma.
articular facet joints mainly in the caudal
- Lymphoma.
cervical regionf especially Great Dane and
- Lipomaf angiolipoma or myelolipoma. Mastiff.
- Haemangiosarcoma. b. Facet arthrosis in older dogs; usually
c. Para spinal tumour from the soft tissues thoracolumbar area.
surrounding the vertebral colurrm. c. Juxta-articular cysts.
- Phaeochromocytomaf usually cranial Synovial cysts; cervical often multiple in
lumbar region. younger dogsf especially Great Danef
- Spinal nerve tmnour (may also produce Boerboel and Mastiff; thoracolmnbar
intradural-extramedullary and often single in older dogsf especially
intramedullary lesions). German Shepherd dog.
d. Cats - lymphoma from as young as 6 - Ganglion cystsf usually in cervical or
monthsf male preponderance. Test for feline lumbosacral regions.
leukaemia virus and look for lymphoma in 10. Extradural haematoma or haemorrhage.
other organs.
a. Trauma.
8. Extradural bony lesions.
- External trauma (e.g. road traffic accident).
a. Neoplasia (see above).
- Internal trauma due to acute disc
b. Congenital vertebral malformations (see 5.3). herniation or dural tearingf especially if a
c. Trauma. vertebral venous sinus is lacerated; may
- Fracture; acute fracture or fracture be very extensive.
healing with callus formation. - Post-surgical haemorrhage.
- Spinal luxation or subluxation. Iatrogenic haemorrhage caused by spinal
d. Cervical spondylopathy (wobbler needle.
syndrome). b. Coagulopathy.
- Ventral or dorsal compression from Haemophilia Af especially young male
vertebral canal stenosis - caudal cervical German Shepherd dogs.
spine; especially Dobermann (see 5.3.8 - Anticoagulant poisoning.
and Fig. 5.5). - Thrombocytopenia.
Chapter 5 Spine 1 37

- Von Willebrand's disease; especially 17. Extradural foreign body (e.g. small fragments
Dobermann. of wood following pharyngeal stick injuries);
c. Haemorrhage secondary to: may be acute or months after the initial injury.
- tumour 18. Post-operative seroma.
- vascular malformation 19. Extradural infiltrative lipoma.
- parasitic migration, especially Spirocerca 20. Cyst of disc or associated intraspinal
lupi'" ligament.
- meningitis
- necrotizing vasculitis - Bemese Mountain 5 .1 7 INTRADURAL- EXTRAM ED U LLARY
Dog, German Short-haired Pointer and SPINAL CORD COMPRESSION ON
Beagle. MYELOGRAPHY
d. Subperiosteal vertebral haematoma.
The colurrm of contrast medium splits (golf tee
11. Extradural infectious or inflammatory process,
sign) or widens (teardrop shape) and often shows
granuloma, focal abscess or more diffuse
abrupt termination (Fig. 5.18). In the orthogonal
empyema.
planef the spinal cord may appear widened due
a. Haematogenous infection.
to compression caused by the intradural lesion.
- Bacterial.
- Fungal (e.g. histoplasmosis'" in cats). 1. Artefactual golf tee sign due to extradural
contrast leakage outlining an extradural lesion.
b. Direct extension from adjacent septic
2. Artefactual splitting of contrast column (usually
process in soft tissues.
on a lateral view) due to a focal centrat ventral
c. Extension from discospondylitis (see 5.9.1
extradural lesion indenting the cord but
and Fig. 5.10).
allowing the subarachnoid space to drape back
- Bacterial.
into place on either sidef or a ventrolateral
- Fungat especially cryptococcosis'" in cats. extradural lesion: differentiated from a true
d. Extension from spondylitis (see 5.4.4 and intradural lesion by utilizing oblique views.
Fig. 5.7). 3. Spinal arachnoid pseudocyst (leptomeningeal or
- Bacterial. meningeal cyst) - two distinct types are now
- Fungat especially cryptococcosis* in cats. recognized.
- Parasitic (e.g. Spirocerca lupi*). a. Bulbous or teardrop-shaped expansion of the
e. Steatitis - inflammation of epidural fat. dorsal subarachnoid space with attenuation
12. Membrane disease (epidural scarring) - weeks of the subjacent spinal cord (Fig. 5.19A).
to months after laminectomy or
hemilaminectomy.
13. Fibrosis of the interarcuate (yellow) ligament
at C2-3 causing dorsal cord compression has
been reported in two young Rottweilers.

,
14. Parasites.
a. Granuloma from aberrant migration of
o
Spirocerca lupi* larva in the caudal thoracic
region; may present with acute pelvic limb
paresisf mimicking disc extrusion. !'
b. Aberrant migration of heartworm (Dirofilaria
immitis*).
15. Vascular anomalies.
® ©
Figure 5.18 Schematic representation of an extramedullary,
a. Aneurysm of venous sinus. intradural lesion: (A) mass position, lying within the
b. Aortocaval fistula with distension of meninges but outside the spinal cord; (8) myelogram view
vertebral venous plexus. tangential to the lesion shows spinal cord compression but
16. Calcinosis circumscripta - extradural location splitting of the contrast column, which often terminates;
reported (e.g. at Cl-2); especially young (C) the orthogonal view shows apparent spinal cord widening
German Shepherd dogs. due to spinal cord compression in the other plane.
1 38 Handbook of Small Animal Radiology and U ltrasound

intradural-extramedullary lesions. Howeverf
if they do not enter the vertebral canat
radiographs are normal and MRI is needed for
diagnosis.
a. Meningioma - mainly caudal cervical region
and often near an intervertebral foramen.
b. Peripheral nerve sheath tmnours (e.g.
neurofibromaf neurofibrosarcmna and
schwannoma) - mainly caudal cervical region.
c. Nephroblastoma (neuroepitheliomaf Wilmsf
tumour) - caudal thoracic to cranial lmnbar
"
... . .
. � . .':"
region (TlO-L3) in dogs 6 months to 3 years
of age; males and German Shepherd dogs are
over-represented. May infiltrate the cord and
appear intramedullary on myelography.
d. Myxoma or myxosarcoma.
Figure 5.1 9 Spinal arachnoid pseudocyst: (A) dorsal lesion, e. Ependymoma.
typical of most breeds, directed caudally; (8) variant seen f. Lymphoma - especially cats (although more
most often in Rottweilers and occasionally in other large often extradural or intramedullary). Test for
dogs; in the cervical area and may be directed either cranially feline leukaemia virus and look for
or caudally. lymphoma in other organs.
5. Herniated disc material that ruptures dural
membranes.
Usually at C2-3 (generally large dogs), TS-IO
6. Intradural haematoma or haemorrhage (see
(generally small and medium-sized dogs) or
5.16.10 for causes of spinal haemorrhage).
the thoracolumbar area (cats). Tend to occur
7. Intradural lipoma within a subcutaneous
in young male animalsf but the aetiology is
meningocele or myelomeningocele dorsal to the
unknown; possible causes include genetic
lumbosacral or sacrocaudal junction; especially
factorsf inflammation and tramnaf probably
Bulldogs and Manx cats with spina bifida or
giving rise to adhesive arachnoiditisf which
sacrocaudal dysgenesis.
alters CSF dynamics. These lesions are always
directed caudally.
b. More recentlYf a different conformation of
5 .1 8 INTRAMEDU LLARY SPINAL CORD
lesion has been recognized in the cervical
ENLARGEM ENT ON MYELOGRAPHY
spine at C2-3 or CS-6-7 for which Rottweilers
are over-represented (Fig. 5.19B); there are The spinal cord is widened on all views with diver­
both dorsal and ventral accumulations of gence and attenuation of the contrast colurrms and
contrast mediumf and the cord adjacent to the general reduction of contrast opacity in the area
lesion is focally swollen. These lesions are (Fig. 5.20).
usually directed caudallYf but some are 1. Normal spinal cord enlargement.
directed the opposite way. a. Brachial intumescence - caudal cervical area.
c. Erroneous pseudocyst diagnosis has been
b. Lumbar intumescence - mid-lumbar area.
described in the lumbar area due to collapse
c. The spinal cord to canal ratio is larger in cats
of presumed lumbar syringomyelia from
and small-breed dogs than in large-breed dogs.
pressure due to a lumbar myelogram
injection. 2. Neoplasia - most commonly seen at the
cervicothoracic and thoracolumbar junctions.
4. Neoplasia - tumours involving spinal nerve
a. Primary spinal cord tmnours.
roots may cause enlargement of the
intervertebral foramen visible on plain - Astrocytoma.
radiographs. They may also create extradural - Oligodendroglioma.
compression or intramedullary swelling on - Ependymoma.
myelography rather than appearing as - Neurofibroma.
Chapter 5 Spine 1 39

c. Haemorrhage secondary to:
- tumour
- vascular malformation
- parasitic migration.
4. Fibrocartilaginous embolus or spinal infarct -
o occasionally causes mild spinal cord swellingf
but the diagnosis is usually made based on
typical peracute history and lack of
myelographic findingsf ruling out disc disease.
Usually medimn- and larger-sized dogs; rare
in cats.
5. Granulomatous meningoencephalomyelitis -
rarely causes spinal cord swelling; diagnosis
® @ often made based on clinical signs and analysis
Figure 5.20 Schematic representation of an intramedullary of CSF.
lesion: (A) mass position, lying within the spinal cord; (8) and 6. Syringohydromyelia - diffusely widened spinal
(C) myelogram views from any angle show spinal cord cordf especially in the cervical areaf usually
widening. associated with Chiari-like malformation in
Cavalier King Charles Spaniels; inadvertent
- Lymphoma; especially young to middle­ canalogram may occur during cisterna magna
aged male cats; test for feline leukaemia injection.
virus and look for lymphoma in other 7. Dermoid or epidermoid cystsf usually in young
organs. animals; rare. Considered to be developmental
- Nephroblastoma (see 5.17.4). malformations or teratomas.
8. Fungal granuloma.
- Chordoma (see 5.7.7).
9. Aberrant migration of Spirocerca lupi* larva into
b. Metastatic spinal cord tumours.
the spinal cord.
c. Intradural-extramedullary tumour
infiltrating the spinal cord (e.g. nerve root
tumour).
3. Haemorrhage and/or oedema of the spinal
5 .1 9 M ISCELLANEOUS MYELOGRAPHIC
cord.
FINDINGS
a. Acute spinal cord injury. 1. Narrowed spinal cord with no external
External trauma (e.g. road traffic accident). compression.
- Internal trauma due to acute disc a. Spinal cord atrophy due to chronic
herniation causing cord oedema or compression (e.g. at site of type 11 disc
contusion; cord swelling may prevent protrusion).
contrast medium reaching and outlining b. Progressive haemorrhagic myelomalacia -
the underlying lesion. often in non-responding acute disc
- Myelomalacia subsequent to severe spinal herniation. Contrast medium is retained
cord damage; contrast medium enters the within damaged cord tissue.
parenchyma. c. Spinal dysraphism - Weimaraner.
- Intramedullary disc extrusion - herniated 2. Myelomalacia - contrast medium leaks into
disc material enters the cord parenchyma; liquefying cord tissue.
rare. 3. Spina bifida - contrast medium in the dural
- Post-surgical effects on the spinal cord. sac extends dorsal to the spine into a
b. Coagulopathy. subcutaneous meningocele or
- Haemophilia Af especially young male myelomeningocele at the lumbosacral or
German Shepherd dogs. sacrocaudal junctionf and an intradural lipoma
- Anticoagulant poisoning. may also be present; especially Bulldogs and
- Thrombocytopenia. Manx cats (see 5.3.13).
1 40 Handbook of Small Animal Radiology and U ltrasound

4. Epidural contrast leakage. 2. Canine giant axonal neuropathy - starts 14+
a. At the site of needle puncture through the months. Megaoesophagus may develop -
dura. German Shepherd dog.
b. Meningeal trauma with dural tearf usually 3. Central peripheral neuropathy - starts
due to traumatic disc extrusionf vigorous 2+ months - Boxer.
exercise or other tramna. 4. Spinal muscular atrophy - starts 6+ weeks -
c. Increased meningeal permeability due to Swedish Lapland dog, Brittany Spaniel,
meningeal pathology. German Shepherd dog, Rottweiler and English
Pointer.
5.20 CHANGES ON PLAIN RADIOGRAPHS 5. Globoid cell leucodystrophy - starts 4+
THAT ARE UN LIKELY TO BE SIGNIFICANT months. West Highland White Terrier and
Cairn Terrierf Poodlef Pomeranianf Beagle and
1. Spondylosis. Basset Hound.
a. Normal degeneration; Boxers often severely 6. Myelodysplasia, including spinal dysraphism -
affected. WeiInaraner.
b. Secondary to vertebral instability. 7. Hereditary myelopathy - 6-13 months -
- After disc fenestration. Afghan Hound.
- Old disc herniation. S. Hereditary ataxia - 2-6 months - Fox Terrier
2. Mineralized intervertebral discs in situ. and Jack Russell Terrier.
3. Nmnerical variants. 9. Progressive neuronopathy - 5+ months -
4. Butterfly vertebrae. Cairn Terrier.
5. Hemivertebrae in skeletally mature dogs. 10. Sensory neuropathy - 3-8 months - English
6. Ossifying pachymeningitis (dural osseous Pointer.
metaplasia - see 5.10.1 and Fig. 5.110). 1 1 . Inherited hypertrophic neuropathy -
7. Transitional vertebrae at the thoracolumbar or 7-12 weeks - Tibetan Mastiff.
cervicothoracic jllllctions (at the lumbosacral 12. Syringohydromyelia.
junctionf they may be associated with 13. Chiari-like malformation (caudal occipital
degenerative lumbosacral stenosis and cauda malformation syndrome) with secondary
equina syndromef and with unilateral hip syringohydromyelia; mainly the Cavalier
dysplasia if asymmetrical). King Charles Spaniel.
S. Spina bifida in its simplest form with only a cleft 14. Non-mineralized foraminal (dorsolateral) disc
of the dorsal spinous processes. extrusions causing nerve root compression.
Cats
5.2 1 N E U ROLOGICAL DE FICITS INVOLVING 15. Lysosomal storage diseases.
THE SPINAL CORD OR PROXIMAL N E RVE
16. Distal polyneuropathy - 6+ weeks - Birman.
ROOTS WITH NORMAL PLAIN
RADIOGRAPHS AND MYELOGRAM 17. Globoid cell leucodystrophy - Domestic Short­
haired cat.
Ensure that the clinical signs are not due to an ortho­ IS. Neuroaxonal dystrophy - 6 weeks.
paedic problem, myopathy, muscular dystrophy,
neuromuscular transmission disorderf peripheral
neuropathy or infectious agent such as distemperf Acquired diseases
toxoplasmosis or feline infectious peritonitis. Some Dogs
of the conditions may produce changes that can be
1. Degenerative myelopathy - 6+ years -
seen using MR!.
especially German Shepherd dog and German
Shepherd dog cross-breeds.
Congenital or hereditary diseases
2. Fibrocartilaginous embolism (spinal infarct)
Dogs with secondary necrotizing myelopathy -
1. Neuroaxonal dystrophy - starts 1 + year in usually middle-aged medium and large
Rottweiler and 6+ weeks in Papillon. breeds.
Chapter 5 Spine 1 41

3. Acute idiopathic polyradiculoneuritis - adults 5-13 months - Bemese Mountain Dogf
of any breed. German Short-haired Pointer and Beagle.
4. Coonhound paralysis - acute 12. Chronic relapsing idiopathic
polyradiculoneuritis after a racoon bite - polyradiculoneuritis.
adults of any breed. 13. Demyelinating myelopathy - 2-4 months -
5. Granulomatous meningoencephalomyelitis - Miniature Poodles.
1 + years - smaller breedsf especially Poodle 14. Syringohydromyelia.
types.
Cats
6. Corticosteroid responsive meningitis (aseptic
meningitis) - young medium- to large-breed 15. Ischaemic neuromyopathy due to caudal aorta
dogs. thromboembolism - secondary to cardiac disease.
7. Secondary to modified live rabies vaccine - 16. Fibrocartilaginous embolism with secondary
7-10 days post vaccination. necrotizing myelopathy; rare.
8. Ischaemic neuromyopathy due to caudal aorta 17. Eosinophilic meningitis.
thromboembolism. 18. Secondary to modified live rabies vaccine -
9. Leucoencephalomyelopathy - 1.5--4 years - 7-10 days post vaccination.
Rottweiler. 19. Feline polioencephalomyelitis - 6+ months.
10. Hound ataxia - 2-7 years - Fox Houndf 20. Degenerative myelopathy.
Harrier Hound and Beagle. 21. Chronic relapsing idiopathic
11. Meningeal fibrosis with axonal degeneration polyradiculoneuritis.
secondary to necrotizing vasculitis - 22. Syringohydromyelia.

Further reading
General Vet. elin. North Am. Small Anim. Hanna, F.Y., 2001. Lumbosacral
Dennis, R, 1987. Radiographic Pract. 22, 985 1015. osteochondrosis: radiological
examination of the canine spine. Braund, K.G., 1994. Pediatric features and surgical
Vet. Rec. 121, 31 35. neuropathies. Semin. Vet. management in 34 dogs. J. Small
Marioni Henry, K., Vite, CH., Med. Surg. (Small Animals) 9, Anim. Pract. 42, 272 278.
Newton, L., van Winkle, T.J, 2004. 86 98. Hay, CW., Dueland, RT.,
Prevalence of diseases of the Damur Djuric, N., Steffen, F., Dubielzig, RR, Bjorenson, J.B.,
spinal cord of cats. J Vet. Intern. Hassig, J.P., Morgan, J.P., 1999. Idiopathic multifocal
Med. 18, 851 858. Fluckiger, M.A, 2006. osteopathy in four Scottish
McKee, M., 1993. Differential Lumbosacral transitional terriers (1991 1996). J. Am. Anim
diagnosis of cauda equina vertebrae in dogs: classification, Hosp. Assoc. 35, 62 67.
syndrome. In Pract. 15, 243 250. prevalence and association James, CCM., Lassman, L.P.,
McKee, M., 1996. Cervical pain in with sacroiliac morphology. Tomlinson, B.E., 1969. Congenital
small animals. In Pract. 18, Vet. Radiol. Ultrasound 47, anomalies of the lower spine and
169 184. 32 38. spinal cord in Manx cats. J.
McKee, M., Dennis, R, 2003. Drost, W.T., Lehenbauer, T.W., Patho!. 97, 269 276.
Radiology corner Lumbosacral Reeves, L 2002. Mensuration of Kloc, P A, Scrivani, p.v., Barr, S.c.,
radiography. Vet. Radiol. cervical vertebral ratios in Reese, CL Trotter, E.L Forest, T.W.,
Ultrasound 44, 655 657. Doberman pinschers and Great et al., 2001. Vertebral angiomatosis
Morgan, J.P., Bailey, CS., 1990. Danes. Vet. Radiol. Ultrasound in a cat. Vet. Radiol. Ultrasound 42,
Cauda equina syndrome in the 43, 124 13l. 42 45.
dog: radiographic evaluation. Fluckiger, M.A, Damur Djuric, N., Konde, L.L Thrall, M.A, Gasper, P.,
J. Small Anim. Pract. 31, 69 77. Hassig, J.P., Morgan, J.P., Dial, S.M., McBiles, K., Colgan, S.,
Steffen, F., 2006. A lumbosacral et al., 1987. Radiographically
Congenital and developmental transitional vertebra in the dog visualized skeletal changes
diseases; d iseases of young animals predisposes to cauda equina associated with
Bailey, CS., Morgan, J.P., 1992. syndrome. Vet. Radiol. mucopolysaccharidosis VI in cats.
Congenital spinal malformations. Ultrasound 47, 39 44. Vet. Radiol. 28, 223 228.
1 42 Handbook of Small Animal Radiology and U ltrasound

Lang, L Haeni, H., Schawalder, P., Hypervitaminosis A in the cat: a dogs. Vet. Radiol. Ultrasound 40,
1992. A sacral lesion resembling case report and review of the 634 637.
osteochondrosis in the German literature. J. Feline Med. Surg. 7, Levy, M.5., Kapatkin, AS.,
Shepherd dog. Vet. Radiol. 363 368. Patnaik, AK., Mauldin, G.K,
Ultrasound 33, 69 76. 1997. Spinal tumours in 37 dogs:
Morgan, J.P., 1999. Transitional Infective and inflammatory clinical outcome and long term
lumbosacral vertebral anomaly in conditions survival (1987 1994). j. Am.
the dog: a radiographic study. J. Du Plessis, CL Keller, N., Anim. Hosp. Assoc. 33,
Small Anim. Pract. 40, 167 172. Millward, I.R, 2007. Aberrant 307 312.
Newitt, A., German, A.L Barr, F.L extradural spinal migration of Macri, N.P., Alstine, W.v"
2008. Congenital abnormalities of Spirocerca lupi: four dogs. J. Small Coolman, RA, 1997. Canine
the feline vertebral column. Vet. Anim. Pract. 48, 275 278. spinal nephroblastoma. J. Am .
Radiol. Ultrasound 49, 35 4l. Dvir, K, Kirberger, RM., Anim. Hosp. Assoc. 33, 302 306.
Penderis, L Schwarz, T., Mallaczek, D., 2001. Radiographic Morgan, J.P" Ackerman, N.,
McConnell, J.F., Garosi, L.S., and computed tomographic Bailey, CS., Pool, RR, 1980.
Thomson, CK, Dennis, R, 2005. changes and clinical Vertebral tumors in the dog: a
Dysplasia of the caudal vertebral presentation of spirocercosis in clinical, radiologic, and pathologic
articular facets in four dogs: the dog. Vet. Radiol. Ultrasound study of 61 primary and
results of radiographic, 42, 119 129. secondary lesions. Vet. Radiol. 21,
myelographic and magnetic Dvir, K, Ped, S" Loeb, K, Shklar 197 212.
resonance imaging investigations. Hlrsch, 0., Chat, 0., Mazaki Pease, A.P., Berry, CR, Mott, J.P"
Vet. Rec. 156, 601 605. Tovi, M., et al., 2007. Spinal Peck, J.N., Calderwood, M.B.,
Sharp, N.J.H., Wheeler, S.L intramedullary aberrant Spirocerca Hlnton, D., 2002. Radiographic,
Cofone, M., 1992. Radiological lupi migration in 3 dogs. J Vet. computed tomographic and
evaluation of 'wobbler' syndrome Intern. Med. 21, 860 864. histopathologic appearance of a
caudal cervical Frendin, L Funquist, B., Hansson, K., presumed spinal chordoma in a
spondylomyelopathy. J. Small Lonnemark,. L Cadsten, L 1999. dog. Vet. Radiol. Ultrasound 43,
Anim. Pract. 33, 491 499. Diagnostic imaging of foreign 338 342.
Werner, T., McNicholas, W.T., body reactions in dogs with Schultz, RM., Puchalski, S.M.,
Kim, D.K., Baird, D.K., Breur, G.L diffuse back pain. J. Small Anim. Kent, P.F., Moore, P.F., 2007.
2004. Aplastic articular facets in a Pract. 40, 278 285. Skeletal lesions of histiocytic
dog with intervertebral disk Jimenez, M.M., O'Callaghan, M.W., sarcoma in nineteen dogs.
rupture of the 12th to 13th 1995. Vertebral physitis: a Vet. Radiol. Ultrasound 48,
thoracic vertebral space. J. Am. radiographic diagnosis to be 539 543.
Anim. Hosp. Assoc. 40, 490 494. separated from discospondylitis.
Vet. Radiol. Ultrasound 36, 188 195. Trauma
Metabolic diseases (some overlap Kornegay, J.N., Barber, D.L., 1980. Anderson, A, Coughlan, AR, 1997.
with above) Discospondylitis in dogs. J. Am. Sacral fractures in dogs and cats: a
Konde, L.L Thrall, M.A, Gasper, P., Vet. Med. Assoc. 177, 337 34l. classification scheme and review
Dial, S.M., McBiles, K., Colgan, S., Lavely, J.A, Vernau, K.M., of 51 cases. J. Small Anim. Pract.
et al., 1987. Radiographically Vernau, KL Herrgesell, KL 38, 404 409.
visualized skeletal changes Lecouteur, RA, 2006. Spinal Hay, CW" Muir, P" 2000. Tearing of
associated with epidural empyema in seven dogs. the dura mater in three dogs. Vet.
mucopolysaccharidosis VI in cats. Vet. Surg. 35, 176 185. Rec. 146, 279 282.
Vet. Radiol. 28, 223 228. Kinns, L Mai, W" Seiler, G.,
Lieb, AS., Grooters, AM., Tyler, J. Neoplasia Zwingenberger, V., Johnson, V.,
W., Partington, B.P., Pechman, Gilmore, D.R, 1983. Intraspinal Caceres, A., et al., 2006.
RD., 1997. Tetraparesis due to tumours in the dog. Compend. Radiographic sensitivity and
vertebral physeal fracture in an Contin. Educ. Pract.veterinarian negative predictive value for
adult dog with congenital 5, 55 64. acute canine spinal trauma. Vet.
hypothyroidism. J. Small Anim. Green, K, Adams, W.M., Radiol. Ultrasound 47, 563 570.
Pract. 38, 364 367. Steinberg, H., 1999. Malignant Roush, J.K., Douglass, J.P"
Polizopoulou, Z.5., Kazakos, G., transformation of solitary spinal Hertzke, G.A, Kennedy, G.A.,
Patsikas, M.N., Roubies, N., 2005. osteochondroma in two mature 1992. Traumatic dural laceration
Chapter 5 Spine 1 43

in a racing greyhound. Vet. Munan, K.R, Olby, N.}., Sharp, N.}.H., Jurina, K., Grevet V., 2004. Spinal
Radiol. Ultrasound 33, 22 24. Skeen, T.M., 2001. Intervertebral arachnoid pseudocysts in 10
Yarrow, T.G., Jeffery, N.D" 2000. disk disease in 10 cats. J. Am. Anim. Rottweilers. J. Small Anim. Pract.
Dura mater laceration Hosp. Assoc. 37, 384 389. 45, 9 15.
associated with acute paraplegia Squires Bos, A, Brisson, B.A., Kirberger, RM., Jacobson, L.S.,
in three dogs. Vet. Rec. 146, Holmberg, D.L., Nykamp, S., Davies, J.V., Engela, L 1997.
138 139. 2007. Use of the ventrodorsal Hydromyelia in the dog.
myelographic view to predict Vet. Radiol. Ultrasound 38,
Disc disease and fibrocartilaginous lateralization of extruded disk 30 38.
embolism (spinal infarcts) material in small breed dogs with Lewis, D.G., Kelly, D.F., 1990.
Cauzinille, L., Komegay, J.N., 1996. throacolumbar intervertebral disk Calcinosis drcumscripta as a
Fibrocartilagenous embolism of extrusion: 104 cases (2004 2005). cause of spinal ataxia. J. Small
the spinal cord in dogs: review of J. Am . Vet. Med. Assoc. 230, Anim. Pract. 31, 36 38.
36 histologically continned cases 1860 1865. Morgan, J.P., Stavenbom, M., 1991.
and retrospective study of 26 Disseminated idiopathic
suspected cases. J Vet. Intern. Miscellaneous conditions skeletal hyperostosis (DISH)
Med. 10, 241 245. Chrisman, CL., 1992. Neurological in a dog. Vet. Radiol. 32, 65 70.
Dyce, L Houlton, J.E.F., 1993. diseases of Rottweilers: Webb, AA, Pharr, J.W., Lew, L.L
Fibrocartilaginous embolism in neuroaxonal dystrophy and Tryon, K.A, 2001. MR imaging
the dog (review). J. Small Anim. leucoencephalomalacia. J. Small findings in a dog with lumbar
Pract. 34, 332 336. Anim. Pract. 33, 500 504. ganglion cysts. Vet. Radiol.
Gaschen, L., Lang, L Haem, Ho, 1995. Dickinson, P.L Sturges, B.K., Ultrasound 42, 9 13.
Intravertebral disc herniation Berry, W.L., Vemau, K.M.,
(Schmorl's nodes) in five dogs. Koblik, PD., Lecouteur, RA, Contrast radiography of the spine
Vet. Radiol. Ultrasound 36, 2001. Extradural spinal synovial Kirberger, RM., 1994. Recent
509 516. cysts in nine dogs. J. Small Anim. developments in canine lumbar
Gibbons, S.E., Madas, C, de Pract. 42, 502 509. myelography. Compend. Contin.
Stefani, G.L., Pinchbeck, G.L., Dyce, J., Herrtage, M.E., Houlton, J.E.F., Educ. Pract. Veterinarian (Small
McKee, W.M" 2006. The value of Palmer, AC, 1991. Canine spinal Animal) 16, 847 854.
oblique versus ventrcxiorsal 'arachnoid cysts'. J. Small Anim. Kirberger, RM., Wrigley, RH., 1993.
myelographic views for lesion Pract. 32, 433 437. Myelography in the dog: review
lateralization in canine Galloway, AM., Curtis, N.C, of patients with contrast medium
thoracolumbar disc disease. Sommerland, S.F., Watt, P.R, in the central canal. Vet. Radiol.
J. Small Anim. Pract. 47, 658 662. 1999. Correlative imaging Ultrasound 34, 253 258.
Kirberger, RM., Roos, CL Lubbe, A findings in seven dogs and one Lang, L 1988. Flexion extension
M., 1992. The radiological cat with spinal arachnoid cysts. myelography of the canine cauda
diagnosis of thoracolumbar disc Vet. Radiol. Ultrasound 40, equina. Vet. Radiol. 29, 242 257.
disease in the dachshund. Vet. 445 452. Llabres Diaz, F., 2005. Practical
Radiol. Ultrasound 33, 255 261. Gnirs, K., Ruet Y., Blot, S., Begon, D., contrast radiography 4.
Lamb, CR, 1994. Common Rault, F., Delisle, F., et al., 2003. Myelography. In Pract. 27,
difficulties with myelographic Spinal subarachnoid cysts in 13 502 510.
diagnosis of acute intervertebral dogs. Vet. Radiol. Ultrasound 44, Lu, D., Lamb, CR, Targett, M.P.,
disc prolapse in the dog. J. Small 402 408. 2002. Results of myelography in
Anim. Pract. 35, 549 558. Goncalves, R, Hammond, G., seven dogs with myelomalacia.
Lamb, CR, Nicholls, A, Targett, M., Penderis, L 2008. Imaging Vet. Radiol. Ultrasound 43,
Mannion, P., 2002. Accuracy of diagnosis: Erroneous 326 330.
survey radiographic diagnosis of localization of spinal arachnoid Matteucd, M.L., Ramirez Ill, 0.,
intervertebral disc protrusion in cyst. Vet. Radiol. Ultrasound 49, Thralt D.E., 1999. Radiographic
dog. Vet. Radiol. Ultrasound 43, 460 463. diagnosis: Effect of right versus
222 228. Hannet RM., Graham, J P., Levy, J.K., left lateral recumbency on
McKee, M., 2000. Intervertebral disc Buergelt, CD., Creamer, L 2004. myelographic appearance of a
disease in the dog 1. Generalized osteosclerosis in a cat. lateralized extradural mass.
Pathophysiology and diagnosis. Vet. Radiol. Ultrasound 45, Vet. Radiol. Ultrasound 40,
In Pract. 22, 355 369. 318 324. 351 352.
1 44 Handbook of Small Animal Radiology and U ltrasound

McKee, M., Penderis, L Dennis, R, for cauda equina syndrome. 'double line' sign. Vet. Radiol.
2000. Radiology corner Vet. Radiol. Ultrasound 39, Ultrasound 37, 264 265.
Obstruction of contrast medium 283 296. Stickle, R, Lowrie, C, Oakley, R,
flow during cervical Roberts, RE., Selcer, B.A., 1993. 1998. Radiology corner: Another
myelography. Vet. Radiol. Myelography and epidurography. example of the myelographic
Ultrasound 41, 342 343. Vet. Clin. North Am. Small Anim. 'double line' sign. Vet. Radiol.
Penderis, L Sullivan, M., Schwarz, T., Pract. 23, 307 328. Ultrasound 39, 543.
Griffiths, I.R, 1999. Subdural Scrivani, P.V., 2000. Myelographic Weber, W.L Berry, CR, 1994.
injection of contrast medium as artefacts. Vet. Clin. North Am. Radiology corner: Determining
a complication of myelography. Small Anim. Pract. 30, 303 314. the location of contrast medium
J. Small Anim. Pract. 40, 173 176. Scrivani, p.v., Barthez, P.Y., on the canine lumbar myelogram.
Ramerez Ill, 0., Thrall, D.E., 1998. Leveille, R, 1996. Radiology corner: Vet. Radiol. Ultrasound 35,
A review of imaging techniques The fallibility of the myelographic 430 432.
1 45

Chapter 6

Lower respiratory tract

6.22 Interstitial lung pattern 1 63
CHAPTER CONTENTS 6.23 Vascular lung pattern 1 65
6.1 Radiographic technique for the thorax and 6.24 Mixed lung pattern 1 67
effect of positioning 1 45 6.25 Generalized pulmonary hyperlucency 1 68
6.2 Ultrasonographic technique for the 6.26 Focal areas of pulmonary hyperlucency

thorax 1 46 (including cavitary lesions) 1 69
6.3 Poor intrathoracic ultrasonographic 6.27 Intrathoracic mineralized opacities 1 70
visualization 1 47 6.28 Hilar masses 1 71
6.4 Thoracic radiological changes associated 6.29 Increased visibility of lung or lobar

with ageing 1 47 edges 1 71
6.5 Border effacement in the thorax 1 48 6.30 Lower respiratory tract clinical signs but normal

6.6 Tracheal displacement 1 48 radiographs 1 71
6.7 Tracheal diameter variations 1 50
6.8 Tracheal lumen opacification 1 51
6.9 Tracheal wall visibility variations 1 51
6. 1 0 Tracheal ultrasonography 1 52 6 .1 RADIOGRAPHIC TECHNIQUE FOR THE
6. 1 1 Changes of the main stem (principal)
THORAX AND EFFECT OF POSITIONING
bronchi 1 52 Precise positioning using artificial aids is requiredf
6. 1 2 Bronchial lung pattern 1 53 with the thoracic limbs pulled forwards to avoid
6. 1 3 Artefactual increase in lung opacity 1 54 overlay of the cranial thorax. True lateral and dor­
6. 1 4 Alveolar lung pattern 1 54 soventral (DV) or ventrodorsal (VD) positioning
6. 1 5 Poorly marginated pulmonary opacities or areas should be ensured. In lateral recumbenCYf the
of consolidation 1 57 upper lung lobes are seen better due to relatively
6. 1 6 Ultrasonography of areas of alveolar increased aeration. The dependent lobes are poorly
filling 1 59 aerated due to pressure from mediastinal struc­
6. 1 7 Single radiopaque lung lobe 1 59 tures (especially the heart) and the dependent crus
6. 1 8 Ultrasonography of consolidated lung of the diaphragmf particularly in anaesthetized
lobes 1 60 dogsf and this means that lesions in the dependent
6. 1 9 Solitary pulmonary nodules or masses 1 60 lobe are often not visible. Anaesthesia-induced
6.20 Nodular lung pattern 1 61 atelectasis may arise quickly after inductionf espe­
6.21 Ultrasonography of pulmonary nodules cially in large or fat dogsf and it may be wise
or masses 1 63 to obtain the DV view firstf because atelectasis aris­
ing in lateral recumbency may mimic aspiration

© 2010 Els�yi�r Ltd.
1 46 Handbook of Small Animal Radiology and U ltrasound

pneumonia radiographically. In dorsal recum­ Optimal evaluation of thoracic radiographs
bency for the VD viewf the cardiac silhouette tends requires a systematic approachf which involves
to displace craniallYf allowing greater visualization assessing radiographic techniquef extrathoracic
of the accessory lung lobe region; the divergence of structures (soft tissuesf osseous structuresf thoracic
the X-ray beam plus the shape of the diaphragm inlet and diaphragm) and intrathoracic structuresf
also mean that more of the caudal lung field will and then re-evaluating abnormalities and areas
be visible. Howeverf the VD view is often less indicated by clinical history. Intrathoracic eval­
helpful than the DV for assessment of cardiac size uation is done on a system basis: respiratorYf
and shape. cardiovascularf lymphaticf pleural space and medi­
A minimum of two orthogonal views are astinum (including the oesophagus). For viewing
required to build up a three-dimensional imagef thoracic radiographsf the convention is that lateral
i.e. a right or left lateral recmnbent and a DV or views are examined with the thoracic inlet facing
VD radiograph. Some radiologists prefer left lateral to the left and DV and VD views with the thoracic
recumbency (LLR) and VD for general thoracic inlet uppermost and the left side of the patient on
evaluation and right lateral recumbency (RLR) the right side of the computer screen or light box.
and DV for assessment of the heartf but consis­ Consider the effect that agef body conditionf breed
tency of technique is probably more important. A and respiratory phase may have on the image. (See
combination of RLR and LLR ± VD views is Table 6.1, and 8.26 and Fig. 8.16.)
recommended for suspected metastases or smalt
poorly defined puhnonary lesions. Dorsal recum­
6.2 U LTRASONOGRAPHIC TECHNIQUE
bency for a VD view is contraindicated in patients
FOR THE THORAX
with severe dyspnoeaf and in such patients it may
be wise to obtain horizontal beam radiographs Normat aerated lung does not transmit ultra­
with the patient non-recumbent first. Horizontal soundf but in the presence of pulmonary disease
beam radiographs utilizing the effect of gravity or free thoracic fluid ultrasonography may be very
may also be helpful to highlight certain types of useful. Sector or curvilinear transducers allow opti­
pathologYf such as mediastinal massesf fluid lines mal access to intrathoracic structures. As high
in cavitary masses and small amOilllts of free fluid a frequency as possible should be selected while
or air. In the case of suspected emphysemaf a hori­ still achieving adequate tissue penetration (e.g.
zontal beam view with the suspected affected lobe 7.5 MHz for cats and small dogs and 5 MHz for
dependent will show whether or not it collapses medium or large dogs). An acoustic window that
under the weight of the overlying heart. overlies the area of interest is chosenf avoiding
Routine views should be made at maximum intervening skeletal structures and minimizing
inspiration. Additional expiratory views are indi­ the amount of interposed air-filled lung. In generat
cated for suspected tracheal or bronchial collapse; this means placing the transducer in an appropri­
incomplete bronchial obstruction; identification of ate intercostal spacef but parts of the thorax may
occult bullaef blebs or emphysema; and detection also be imaged from a cranial abdominal approach
of small-volume pnemnothorax. through the liverf or from the thoracic inlet. When
For digital radiographYf an appropriate algo­ the patient is in lateral recumbencYf the dependent
rithm should be used to combine resolution and lung lobes become compressedf and less interfer­
contrast. For conventional fihn radiographYf a fast ence from air-filled lilllg then occurs if the thorax
fihn-screen combination should be used to mini­ is imaged from beneath. The position of the animal
mize motion blurf and a grid should be employed can be altered if necessary to make use of the
if the thorax is > 12 cm thick or in smallerf obese effects of gravity on the distribution of free fluid
dogs. A long-scale contrast technique (high kV, or free air in the thoracic cavity. Free fluid acts as
low mAs) will reduce the naturally high contrast an excellent acoustic windowf and thoracic ultra­
in the thorax and increase the lung detail visiblef sound should be performed before thoracocentesis.
as well as reducing the exposure time. Exposure The chosen acoustic window should be care­
should be made at the end of inspiration to maxi­ fully prepared by clipping hair from the area,
mize lung aeration and optimize contrastf using cleaning the skin with surgical spirit to remove
manual inflation if necessary in anaesthetized dirt and greasef and applying liberal quantities
patients (allowing for radiation safety). of acoustic gel.
Chapter 6 Lower respiratory tract 1 47

Table 6.1 Effect of positioning on thoracic structures i n normal dogs

ANATOMICAL AREA RIGHT LATERAL RECUMBENCY LEFT LATERAL RECUMBENCY

Diaphragm Right crus l ies more cranially; crura are parallel Left crus l ies more cranially; crura diverge dorsally
Heart More sternal contact Less stt":rnal contact: the apex may be elevated from
the stt":rnum and the heart appears more rounded
Lungs Any pathology seen is likely to be in the left Any pathology set":n is likely to be in the right
(uppt":rmost) lung (up�rmost) lung
Mt":diastinum Cranioventral mediastinum is seen more clearly
than on LLR
Extraplt":ural sign of sterna I lymph nodt": is st":en
more clearly than on LLR
Aorta Mort": clt":arly st":en than on RLR
Distal oesophagus Not seen Somt":times seen in largt":r dogs

DORSOVENTRAL VENTRODORSAL

Diaphragm Set":n as a singlt":, rounded structure Oftt":n seen as a th ree domed structure (two crura
and central cupola)
Ht":art Usually contacts the diaphragm Usually dot":s not contact tht": diaphragm
Constant location Oftt":n tilts cranially and to tht": right
Asymmetrical ovoid shape; right margin more curved Right atrium may protrudt":, giving the heart a slightly
angular outline
1 2 o'clock bulge due to pul monary artt":ry
Caudal vt":na cava Longer and seen more clearly
Lungs Caudal lobe blood vt":sst":ls are seen more clearly
Less divergence of the main stem (principal) bronchi More divergenct": of the main stem (principal) bronchi
Less visibility of the accessory lobe More visibility of the accessory lobe
Thoracic disc spact":S Caudal disc spaces st":t":n mort": clt":arly Cranial disc spaces set":n more clearly
Thoracic width Wider Narrower

Ultrasound-guided fine needle aspiration using a 6.4 THORACIC RADIOLOGICAL CHANGES
22-gauge spinal needle may be performed on superfi­ ASSOCIATED WITH AG EING
cial lesions that are in contact with the thoracic wall.
1. Calcification of costochondral junctions and
chondral cartilages.
6.3 POOR INTRATHORACIC a. Rosette appearance around costochondral
U LTRASONOGRAPHIC VISUALIZATION junctions in old dogs.
May be due to any combination of the following b. Appearance of fragmentation of calcified
factors: costal cartilages in old cats.
1. Poor preparation of the scanning site. 2. Tracheal ring calcification - especially
chondrodystrophic breeds.
2. Poor skin-transducer contact.
3. Bronchial wall calcification - especially
3. Rib interposed between the transducer and the
chondrodystrophic breeds.
region of interest.
4. Spondylosis and sternal new bone.
4. Too much aerated lung interposed between the S. Pleural thickening.
transducer and the region of interest.
6. Pulmonary osteomata (heterotopic bone
S. Free air in the thoracic cavity.
formation) and calcified pleural plaques in
6. Subcutaneous emphysema. olderf large-breed dogs; 2- to 4-mm diameter
7. Obesity. nodules of varying number and slightly
8. Calcification of intra-thoracic structures irregular outlinef very radiopaque and
sufficient to result in acoustic shadowing. distributed randomly throughout the lungsf
1 48 Handbook of Small Animal Radiology and U ltrasound

although often in greatest numbers ventrally; two superimposing soft tissue structures are visible
differential diagnosis is miliary neoplasia when it implies that these two structures are not touch­
present in large numbers. ing each other and that air-filled lung is interposed
7. Finef diffusef reticular to reticulonodular (Fig. 6.1B). Border effacement must not be confused
interstitial lung pattern. with fat deposits (pleurat pericardial and epicar­
S. More horizontal orientation of the heart in aged dial) lying adjacent to soft tissues. Accumulations
catsf with exaggerated cranial curvature of the of fat are less radiopaque than soft tissue and can
aortic arch and sometimes marked undulation be differentiated on good-quality radiographs.
of the descending aorta. 1. Artefactual border effacement due to technical
factors.
6.5 BORDER EFFACEM ENT I N THE THORAX a. Underexposure due to inadequate
penetration of tissues (kV too low).
Border effacementf previously referred to as the sil­ b. Underdevelopment of the fihn.
houette signf occurs when pathological soft tissue c. Poor aeration of the lungs.
or fluid opacity comes into direct contact with nor­
mal thoracic soft tissue structures (Fig. 6.1A). This 2. Pleural or mediastinal effusion.
eliminates the air usually present between the 3. Pleural masses.
two structuresf resulting in the creation of a single 4. Alveolar lung pattern.
shadow with loss of visibility of the adjacent mar­ S. Severe interstitial lung pattern.
gins of the individual structures. This can affect 6. Pulmonary masses.
the cardiac silhouettef vascular markings and 7. Diaphragmatic rupture or hernia.
diaphragmatic line and may be generalized or S. Large mediastinal masses.
localized. ConverselYf if the individual borders of

6 .6 TRACHEAL DISPLACEM ENT
The normal position of the trachea is shown in
Figure 6.2A and E.
1. Dorsal displacement of the trachea.
a. Artefactual.
- Expiration; cranial movement of
intrathoracic structures.
Rotated lateral positioning.
b. Conformation (e.g. Bulldog and Yorkshire
Terrier).
c. Whole trachea elevated (Fig. 6.2B).
Generalized cardiomegaly (see 7.5).
Right heart enlargement (see 7.11 and 7.12).
- Left heart enlargement (see 7.8 and 7.9).
- Large cranial mediastinal mass (see S.11.1
and Fig. 8.10).
- Large amount of mediastinal fluid.
- Diaphragmatic rupture and displacement
by herniated abdominal contents.
d. Cranial thoracic trachea elevatedf dipping
ventrally towards the carina (Fig. 6.2C).
Figure 6.1 (A) Effacement of the cranial heart border due to - Artefactuat due to neck flexion.
a mediastinal mass (*) : the mass is touching the heart and no - Cranial mediastinal mass (see S.11.1 and
air-filled lung lies between the two structu res. (8) A large Fig. 8.10).
caudal lobe mass (*) with no border effacement of the heart - Cranial mediastinal and tracheobronchial
or diaphragm, indicating that air-filled lung is interposed. lymphadenopathy (see 8.11.3 and Fig. 8.10).
Chapter 6 Lower respiratory tract 1 49

;;"
�r/ -{ ---'

b :�;

® ® ®
Figure 6.2 (A) Normal tracheal position (lateral view). In most breeds of dogs and in cats, the trachea diverges slightly from
the spine. (8) The trachea is elevated throughout its length, in this case due to generalized cardiomegaly. (C) The trachea is
elevated cranial to the heart, but the carina is in a normal position, in this case due to a cranial mediastinal mass. (D) Ventral
tracheal displacement. (E) Normal tracheal position (dorsoventral view): slight curvature to the right through the thoracic inlet,
especially in chondrodystrophic dogs. (F) Lateral displacement of the trachea, usually to the right. (G) Lateral displacement of the
terminal trachea to the left; the cranial mediastinum is also widened due to the presence of a dilated oesophagus (Oes).

c. Severe ventral displacement just cranial to the
- Right atrial enlargement (see 7.11 and heart.
Fig. 7.7). - Persistent right aortic arch with retro­
- Heart base tumour (see 7.16.2). oesophageal subclavian artery.
- Lung lobe torsion (see 6.17.5 and Double aortic arch.
Fig. 6.11). d. Tracheobronchial lymphadenopathy (see
2. Ventral displacement of the trachea (Fig. 6.20). 8.11.3 and Fig. 8.10).
a. Oesophageal dilation (see 8.17 and Fig. 8.11). e. Craniodorsal mediastinal mass or loculated
b. Oesophageal foreign body (see 8.20). fluid (see 8.11.2 and Fig. 8.10).
1 50 Handbook of Small Animal Radiology and U ltrasound

f. Massive cervicothoracic spondylosis or other 1. Narrowing of the trachea.
bony mass. a. Artefactual.
g. Post-stenotic aortic dilation distal to - Superimposition of the longus colli muscle
coarctation of the aorta (see 7.10.1). or oesophagus at the level of and cranial to
3. Right lateral displacement of the trachea the thoracic inlet.
(Fig. 6.2F); displacement is usually to the right, - Hyperextension of the neck.
as the aorta prevents displacement to the left. - Intrathoracic structures superimposed on
a. Artefactual. the thoracic trachea (e.g. dilatedf post­
- Ventral flexion of the head or neck. stenotic pulmonary arteryf cranial
- Expiration; cranial movement of mediastinal blood vessels highlighted by
intrathoracic structures. pnemnomediastinumf or pulmonary
- Rotated DV or VD positioning. nodules).
b. Normal in chondrodystrophic dogsf b. Congenital hypoplasia - Bulldog and other
especially if obese. brachycephalic breedsf Bullmastiff and
c. Cranial mediastinal mass (see 8.11.1 and occasionally the Labradorf German Shepherd
8.11.2 and Fig. 8.10). dogf Weimaranerf Basset Hound and in cats.
d. Oesophageal dilation (see 8.17). May be accompanied by other congenital
e. Cranial mediastinal shift (see 8.8). abnormalitiesf megaoesophagus and
f. Diaphragmatic rupture and displacement by secondary aspiration bronchopneumonia.
herniated abdominal contents. c. Tracheal collapse syndrome - due to
g. Heart base tumour (see 7.16.2). deformed tracheal cartilage rings and
invagination of the dorsal tracheal
4. Left lateral displacement of the terminal trachea
membrane. Often there is dynamic narrowing
(Fig. 6.2G) - persistent right aortic arch; the
of the cervical trachea during inspiration and
cranial mediastinum will also be widened.
of the intrathoracic trachea during expiration.
The tangential view of the thoracic inlet is
more reliable for detection of collapse than
6.7 TRACHEAL DIAMETER VARIATIONS
lateral radiographs (Fig. 6.4). Fluoroscopy
The tracheal diameter as a ratio to the thoracic and endoscopy are useful ancillary diagnostic
inletf measured at the thoracic inlet on the lateral techniques.
viewf should be not less than 0.20 in normat non­ - Congenital - Yorkshire Terrier and
brachycephalic dogs (Fig. 6.3). In brachycephalic Chihuahua; may not manifest until
dogs, the ratio should be 0.16 or higher, although older age.
in Bulldogs the ratio may be as low as 0.13.

Figure 6.4 Tangential view of the thoracic inlet for
demonstration of the trachea in cross-section. The normal
trachea is round in cross-section or only slightly flattened
dorsally. A collapsed trachea appears more markedly
Figure 6.3 Measurement of the trachea at the thoracic flattened dorsally, or crescentic, depending on the degree of
in let: the tracheal diameter is usually at least 200/0 of the collapse. Positioning is achieved using soft ties or a perspex
thoracic inlet depth in non-chondrodystrophic breeds. frame; positioning aids are not shown.
Chapter 6 Lower respiratory tract 1 51

- Acquired - obesef olderf small and 6.8 TRACHEAL LU M EN OPACIFICATION
miniature breeds (Pomeranian and Toy
Poodle)f often secondary to chronic 1. Artefactual.
bronchitis; rare in large dog breeds and a. Intrathoracic structures superimposed on the
cats. thoracic trachea.
d. Mucosal thickening. 2. Aspirated foreign body.
- Tracheitis due to respiratory viral 3. Oslerus osleri* (previously Filaroides osleri) - soft
infections; inhalation of gases; smoke and tissue nodules on the floor of the terminal
dust; allergies; bacterial and parasitic trachea and main stem (principal) bronchi. More
infections. common in young dogs; does not occur in cats.
- Submucosal haemorrhage - anticoagulant 4. Abscess or granuloma involving the tracheal
poisoning or trauma. mucosa.
- Cats - feline infectious peritonitis (FIP). a. Infectious.
e. Extrinsic pressure - the tracheal rings are b. Eosinophilic.
fairly rigid and tracheal displacement is more c. Trauma.
likely than narrowing. d. Iatrogenic (e.g. post tracheotomy).
- Cranial mediastinal mass (see 8.11.1 and
5. Neoplasia.
Fig. 8.10).
- Hilar mass (see 8.11.3 and Fig. 8.10). a. Osteochondroma - young large breedsf may
mineralize.
- Oesophageal foreign body (see 8.20).
b. Hamartoma - may mineralize.
- Oesophageal dilation (see 8.17).
c. Chondrosarcoma - may mineralize.
- Vascular ring anomaly with oesophageal
d. Osteosarcoma - may mineralize.
dilation cranial to the anomaly.
f. Tracheal stricture or segmental stenosis. e. Mast cell tumour.
f. Leiomyoma.
- Old traumatic injury.
- Prolonged intubation with excessive cuff g. Infiltrative tumour (e.g. thyroid carcinoma).
pressure. h. Fibrosarcoma.
- Congenital. i. Extramedullary plasmacytoma.
- Cats - intrathoracic tracheal avulsion with j. Lymphoma - especially cats.
stenosis of the separated tracheal ends; k. Adenocarcinoma - especially cats.
usually 2-3 weeks after blunt trauma. An 6. Tracheal polyp.
air-filled tracheal pseudodiverticulum may 7. Positive contrast agents - mineral opacity.
also be seen as a circular gas lucency
a. Inadvertent aspiration during gastrointestinal
superimposed over the thoracic trachea.
contrast studies.
g. Focal mass lesions of the tracheal wall (see
b. Oral contrast studies in dysphagic animals.
6.8.2-6).
c. Gastrointestinal contrast studies with a
h. Cats - dynamic tracheal collapse secondary to
tracheo-oesophageal or broncho-oesophageal
obstruction of the upper respiratory tract (e.g.
fistula present.
nasal or laryngeal neoplasia).
2. Widening of the trachea.
a. Normal variant in chondrodystrophic breeds.
6.9 TRACHEAL WALL VISIBILITY
VARIATIONS
b. On inspirationf due to obstruction of airflow
cranially resulting from a laryngeal or The tracheal wall is a soft tissue opacity that con­
proximal tracheal lesion. tacts the surrounding cranial mediastinal struc­
c. Adjacent to tracheal collapse or during the tures and is therefore not usually visible.
opposite phase of respiration. 1. Mineralization of cartilage rings - a normal
d. Scarring adjacent to the trachea. ageing changef especially in chondrodystrophic
e. Cats - intrathoracic tracheal avulsionf with dogs.
focal widening between the separated 2. Tracheal stripe sign -the dorsal wall of the trachea
segments. and adjacent ventral oesophageal wall smnmate
1 52 Handbook of Small Animal Radiology and U ltrasound

and become visible due to the presence of air in the 6 . 1 1 CHANGES OF THE MAIN STEM
oesophagus - usually due to oesophageal dilation (PRINCIPAL) BRONCHI
(see 8.17 and Figs 8.11 and 8.12).
The main stem bronchi are visible for a short dis­
3. Pnemnomediastinum (see 8.9.1-6).
tance caudal to the carina as superimposed air­
filled structures on the lateral view and diverging
6 . 1 0 TRACHEAL ULTRASONOGRAPHY at an angle of about 60-90 ° on the DV view
(Fig. 6.5A-C).
Because the trachea is air-filledf ultrasonographic
1. Displacement of the main stem bronchi.
imaging is limited. Howeverf the shape of the air
colurrm in the cervical trachea may be evaluated. a. Artefactual.
- Rotated lateral view (Fig. 6.5B).
1. Flattening of the air column in the cervical
trachea. - Wider main stem bronchi angle on VD
a. Dynamicf on hyperextension of the neck. than DV radiograph.
b. Enlarged left atrium (see 7.8) (Fig. 6.5B
- Tracheal collapse syndrome.
and D).
b. Static.
c. Hilar lymphadenopathy (see 8.12.1-6)
- Traumatic stricture. (Fig. 6.5B and D).
- Congenital stenosis. d. Large caudal oesophageal mass (e.g.
- Mass lesions of the tracheal wall Spirocerca lupi'" granuloma).
(see 6.8.2-5) .

.---.,-

© ®
Figure 6.5 (A) Normal superim posed main stem (principal) bronchi on the lateral view. (8) Displacement or 'splitting' of the
main stem bronchi on the lateral view. (C) Normal main stem bronchi on the dorsoventral (DV) view, diverging at 50-60 o.
(D) Widened angle of the main stem bronchi on the DV view.
Chapter 6 Lower respiratory tract 1 53

e. Lung lobe torsion - may result in axial
rotation of the tracheal bifurcation (see 6.17.5
and Fig. 6.11).
2. Narrowing of the main stem bronchi.
a. External compression from enlarged left
atriumf hilar lymphadenopathy or
-�
oesophageal massf as above; may be
displaced too.
b. Loss of bronchial wall rigidity resulting in
dynamic airway collapse and secondary
Figure 6.7 Bronchial lung pattern, producing 'tram line'
chronic obstructive pulmonary disease is
and 'doughn ut' markings. Bronchiectasis results in widened
frequently observed in association with
or irregular bronchi, as shown. (Compare with Fig. 6.6,
tracheal collapse syndrome (see 6.7.1).
Normal lung pattern.)
c. Severe mucosal thickening.
d. Lung lobe torsion (see 6.17.5 and Fig. 6.11).
3. Opacification of the main stem bronchi - similar
to the trachea and the rest of the bronchial tree Increased bronchial wall visibility
(see 6.8 and 6.12).
1. Normal in aged and chondrodystrophic dogs -
thinf mineralized wall.
6 . 1 2 BRONCHIAL LUNG PATTERN 2. Chronic bronchitis - mucosal inflammation
In the normal hmgf vessels are seen clearly but bron­ and peribronchial cuffing produce thickenedf
chial walls are usually seen only in the perihilar areaf soft tissue opacity walls (acute bronchitis
where the bronchi are relatively large (Fig. 6.6). usually lacks radiographic changes).
A bronchial pattern implies increased visibility of the Often a component of bronchopneumonia
bronchial treef which may be accompanied by changes (see 6.14.2).
in size and shape of the hunen and reduced visibility a. Bacterial.
of adjacent vascular structures (Fig. 6.7). Howeverf it - Non-specific bacterial infection.
is not necessarily due to primary airway disease. The - Irish Wolfhound: hereditary rhinitis-
bronchial pattern may be due to luminal exudatef bronchitis complex; young dogs with
thickened bronchial mucosa or peribronchial cuffingf recurrent clinical signs due to primary
and is often accompanied by an interstitial hmg pat­ immunodeficiency .
tern. In yOilllg animalsf only the mineralized wall of b. Viral.
the main stem (principal) bronchi may be visible. As c. Allergic.
the animal agesf this mineralization may extend more - Eosinophilic bronchopnemnopathy
peripherally along the bronchial tree and may be (pulmonary infiltrate with eosinophils).
accompanied by pulmonary fibrosis. - Cats - feline bronchial asthma.
d. Fungal (see 6.15.5).
e. Parasitic; usually a component of a
pneumonic patternf although sometimes the
bronchial pattern may predominate (see
6.14.2e for list of parasites).
f. Protozoal.
- Toxoplasmosis*.
g. Secondary to primary ciliary dyskinesia;
mainly in youngf purebred dogsf
particularly Bichon Frisef Newfoillldland
and Rottweiler. May be accompanied by
Figure 6.6 Normal lung pattern: the bronchus runs between situs inversus (mirror image inversion of
the artery and vein and is barely visible (inset shows a thoracic and abdominal structures).
cross-section). h. Severe small airway disease.
1 54 Handbook of Small Animal Radiology and U ltrasound

3. Neoplasia. often right bronchus. Chronic cases show
a. Lymphomaf accompanied by a diffuse or secondary lobar bronchopneumonia.
reticulonodular interstitial lilllg pattern and 11. Oslerus osleri* (previously Filaroides osleri) -
mediastinal lymphadenopathy. nodules in main stem (principal) bronchif
b. Bronchogenic carcinomaf possibly usually also with tracheal nodules. More
accompanied by pulmonary nodules or common in young dogs; does not occur in cats.
masses. 12. Bronchiolitis obliterans - rare.
4. Bronchial wall oedema - may be part of 13. Cats - bronchial microlithiasis - rare.
alveolar or interstitial oedema (see 6.14.1 and
6.14.7 for causes).
S. Bronchiectasis - see below. 6 . 1 3 ARTEFACTUAL INCREASE IN LUNG
6. Hyperadrenocorticism (Cushingfs disease) or OPACITY
long-term corticosteroid administration; thinf The following factors all contribute to an artefac­
mineralized bronchial wallsf and may also see tual increase in lung opacitYf which may result in
hepatomegalYf osteopenia and soft tissue false negative or false positive diagnoses.
mineralization.
1. Poorly inflated lungs.
7. Idiopathic pulmonary fibrosis - in combination
with interstitial (dogs) or interstitial or alveolar a. Exposure made on expiration.
(cats) pattern. b. Preceding lateral recumbencYf especially if
anaesthetized.
c. Laryngeal paralysis or other upper
Bronchial dilation respiratory tract obstruction.
d. Abdominal distension.
8. Bronchiectasis - usually cranioventrally;
2. Obesity.
uncommon in dogs and rare in cats. Saccular
or cylindrical. 3. Motion blur.
a. Congenital predisposition. 4. Underexposure.
- Irish Wolfhound: hereditary rhinitis­ S. Underdevelopment.

bronchitis complex; young dogs with 6. Cranial thorax - overlying musculature if the
recurrent clinical signs due to primary thoracic limbs are not pulled cranially.
immunodeficiency. 7. Bandages.
- Primary ciliary dyskinesia - inherited 8. Wet or dirty hair coat.
abnormality of ciliary hmction leading to 9. Thymus in young animals (especially cats) - an
chronic rhinitis and severe pneumonia ill-defined radiopacity blurring the cranial heart
± bronchiectasis; especially yOilllg Bichon margin in the lateral view.
Frisef Newfoundlands and Rottweilers.
- Kartagenees syndrome - inherited
condition as above but also associated 6 . 1 4 ALVEOLAR LUNG PATTERN
with total situs inversus (mirror image The alveoli lose air either by being filled with fluid
transposition of heart and abdominal and/ or cells (alveolar consolidation) or by collaps­
viscera) as well as rhinitis. ing (atelectasis). The pattern is usually character­
b. Acquired bronchiectasis - usually middle­ ized by ill-definedf poorly demarcated infiltrates
aged patients with chronic inflammatory producing a patchy increase in lung opacitYf
airway disease. although a more homogeneous infiltrate may give
rise to a ground glass appearance. These patterns
Bronchial lumen opacification may progress to more severe lung opacification
with air bronchograms and border effacement
9. Ill-defined opacities: mucus or exudate due to (see 6.5) in more advanced cases (Fig. 6.8). Changes
pneumonia (see 6.14.2) or bronchiectasis. may be widespread or lobar. A severe alveolar pat­
10. Single aspirated foreign body, especially grass tern may give rise to single or multiple poorly mar­
awns in working dogs - mainly caudal lobesf ginated apparent pulmonary masses or areas of
Chapter 6 Lower respiratory tract 1 55

b. Aspiration pneumonia - observed along the
bronchial treef more commonly in ventral
areas. Secondary to:
- Regurgitation and vomitingf especially if
oesophageal dilation is present.
Iatrogenic aspiration - force feedingf
medicationf anaesthesia and oral
administration of contrast medium.
- Swallowing disorders.
- Weakness and debilitation.
Figure 6.8 Alveolar lung pattern with blurring or loss of - Cleft palate.
normal lung detail, patchy or diffuse increase in radiopacity - Tracheo-oesophageal or broncho-
and air bronchogram formation. (Compare with Fig. 6.6, oesophageal fistula.
Normal lung pattern.) - Gastrobronchial fistula.
c. Aspirated foreign body pneumoniaf usually
grass and barley awns in working dogs -
consolidationf which are described in Section 6.15. caudodorsal segments of caudal lobesf
Alveolar changes are fairly labilef and frequent usually affecting a single lobe. Focal alveolar
repeat radiography may be necessary to monitor or interstitial patternf with a more
the course of a disease. Alveolar lung patterns widespread bronchial pattern too in chronic
may arise fromf or give rise tOf interstitial lung cases. May be accompanied by
patterns (see 6.22 and 6.24). pneumothoraxf pleural effusion or pleural
1. Cardiogenic pulmonary oedema - usually thickening.
associated with cardiomegalYf especially left d. Fungal pneumonia (see 6.15.5); often with
atrial dilationf and possibly a hypervascular mediastinal lymphadenopathy.
pattern (see 6.23.1-4). However, with heart - Also diffuse fungal pneumonia due to
failure of rapid onsetf the heart may appear Pneunwcystis carinii* in
unremarkable. immunocompromised dogs; especially in
a. Perihilar and symmetrical distribution in younger Miniature Dachshilllds and
dogs. Cavalier King Charles Spaniels.
b. Perihilar to peripheral distribution in cats; e. Parasitic pneumonia.
the consolidations are often patchy and - Dirofilaria immitis* (heartworm); with
asymmetrical; may affect the right caudal right heart enlargementf prominence of
lobe only. the main pulmonary artery and an
2. Pneumonia. arterial hypervascular lung pattern; lilllg
a. Bronchopneumonia - asymmetricat mainly parenchymal changes are often most
cranioventral lung lobes; starts peripherally severe in the caudal lung lobes.
and then spreads inwards. Often involves - Angiostrongylus vasorum* (French
the right middle lobe. Usually initiated by heartworm); younger dogs; often
viral infections (e.g. tracheobronchitis and characteristic multifocal or peripheral lilllg
distemper) or mycoplasma and then involvement and usually no vascular
complicated by a bacterial infection. Usually changes; may present with coagulopathy
also a pronounced bronchial hmg pattern. rather than respiratory signs.
Irish Wolfhound: hereditary rhinitis­ - Filaroides hirthi* and F. milksi*: usually
bronchitis complex; young dogs with Beagles in breeding colonies.
recurrent clinical signs due to primary - Crensoma vulpis* infection (fox lungworm) ­
immunodeficiency . bronchial pattern may predominate.
Newfoundland and Rottweiler: ciliary - Aelurostrongylus abstrusus* (feline
dyskinesia (see 6.12.8). lungworm) - usually younger cats but
- Uncommon in cats. mostly asymptomatic; initial alveolar or
1 56 Handbook of Small Animal Radiology and U ltrasound

bronchoalveolar pattern progresses to a e. Cicatrization due to chronic pleural and
miliary nodular pattern. pulmonary disease.
f. Lipid or lipoid pneumonia (exogenous or f. Adhesive atelectasis - lack of surfactant;
endogenous) - especially cats. airways are patent.
g. Secondary to primary ciliary dyskinesia or as - Newborn animal.
part of Kartagener's syndrome - especially - Acute lung injury or acute respiratory
Newfoundland and Rottweiler (see 6.12.8). distress syndrome (see 6.14.7 below).
h. Radiation pneumonitis 1-2 months post g. Lung lobe torsion (see 6.17.5).
radiation - localized to the irradiated area of h. Cats - right middle lobe atelectasis often
the lung. occurs in feline bronchial astluna; usually
i. Tuberculosis - often also with cavitary lung also with a bronchointerstitial pattern and
lesions, mediastinal lymphadenopathy and/ pulmonary overinflation.
or pleural effusion. 5. Allergic puhnonary disease - eosinophilic
j. Francisella (Pasteurella) tularensis* (tularaemia) bronchopneumopathy (pulmonary infiltrate
- very rare, potential contact with rodents. with eosinophils); occasionally see an alveolar
3. Pulmonary haemorrhage - usually pattern, more often interstitial or nodular ±
asymmetrical and less homogeneous than bronchial.
cardiogenic oedema. 6. Neoplasia.
a. Trauma - fractured ribs and subcutaneous a. Primary lung tumour - an alveolar or
emphysema may also be seen. interstitial-type pattern is occasionally seen
b. Coagulopathy. in cases of diffuse bronchiolar-alveolar
- Disseminated intravascular coagulation carcinoma and may affect more than one
(DIC). lobe; air bronchograms are rare.
- Anticoagulant poisoning. b. Histiocytic sarcoma (malignant histiocytosis) ­
- Haemophilia, von Willebrand's disease middle-aged, large-breed dogs, with male
(especially Dobermann) and other preponderance; mainly Bernese MOillltain
inherited coagulopathies. Dog but also Rottweiler and Golden or Flat­
- Immune-mediated diseases. coated Retrievers.
- Bone marrow depression. c. Pulmonary lymphomatoid granulomatosis -
4. Atelectasis (reduced aeration of a lung lobe) rare neoplastic disorder; often with
recognized by mediastinal shift on DV or pulmonary nodules or masses and hilar
VD views (see 8.8). Air bronchograms are lymphadenopathy.
observed only with moderate to severe 7. Non-cardiogenic pulmonary oedema.
lung collapse. a. Perihilar to peripheral - more likely in the
a. Peracute collapse of dependent lobes under caudodorsal area, often asymmetrical and
gaseous anaesthesia; especially in the region more on the right side.
of the heart (main differential diagnosis is - Airway obstruction (e.g. common in
aspiration pneumonia). Bulldogs, also strangulation or laryngeal
b. External compression of a lobe. paralysis).
Extended periods in lateral recmnbency. - Neurogenic causes (e.g. post-ictat electric
- Severe pneumothorax. shock, cranial trauma).
Severe pleural effusion. - Near-drowning - more severe with salt
water than fresh water.
- Large pleurat rib or soft tissue mass.
- Hypoalbuminaemia.
c. Minor airway obstruction due to chronic
- Multisystemic inflammatory and non-
bronchitis - especially middle and cranial lobes.
inflammatory diseases (e.g. uraemia,
d. Major airway obstruction - any single lobe;
acute pancreatitis and sepsis).
usually no air bronchograms visible.
- Hilllting dogs that bark continuously,
- Intrinsic obstruction due to a foreign
especially in Sweden.
body or tmnour blocking the bronchus.
- Anaphylactic reactions, including those to
- Extrinsic obstruction due to compression.
intravenous contrast media.
Chapter 6 Lower respiratory tract 1 57

Aspirated hyperosmolar contrast

/�
medium.
- Toxins (e.g. alphanapthylthioureaf snake
venom and endotoxinf bee stings).
Inhaled irritants (e.g. smoke and

�t�t�.
phosphorus).
- Re-expansion pulmonary oedema after
treatment of pneumothoraxf etc.
b. Symmetrical - entire lung.
..�
._-"
- Acute hmg injury or acute respiratory
distress syndrome (or shock lung). Causes
include tramnaf infectionf anaphylaxisf Figure 6.9 Poorly marginated pulmonary opacities or areas
severe babesiosis*f pancreatitisf inhalationf of consolidation.
disseminated intravascular coagulationf
ingested toxins and iatrogenic causes such
as oxygen therapYf overhydrationf For smaller lesionsf see 6.14f Alveolar lung pattern;
cardioversion and drug reactions. Initial for well-defined lesions, see 6.19, Solitary pulmonary
interstitial pattern progresses to a patchy nodules or masses and 6.20, Nodular lung pattern.
alveolar pattern with reduced hmg volmne. 1. Artefactual - food material in a distended
c. One hemithorax. oesophagus.
- Hypostasis from extended lateral 2. Pneumonia - a mixed bronchial-alveolar hmg
recumbency or anaesthesia. pattern ± larger areas of consolidation or poorly
- Hilar mass blocking pulmonary drainage marginated opacities (see 6.14.2).
mechanisms. 3. Neoplasia - may cavitate or calcify.
d. Perihilar. a. Primary lung tumours.
- Hilar mass blocking pulmonary drainage Bronchogenic carcinoma most common -
mechanisms. may be a solitary nodule or multicentricf
- Iatrogenic overhydration with although more often well-defined or lobar
intravenous fluids. in shape than poorly marginated.
8. Pulmonary contusion due to trauma; other - Adenocarcinoma and squamous cell
signs of trauma are often present too (see 8.28). carcinoma - especially cats (may be
a. Road traffic accident. associated with multiple digital metastases ­
b. High-rise syndrome - triad of injuries: see 3.7.11 and Fig. 3.18).
puhnonary contusion and/or b. Metastatic lung tumours - a single metastatic
pneumothoraxf facial injuries and limb nodule tends to be smaller than a single
fractures. primary tmnour; againf more likely to be
9. Pulmonary thromboembolism - occasionally well-defined, or ill-defined but small; usually
with a localized alveolar pattern (see 6.23.6). multiple when diagnosed.
10. Lung lobe torsion (see 6.17.5). c. Histiocytic sarcoma (malignant histiocytosis)
11. Puhnonary alveolar proteinosis - middle-aged, large-breed dogs, with male
(phospholipoproteinosis) - rare, young dogs. preponderance - mainly Bernese Mountain
12. Bronchiolitis obliteransf with bronchial and Dog but also Rottweiler and Golden and
interstitial patterns too - rare. Flat-coated Retrievers.
13. Cats - idiopathic pulmonary fibrosis may give 4. Pulmonary oedema - usually produces an
rise to an alveolar pattern. alveolar or interstitial lung pattern if cardiogenic
in dogsf but in catsf cardiogenic puhnonary
oedema can lead to patchy and asymmetric
6 . 1 5 POORLY MARGINATED PULMONARY
consolidationsf especially in the right caudal
OPACITIES OR AREAS OF CONSOLIDATION
lobe; oedema due to other causes may also
Lesions may be single or multiple and are gener­ produce poorly marginated areas of
ally greater than 4 cm in diameter (see Fig. 6.9). consolidation (see 6.14.7).
1 58 Handbook of Small Animal Radiology and U ltrasound

5. Pulmonary granulomatous diseases - cellular puhnonary artery and a hypervascular
rather than exudative inflammatory reactionf pattern.
often accompanied by thoracic - Angiostrongylus vasorum* (French
lymphadenopathy. Granulomata may cavitate. heartworm); younger dogs; often
a. Aspirated foreign bodYf especially grass awns characteristic multifocal or peripheral lung
in working dogs; usually solitary and in the involvement and usually no vascular
caudal or intermediate lobes. changes.
b. Fungal and fungal-like diseases - in - Paragonimus kellicotti* (lung fluke);
endemic areas and more likely in working amorphous consolidations in the caudal
and hunting dogs. No typical radiographic lobes progressing to thin-walled cysts that
appearance; may also be a nodular to may be septated.
interstitial lung pattern. Additional foci of - Toxoplasmosis* - usually younger cats.
infection may be present elsewhere in the - Larval migransf changes very subtle.
body (e.g. osteomyelitisf chorioretinitisf - Capillariasis* - rare.
dermatitis and central nervous system - Filaroides hirthi* and F. milksi*; usually
involvement). There may also be a pleural Beagles in breeding colonies.
effusion. - Cats - Aelurostrongylus abstrusus* (feline
Specific obligate pathogens lungworm) - an initial bronchoalveolar
- Histoplasmosis* - with moderate to pattern tends to become nodular with
marked lymphadenopathy that tends to time.
calcify during healing; rare in cats. e. Eosinophilic pulmonary granulomatosis -
- Blastomycosis* - moderate often marked hilar lymphadenopathy.
lymphadenopathy occurs occasionally; f. Lymphomatoid granulomatosis - rare
rare in catsf in which a nodular pattern neoplastic disease; often with an interstitial­
is more likely. alveolar lung pattern and hilar
- Coccidioidomycosis* - moderate to lymphadenopathy.
marked lymphadenopathy; rare in cats. g. Bacterial granulomatous diseases.
- Cryptococcosis* - llllcommon in dogs
- Tuberculosisf rare due to the reduction in
but the most common fungal infection
incidence of bovine tuberculosis. The
in cats. Often associated with sternal
source of infection may include humans or
lymphadenopathy.
birds. Pleural effusion and
Opportunistic infections lymphadenopathy occur in dogs; pleural
- Actinomycosis* - severe or mild pleural effusion is less common and milder in
effusions. Pleurat mediastinal and catsf in which a nodular pattern is more
puhnonary abscesses are more likely.
common; rare in cats. - Corynebacterium.
- Nocardiosis* - uncommon. Often
6. Allergic lung disease - especially cats; although
younger dogsf also in cats; may be
more usually a bronchointerstitial pattern with
associated with migrating plant material.
pulmonary overinflation.
Severe or mild pleural effusions and
7. Thromboembolic pneumonia - most likely
moderate lymphadenopathy.
peripherally in the caudal lobes.
- Aspergillosis* - most likely in llnmlllle­
a. From a non-respiratory abscess or infection.
incompetent animals and a predisposition
b. In immune-compromised animals:
to the German Shepherd dog.
Sporotrichosis* - rare. - With lymphoma.
c. Exogenous lipid or lipoid pneumonia - - On immllllosuppressive therapy.
aspirated mineral or vegetable oil. - Associated with autoimmlllle haemolytic
d. Parasites. anaemia.
- Dirofilaria immitis* (heartworm); with right c. From bacterial endocarditis.
heart enlargementf prominence of the main d. In animals with fever of unknown origin.
Chapter 6 Lower respiratory tract 1 59

e. From inflammatory joint disease.
S. Pulmonary embolism from other causes (see
6.23.6) - similar distribution to thromboembolic
pneumonia. >-
<\
..
9. Pulmonary alveolar proteinosis \

· i .;
.-
. .:
(phospholipoproteinosis) - rare, young dogs. . . ; ::\
.. . \
.

6 . 1 6 ULTRASONOGRAPHY OF AREAS
OF ALVEOLAR FILLING
Regions of alveolar filling may be imaged ultraso­
.\
nographically if they lie adjacent to the thoracic
waIt the heart or the diaphragm. Bright echogenic
specks indicate residual air. Anechoic tubes may
Figure 6.1 0 A single consolidated or collapsed lung lobe
represent pulmonary vessels or fluid-filled bron­
seen on the dorsoventral view; the right middle lobe is most
chi. The latter have more echogenic wallsf but a
often affected, especially in cats. Atelectasis (collapse)
better way to differentiate between these is to use
results in reduction in size of the lobe, whereas the size
colour or power Doppler. Ultrasound-guided fine
remains normal if the lobe is consolidated without collapse
needle aspiration of superficial lung lesions is pos­ and may increase if neoplasia or torsion is present.
sible (see 6.2). For differential diagnoses for alveo­
lar filling, see 6.14 and 6.1S.
- Epidermoid (squamous).
- Bronchial gland carcinoma.
6 . 1 7 SINGLE RADIOPAQUE LUNG LO BE - Anaplastic.
Increased radiopacity of the lobe with loss of visibil­ b. Chondromaf chondrosarcmnaf osteosarcoma -
ity of the pulmonary vessels and border effacement may mineralize.
of adjacent structures. Air bronchograms may be - Hamartoma - rare - may mineralize.
present (see 6.14 and Fig. 6.8). If the lobe is of normal S. Lung lobe torsion (Fig. 6.11) - most commonly
sizef consolidation is likelYf whereas if it is reducedf left or right cranial or right middle lobes; less
collapse (atelectasis) is present. Increased size of a likely to affect the caudal lobes; rarely affects the
radiopaque lobe suggests neoplasia or torsion. accessory lobe. The lobe is initially enlargedf
1. Artefactual. with pulmonary vasculature or air
a. Mediastinal masses mimicking pulmonary bronchogramsf if visiblef running in an
lesions (e.g. Spirocerca lupi'" granuloma may
mimic an accessory lobe mass).
b. Diaphragmatic herniaf with herniated liver
mimicking a caudal pulmonary mass.
2. Lobar pnemnonia - often the right middle lobe;
best seen on the DV or VD view (Fig. 6.10).
3. Atelectasis (collapse) - smaller lobe, possibly
with concave borders; mediastinal shift towards
the lobe. Especially cats with lower respiratory
tract disease and usually the right middle lobe
(Fig. 6.10).
4. Neoplasia - primary lung tumour; affected
lobe may be enlarged with convex borders Figure 6.1 1 Lung lobe torsion, showing a consolidated and
and mediastinal shift away from the lobe. em physematous cranial lung lobe and a marked pleural
a. Epithelial carcinomas are commonest. effusion. The terminal trachea is displaced ventrally, and the
- Bronchiolar-alveolar. cranial lobe bronchus is occluded. The heart is partly
- Bronchogenic. obscured.
1 60 Handbook of Small Animal Radiology and U ltrasound

abnormal direction. The bronchus may be a. Lobar neoplasia.
displacedf narrowed or seem to end abruptly. b. Abscessation.
A characteristic vesicular gas pattern may be 3. Abnormal orientation of a lung lobe.
present within the consolidated lobe. UsuallYf
a. Lung lobe torsion.
there is concurrent pleural effusion. The
b. Displacement of lobe by adjacent mass or
diagnosis may be confirmed by means of
abdominal viscera.
bronchoscopy or thoracotomy.
a. Spontaneous - most commonly the right
middle lobe in larger or deep-chested breeds
and the cranial segment of the left cranial 6 . 1 9 SOLITARY PULMONARY NODU LES
lobe in smalt chondrodystrophic breeds such OR MASSES
as Pugs. A nodule is a well-marginatedf evenly rounded
b. Predisposed to by pleural effusion. Usually lesion measuring up to 4 cm in diameter. A mass
impossible to determine whether the effusion is well marginated and larger than a nodule; it
is primary or secondary. Cats often have a may be smooth or irregular in outline. The larger
severef bloody effusion. the nodule or massf the more radiopaque it should
c. Acute traumatic impact - rare; small breeds. be. Mineralized areas may be seen.
6. Occlusion of a bronchus. Solitary lesions are easily missed if they are
a. Aspirated foreign body. small or in the perihilar regionf cranial thoraxf
b. Mass within or compressing lumen. costophrenic recesses or paraspinal gutters. A soli­
c. Incorrectly placed endotracheal tube. tary lesion should be differentiated from a compos­
ite mass consisting of multiple small coalescing or
7. Pulmonary thromboembolism (see 6.23.6). superimposed nodules. It is not possible to differen­
8. Fat embolism following a fracture. tiate between causes radiologicallYf but repeat
radiographs after 3--4 weeks are indicated. If the
6 . 1 8 U LTRASONOGRAPHY OF nodule or mass has enlargedf then biopsy is advised
CONSOLIDATED LUNG LO BES if possible. If no enlargement has occurredf repeat
radiography should be performed after a further
Consolidated lung lobes are usually seen a s mod­
3--4 months.
erately echoicf well-demarcated structures that
Nodules and masses may cavitatef especially if
can be followed to the perihilar region. The main
they are rapidly growing. In these casesf a radiolu­
lobar blood vessels may be seen within the solid
centf gas-filled centre to the lesion is seen. For a
lung tissue in the perihilar regionf with blood flow
fuller description and list of causesf see Section
demonstrated by colour Doppler. Echogenic­
6.27 and Figure 6.16.
walledf tubular structures with static anechoic con­
tents are fluid-filled bronchi. Hyperechoic foci 1. Artefactual.
within the lobef with or without acoustic shadow­ a. Overlying soft tissue structuref especially
ingf usually indicate areas of residual aeration. nipplesf which lie ventrally and are often seen
to be paired; ticks and warts may also be
1. Uniformly hypoechoic lung lobe, smoothly
visible (see 8.21.4 and Fig. 6.12A). If a suspect
marginated with pointed tips; echotexture
external nodule can be identified clinicallYf
similar to that of liver.
repeating the radiograph after coating the
a. Atelectasis due to:
structure with radiopaque contrast medium
- Adjacent thoracic mass.
will identify it.
- Pleural effusion. b. Costochondral junction (Fig. 6.12B).
- Airway obstruction. c. Single blood vessel seen end on (Fig. 6.12C).
b. Lobar pneumonia. d. Healed rib fracture (Fig. 6.120).
c. Lobar haemorrhage. e. Adjacent pleural mass.
d. Lung lobe torsion (usually associated with f. Small diaphragmatic rupture or herniaf often
pleural fluid). with incarcerated liver: between the heart and
2. Variable echogenicity with loss of normal shape the diaphragm (Fig. 6.12E).
and lacking internal liver-like structure. g. Diaphragmatic eventration (see 8.26.1).
Chapter 6 Lower respiratory tract 1 61

4. Abscess - often in younger patients and tend to
occur in the perihilar or peripheral lung field;
may cavitate.
5. Haematoma (haematocyst) - history of traumaf
resolves with time.
6. Cyst.
7. Fluid-filled bulla.
S. Exudate- or mucus-filled bronchus or focal
bronchiectasis.
9. Area of consolidation simulating a nodule
Figure 6.1 2 Artefactual lung nodules: (A) n i pple, (B) (see 6.15).
prominent costochondral junction in an old dog, (C) blood
vessel seen end on, (D) healed rib fracture, (E) small
diaphragmatic ruptu re.
6.20 NODULAR LUNG PATTERN
Nodules have to be at least 3 mm in diameter to
be visible unless either they are mineralized or
multiple nodules are summated on each other
2. Neoplasia.
(Fig. 6.13). For differential diagnoses of cavitary
a. Primary lung tumour - often arise in the nodulesf see 6.26. A nodular pattern is sometimes
perihilar regionf tend to be large and may associated withf and obscured bYf an alveolar infil­
have partially irregular borders. Secondary
tratef and high-definition imagesf lacking respira­
changes include cavitation (becoming air­
tory blurf are required to detect it.
filled), calcification, spread to regional lymph
nodesf compression of adjacent bronchi or 1. Superimposition of nipplesf costochondral
pleural effusion. In dogsf metastasis tends to jllllctions in older dogs or thoracic wall nodules
occur within the thoraxf whereas in cats 75% (see 8.21 .4).
metastasize elsewheref for example the digits 2. Normal blood vessels seen end on (see
(see 3.7.13 and Fig. 3.18). Table 6.2) - these are more radiopaquef perfectly
- Adenocarcinoma. circular and well marginatedf decrease in size
towards the periphery and are associated with
- Bronchogenic carcinoma.
adjacent longitudinal blood vessels. If there is a
- Squamous cell carcinoma.
hypervascular lung pattern (see 6.23), the end­
- Histiocytic sarcoma (malignant on vessels will be larger and more nmnerous.
histiocytosis) - middle-aged, large-breed 3. Severe bronchial disease with thickly cuffed ring
dogsf with male preponderance; markings or plugs of mucus or exudate in
mainly Bernese MOlllltain Dog but also bronchi seen end on - especially in cats.
Rottweiler and Golden or Flat-coated
Retrievers.
b. Solitary lung metastasis - tend to involve the
middle or periphery of the lung field and are
usually nodular; additional metastases
usually develop quickly.
3. Granuloma (see 6.15.5) - may cavitate.
a. Foreign body - especially working dogs
aspirating grass awns.
b. Fungal - although more usually multiple,
poorly defined and bizarrely shaped lesions;
tend to be perihilar.
Figure 6.1 3 Nodular lung pattern. Apparent nodular
c. Bacterial.
opacities may be created by summation of two or more
d. Eosinophilic. lesions. There may be an associated reticular interstitial
e. Parasitic. pattern (see Fig. 6.14C). (Compare with Fig. 6.6, Normal lung
f. Tuberculosis. pottern.)
1 62 Handbook of Small Animal Radiology and U ltrasound

Table 6.2 Distinguishing blood vessels seen end on from metastatic nodules

CHARACTERISTIC BLOOD VESSEL SEEN END ON METASTATIC NODULE

Size Become smaller peripherally; same size as other local blood vessels Any size, unrelated to location in thorax
Location May be superimposed OVN a longitudinal blood vessel Not associated with blood vessels
Opacity More radiopaque than a nodult": Less radiopaque than an end on blood vessel
Margination Well defined Often indistinct

4. Nodules associated with ageing (incidental - Filaroides hirthi* and F. milksi*.
findings). - Cats - Aelurostrongylus abstrusus* infection
a. Pulmonary osteomas (heterotopic bone (feline lungworm) - initial bronchoalvolear
formation) in older, large-breed dogs (see 6.4.6). patternf although older cats with resolving
b. Calcified pleural plaques - appear identical disease tend to show a more nodular
(see 6.4.6). pattern.
c. Fibrotic nodules. e. Protozoal.
5. Multiple small lung nodules, 3-5 mm in - Toxoplasmosis*.
diameter (see Table 6.2). f. Idiopathic mineralization (see 6.27.5).
a. Miliary nodules - a large number of smallerf g. Leptospirosis - often a reticulonodular pattern.
diffusely distributed nodules that may have h. Francisella (Pasteurella) tularmsis' (tularaemia) ­
summating opacitiesf appearing to form very raref potential contact with rodents.
larger conglomerates. They occur as a result
6. Multiple medium-sized lung nodulesf 5--40 mm
of widespread haematogenous and/or
in diameter.
lymphatic dissemination of pathogens or
a. Metastatic tmnours - often 'cannon ball'
neoplastic cells and may be accompanied by
nodules; randomly distributed, well-defined
hilar lymphadenopathy.
and do not coalesce although may summate;
- Metastatic tumours (e.g. mammary and
especially from primary osteosarcoma. Rapidly
thyroid carcinoma and
growing metastases may cavitate and become
haemangiosarcoma); has also been seen
air-filled; main differential diagnosis is
with multiple myeloma (rare).
cavitating abscesses or granulomata.
- Pulmonary lymphoma - usually with an
b. Pulmonary lymphoma - usually with an
interstitial lung pattern and mediastinal
interstitial lung pattern and mediastinal
lymphadenopathy.
lymphadenopathy.
- Haematogenous bacterial pneumonia.
c. Fungal granulomata or abscesses (see 6.15.5).
- Fungal pneumonia (see 6.15.5).
- Histoplasmosis nodules are often well
- Disseminated intravascular coagulation. circumscribed and may calcify.
- Mycobacterial pneumonia - rare. d. Multicentric primary tumours.
b. Alveolar nodules due to aspiration or e. Histiocytic sarcoma (malignant histiocytosis) -
inhalation of radiopaque material. middle-aged large-breed dogs, with male
- Aspirated barium. preponderance; mainly Bernese Mountain
- Pnemnoconiosis. Dog but also Rottweiler and Golden and Flat­
c. Eosinophilic bronchopneumopathy coated Retrievers.
(puhnonary infiltrate with eosinophils) - f. Bacterial granulomata or abscesses.
there may be an ill-defined nodular pattern g. Foreign body granulomata.
superimposed over the interstitial pattern. - Multiple small nodules due to mineral or
d. Parasitic - usually fewer nodules; may calcify vegetable oil aspiration.
(see 6.15.5). h. Enlarged blood vessels seen end on (see
- Larval migrans. 6.23.1-4).
Eosinophilic granulomatosis due to i. Bronchi or bronchiectasis lesions filled with
Dirofilaria immitis* infection. mucus or exudate.
Chapter 6 Lower respiratory tract 1 63

j. Haematomata (haematocyst). b. Organizing haematoma.
k. Fluid-filled cysts. c. Abscess.
- Congenital. d. Granuloma.
- Hydatid.
1. Disseminated intravascular coagulation.
6.22 INTERSTITIAL LUNG PATTERN
m.Pulmonary lymphomatoid granulomatosis -
rare neoplastic disorder; often with an Changes occur primarily in the interstitial tissues (the
interstitial-alveolar lung pattern and hilar alveolar walls and the connective tissue supporting
lymphadenopathy. airways and vessels) and not the air spacesf although
n. Parasitic. the air content of the affected lung may be reduced as
- Paragonimus kellicotti* (lung fluke); nodules a result. It may be possible to recognize three
are rare in the dog and cystic lesions are types of interstitial hmg pattern. A diffusef unstruc­
more common (see 6.26.5)f but the nodular tured interstitial pattern results in a semiopaquef
granulomatous form is more common in generalized or regional pulmonary background
the cat. opacity with reduced visibility of the puhnonary vas­
- Cats - Aelurostrongylus abstrusus* infection culature (Fig. 6.14A). Unlike the alveolar pattern,
(feline lungworm - see 6.20.5). which is uneven and which may be most marked cen­
o. Feline infectious peritonitis. trallYf it is usually of a similar opacity throughout the
affected area. There is no border effacementf but
smudging or blurring of the outline of structures
6.2 1 ULTRASONOGRAPHY O F PULMONARY occurs. Air bronchograms may be seen in severe
NODU LES OR MASSES cases. A linear or reticular interstitial lung pattern is
similarf but not all alveolar walls are affected. It con­
Puhnonary nodules or masses are visible ultra­
sists of randomly arranged linear opacities that are
sonographically only if they lie adjacent to the tho­
more visible peripherally (Fig. 6.14B). This pattern is
racic waIt heart or diaphragm or are outlined by
often described as being reticular (meshwork-like).
free thoracic fluid.
It may also be accompanied by small nodules to form
1. Well-definedf thin-walled nodule or mass with a reticulonodular interstitial pattern (Fig. 6.14C).
anechoic or hypoechoic contents (the presence Other patterns may occur simultaneously; a
of gas may result in hyperechoic foci within the bronchial component is often also present as well
anechoic or hypoechoic contents). as an alveolar pattern.
a. Cyst.
1. Artefactual interstitial lung pattern (see 6.13).
b. Haematoma.
2. Age-related interstitial lung pattern.
c. Abscess.
a. In very young animalsf due to increased
2. Variably well-definedf thick or irregular-walled water content of interstitial tissue.
nodule or mass with anechoic or hypoechoic b. In old animalsf due to ageing changes of
contents (the presence of gas may result in interstitial fibrosis in the lung; usually
hyperechoic foci within the anechoic or reticular.
hypoechoic contents).
3. Infectious causes - pneumonia.
a. Abscess.
a. Bacterial.
b. Cavitating tumour.
- Irish Wolfhound: hereditary rhinitis­
c. Organizing haematoma.
bronchitis complex; young dogs with
3. Solidf homogeneous nodule or mass. recurrent clinical signs due to primary
a. Tumour of homogeneous cell type with little immunodeficiency .
necrosis. b. Viral (e.g. distemper) - often involves the
b. Alveolar consolidation or collapse simulating caudodorsal lung lobesf but the changes are
a mass (see 6.14-6.18 for lists of differential minimal unless complicated by bacterial
diagnoses) . infection.
4. Solidf heterogeneous nodule or mass. c. Fungal - often with mediastinal
a. Tumour of heterogeneous cell type and/or lymphadenopathy (see 6.15.5); may be
areas of necrosisf haemorrhage or calcification. reticular.
1 64 Handbook of Small Animal Radiology and U ltrasound

i. Cats - Aelurostrongylus abstrusus* infection
(feline lungworm) - caudal lobesf often cats
less than 1 year old; may also show a
bronchoalveolar pattern progressing to a
nodular pattern with time.
j. Cats - feline infectious peritonitis.
k. Cats - feline tuberculosis.
4. Oedema - interstitial oedema precedes
alveolar oedemaf and the aetiologies are
similar (see 6.14.1 and 6.14.7).
a. Cardiogenic - in dogsf symmetrically
distributed in the perihilar regionf extending
peripherallYf with progressing heart failure;
in catsf more patchy or peripheral
distribution; symmetricat asymmetrical or
right caudal lobe involvement.
b. Non-cardiogenic - caudodorsal lobesf often
asymmetrical (see 6.14.7).
5. Pulmonary haemorrhage.
® a. Trauma - fractured ribs and subcutaneous
emphysema may also be seen.
b. Coagulopathy.
- Disseminated intravascular coagulation.
- Anticoagulant poisoning.
- Haemophiliaf von Willebrandfs disease
(especially Dobermann) and other
inherited coagulopathies.
- Immune-mediated diseases.
- Bone marrow depression.
c. Metastatic haemangiosarcoma.
Figure 6.1 4 (A) Diffuse, u nstructured interstitial lung d. Leptospirosis - due to vasculitis; often a
pattern. (8) Linear or reticular interstitial lung pattern. reticulonodular pattern.
(C) Reticu lonodular interstitial lung pattern. (Compare with
6. Neoplasia.
Fig. 6.6, Normal lung pattern.)
a. Primary.
- Puimonary lymphoma (may be a
- Histoplasmosis*. reticulonodular pattern); usually also with
- Cryptococcosis*. marked mediastinal lymphadenopathy.
- Blastomycosis*. Bronchiolar-alveolar carcinoma; may
- Coccidioidomycosis*. affect multiple lobesf giving rise to a
- Pneunwcystis carinii* - immune- severe interstitial or alveolar pattern.
compromised patientsf especially in b. Metastatic.
younger miniature Dachshunds and - Pulmonary alveolar septal metastasis due
Cavalier King Charles Spaniels. to anaplastic scirrhous mammary
d. Mycoplasma infection. carcinoma - rare; often reticular.
e. Rocky Mountain spotted fever (Rickettsia c. Pulmonary lymphomatoid granulomatosis -
rickettsii* infection). rare neoplastic disorder; with pulmonary
f. Babesiosis*. nodules or masses and hilar
g. Toxoplasmosis* - caudal lobes; especially lymphadenopathy too.
cats. 7. Allergic - eosinophilic bronchopneumopathy
h. Leptospirosis - reticulonodular pattern. (pulmonary infiltrate with eosinophils); an
Chapter 6 Lower respiratory tract 1 65

ill-defined nodular pattern and bronchial 14. Toxins - paraquatf diquat and morfamquat
markings may also be present. (herbicides) poisoning; often with
8. Parasitic. pneumomediastinum too.
a. Dirofilaria immitis* (heartworm) - plus 15. Lipid or lipoid pneumonia (exogenous or
hypervascular and alveolar patterns (see endogenous) - especially cats.
6.23.1), often worst in the caudal lung lobes; 16. Acute lung injury or acute respiratory distress
also right-sided cardiomegalYf puhnonary syndrome (shock lung) - initial interstitial
artery enlargement and arterial pattern progresses to a patchy alveolar pattern
hypervascular pattern. with reduced lung volume (see 6.14.7 for
b. Angiostrongylus vasorum* (French heartworm) - causes).
plus multifocal or peripheral alveolar pattern 17. Uraemia - rare.
(see 623.1). 18. Pancreatitis.
c. Filaroides hirthi* and F. milksi*. 19. Radiation pneumonitisf 2-24 months following
d. Cats - Aelurostrongylus abstrusus* (feline exposure - localized to the irradiated area of
hmgworm) - caudal lobesf often cats less the lung; may be reticular.
than 1 year old; may also show a 20. Chronic antigen exposure.
bronchoalveolar pattern progressing to a 21. Oxygen therapy.
nodular pattern with time. 22. Adverse drug reactions (e.g. to bleomycin).
9. Pulmonary thromboembolism (see 6.23.6).
10. Pulmonary fibrosis (usually reticular).
a. Idiopathic - middle- to old-aged terriersf 6.23 VASCULAR LUNG PATTERN
especially West Highland White and
Staffordshire Bull Terrier and recently also The visibility of blood vessels depends on the
described in cats; may also have a bronchial amount of air in the lungs. Arteries and veins nm
pattern. adjacent to and on opposite sides of the associated
b. Chronic fibrosing interstitial pneumonia. bronchi and can be distinguished from each other
by their location. On the lateral viewf the cranial
c. Secondary to any chronic respiratory
lobar arteries lie dorsal and parallel to the
disease.
corresponding veins. On the DV or VD viewf the
d. Pneumoconiosis - see below.
caudal lobe arteries arise more cranial and lateral
11. Aspirated foreign bodYf especially grass or to the corresponding bronchi and veins. The veins
barley awns in working dogs; usually a focal run medial to the corresponding bronchus and lie
alveolar or interstitial pattern in a caudal lobe. within the bifurcation of the main stem (principal)
May be accompanied by pnemnothoraxf bronchi. In dogsf arteries are normally the same
pleural effusion or pleural thickening. size or slightly larger than veins. On lateral radio­
12. Inhalation (toxic or irritant pneumonitis) - graphs in dogsf the cranial lobe arteries should be
diffuse interstitial radiopacity in acute cases 0.73 ± 0.24 times the diameter of the proximal
and pulmonary fibrosis (pneumoconiosis) in third of the fourth rib where they cross this ribf
chronic cases. and in cats the ratio is 0.70 ± 0.13. On DV or VD
a. Smoke. radiographs at the level of the tenth ribf the lobar
b. Hydrocarbons (e.g. waterproofing spray). artery width should not exceed that of the rib (see
c. Dust. Fig. 6.15A and B).
- Silica. An abnormal vascular pattern is recognized by a
- Asbestos. change in numberf sizef shapef or radiopacity of
- Diesel exhaust fumes. pulmonary blood vessels (Fig. 6.15C and D).
13. Hyperadrenocorticism (Cushingfs disease) or 1. Arteries larger than veins (Fig. 6.15C).
long-term corticosteroid administration may a. Dirofilaria immitis* infection (heartworm) -
rarely produce interstitial calcificationf as well the dilated arteries are often truncated and
as calcification of the bronchial wallsf tortuous. May be accompanied by right heart
hepatomegalYf osteopenia and soft tissue enlargement and prominence of the main
calcification. pulmonary artery with bronchopnemnonia or
1 66 Handbook of Small Animal Radiology and U ltrasound

®

Figure 6.1 5 (A) Left cranial lobe blood vessels on the lateral view - approximately 75% of the diameter of the fourth rib.
(8) Caudal lobe blood vessels on the dorsoventral view - no larger than the tenth rib. (C) Hypervascular lung pattern - affected
vessels (in this case the artery) are en larged and may become tortuous. (D) Hypovascular lung pattern - the blood vessels
are thin and thread-like. (Compare with Fig. 6.6, Normal lung pattern)

eosinophilic bronchopneumopathy hyperplasia; also an initial bronchoalveolar
(puhnonary infiltrate with eosinophils). pattern becoming more nodular with time.
b. Large left to right shunts. 2. Veins larger than arteries.
- Patent ductus arteriosus. a. Left heart failure.
- Ventricular and atrial septal defect. b. Right to left shuntsf due to relatively smaller
- Endocardial cushion defect. arteries (e.g. tetralogy of Fallot).
c. Pulmonary thromboembolism (see 6.23.6) - c. Left to right shilllts - in some casesf the thin­
occasionally the affected artery may be mildly walled veins show greater dilation than the
dilated proximal to abrupt attenuation. arteries (e.g. ventricular and atrial septal
d. Pulmonary hypertensionf various causes - defect).
often accompanied by right heart d. Lesions restricting pulmonary venous return
enlargement (cor pulmonale). (e.g. mitral valve stenosisf cor triatriatum
e. Peripheral arteriovenous fistula. sinister).
f. Angiostrongylus vasorum* (French heartworm) ­ 3. Generalized increased pulmonary
changes are similar to those caused by vascularity - increased number and
Dirofilaria immitis*f although the diameter of vesselsf extending further to
hypervascular pattern is often mild or absent the periphery.
and an alveolar or interstitial pattern a. Passive pulmonary congestion - left heart
predominates. failure.
g. Cats - Aelurostrongylus abstrusus* (feline b. Active puhnonary congestion - precedes
lungworm) due to arteritis and arterial pneumonia.
Chapter 6 Lower respiratory tract 1 67

c. Left to right shunts. 6. Localized decreased pulmonary vascular
- Patent ductus arteriosus. pattern.
- Ventricular and atrial septal defects. a. Pulmonary thromboembolism; radiographs
- Endocardial cushion defect (large are frequently normat despite severe
ventricular and atrial septal defects dyspnoea, and this finding itself is suggestive
combined; complete atrioventricular of puhnonary thromboembolism;. If
canal). radiographic signs are present, the affected
- Aorticopuhnonary septal defect pulmonary artery may be irregular or
(aorticopulmonary window or abruptly attenuated; occasionally its central
fenestration). part is mildly dilated: DV view is best for
d. Iatrogenic overhydration. assessment of vessels. May also see
peripheral hypoperfusion, small or absent
4. Increased vascular radiopacity.
returning vein, patchy, wedge-shaped or
a. Left heart failure - the dilated veins may be lobar alveolar pattern and a small pleural
more radiopaque than the arteries. effusion. Right lung affected more often than
b. Vessel wall mineralization - rare and of left, and especially caudal lobes.
uncertain aetiology. - Autoimmune haemolytic anaemia.
- Hyperadrenocorticism (Cushing's
- Renal amyloidosis, glomerular disease and
disease) or long-term corticosteroid
nephrotic syndrome.
administration.
- Hyperadrenocorticism (Cushing's disease)
- Chronic renal failure.
or long-term corticosteroid administration.
- Cats - secondary to hypertension. Diabetes mellitus.
5. Generalized decreased puhnonary vascularity - Polycythaemia.
(Fig. 6.150) - the lungs have an empty - Post-operative thromboembolism.
appearance, with thinner peripheral vessels that
- Thrombi from right-sided heart disease.
appear fewer in number and that do not reach
- Dirofilaria immitis* and Angiostrongylus
the periphery.
vasorum' (see 6.23.1).
a. Forced manual overinflation during
- Disseminated intravascular coagulation.
anaesthesia.
b. Pulmonary hypoperfusion (may be - Trauma.
accompanied by microcardia, small caudal - Septicaemia.
vena cava and compensatory hyperinflation). - Pancreatitis.
- Shock. b. Lobar emphysema compressing blood
- Severe dehydration. vessels.
- Blood loss.
- Hypoadrenocorticism (Addison's disease). 6.24 M IXED LUNG PATTERN
c. Other causes of pulmonary overinflation (see Many abnormal lung patterns consist of a combina­
6.25.4-6). tion of two, three or even four constituent patterns.
d. Pericardial disease, reducing right heart Usually, however, one pattern is dominant and will
output. help to elucidate the aetiology. The alveolar and
- Pericardial effusion with tamponade. interstitial patterns may be hard to distinguish and
- Restrictive pericarditis. often coexist. The hypovascular pattern is often an
e. Right heart failure. incidental finding in a sick or dehydrated animal.
f. Congenital cardiac disease with right to left Some examples of common mixed patterns are
shunts. given here.
- Tetralogy of Fallot. 1. Dominant pattern bronchial.
- Reverse-shunting patent ductus arteriosus. a. Bronchial pattern due to ageing changes, with
- Reverse-shunting ventricular and atrial an ageing interstitial pattern and/or other
septal defect. disease process superimposed.
g. Severe pulmonic stenosis. b. Bronchial and alveolar ± interstitial.
1 68 Handbook of Small Animal Radiology and U ltrasound

- Various pneumoniasf especially as they c. Deep inspiration (e.g. dyspnoea).
resolve. d. Emaciation.
- Irish Wolfhound: hereditary bronchitis­ e. Unilaterat due to thoracic rotation on DV or
rhinitis complex. VD views.
- Cats - idiopathic pulmonary fibrosis. 2. Extrapulmonary hyperlucent areas that mimic
c. Bronchial pattern due to increased pulmonary radiolucency.
hyperadrenocorticism (Cushingfs disease) or a. Pneumothorax.
long-term corticosteroid administrationf with b. Air-filled megaoesophagus.
other disease process superimposed - the
c. Diaphragmatic rupture with distendedf
bronchial pattern is clearly calcified.
gas-filled gastrointestinal tract within the
2. Dominant pattern alveolar. thoracic cavity.
a. Alveolar and bronchial ± interstitial. d. Subcutaneous emphysema.
- Various pneumonias. e. Pneumomedias tinum.
- Cardiogenic oedema. 3. Pulmonary hypoperfusion (hypovascular
- Pulmonary haemorrhage. patternf undercirculation - see 6.23.5).
3. Dominant pattern hypervascular. a. Shock.
a. Hypervascular and alveolar. b. Severe dehydration.
- Cardiogenic oedema (congenital or c. Hypoadrenocorticism (Addisonfs disease).
acquired heart disease). d. Cardiac tamponade.
b. Hypervascularf alveolar ± bronchial and e. Congenital cardiac disease with right to left
interstitial. shunts.
- Dirofilaria immitis'" (heartworm) andf to a f. Tetralogy of Fallot.
lesser extentf Angiostrongylus vasorum'" g. Reverse-shunting patent ductus arteriosus.
(French heartworm).
h. Reverse-shunting ventricular and atrial septal
4. Dominant pattern interstitial. defect.
a. Severe ageing interstitial pattern with other i. Severe pulmonic stenosis.
disease process superiInposed.
4. Overinflation by air-trapping due to expiratory
b. Interstitial and bronchial.
obstruction: the diaphragm is flattenedf with
- Severe chronic bronchitis. little movement during respiration.
- Eosinophilic bronchopneumopathy a. Tracheal or bronchial foreign body.
(pulmonary infiltrate with eosinophils). b. Chronic bronchitis.
- Severe small airway disease.
c. Allergic bronchitisf especially bronchial
- Idiopathic pulmonary fibrosis. astluna in cats.
c. Lymphoma; usually with mediastinal d. Upper respiratory tract obstruction (e.g.
lymphadenopathy too. nasopharyngeal polyp).
d. Paraquat poisoning; usually with 5. Compensatory overinflation.
pneumomediastinum too.
a. Following lobectomy.
e. Bronchiolar-alveolar carcinoma.
b. Secondary to atelectasis of another lobe or
f. Leptospirosis.
lobes.
c. Secondary to congenital lobar atresia or
6.25 GENERALIZED PULMONARY agenesis.
HYPERLUCENCY 6. Emphysema - the diaphragm may be caudally
displaced and flattenedf showing its costal
Two or more lung lobes are involved. attaclunentsf the ribs positioned transversely and
1. Artefactual pulmonary hyperlucency. the cardiac silhouette small. Full inspiratory and
a. Overexposuref overdevelopment or fogging expiratory radiographs should be madef and if
of the film. there is little difference in puhnonary
b. Forced manual overinflation during radiopacity and diaphragmatic position the
anaesthesia. diagnosis of emphysema is confirmed.
Chapter 6 Lower respiratory tract 1 69

AlternativelYf a DV or VD view using a the caudodorsal lung on a left lateral
horizontal beam and the animal in lateral recumbent radiograph.
recumbency with the affected lobe down - Oesophageal air.
will show that the affected lung does not - Gas-filled stomach or intestinal loop
collapse despite the weight of the heart herniated into thorax or paracostally (see
above it. 8.2.3 and Fig. 8.3, for ruptured diaphragm).
a. Acquired primary emphysema - rare. - Superimposed subcutaneousf pleurat
b. Congenital lobar emphysema - may involve subpleural or mediastinal air.
one or more lobes; adjacent lobes may be - Foamy pneumothorax (concurrent
compressed and mediastinal shift may occur pneumothorax and hydrothorax).
(e.g. Shih Tzu and Jack Russell Terrier) - - Pleural adhesions accompanied by
usually recognized in puppyhood. pneumothorax.
- Expansile rib osteolysis.
6.26 FOCAL AREAS O F PULMONARY 2. Normal - the tip of the left cranial lung lobe
HYPERLUCENCY (INCLUDING CAVITARY may be outlined just above the sternum on the
LESIONS) lateral view and may appear more radiolucent
than surrounding lung.
Improved visibility of focal areas of pulmonary 3. Bronchial structures seen end on.
hyperlucency occurs on expiratory radiographs a. Prominent bronchi due to age.
and on radiographs with the affected area depen­
b. Chronic bronchitis.
dentf as the surrounding lung becomes more radi­
c. Bronchiectasis.
opaque. Fluid levels and wall thickness may be
demonstrated in cysts and cavitary lesions by 4. Radiolucent structure with absent or
means of horizontal beam radiography; thin fluid barely perceptible wall; may rupture and
contents will produce a flatf horizontat gas-fluid cause spontaneous and recurrent
interfacef whereas thick contents will show a pneumothorax.
curved or irregular interface (Fig. 6.16). a. Bulla - sphericat localized area of
emphysema that is usually small but
1. Artefactual focal areas of pulmonary
sometimes large; may be multiple. Usually
hyperlucency.
traumatic in origin but can be congenital.
a. Intrapulmonary.
b. Bleb - a subpleural bulla whose peripheral
- Ring shadows may be mimicked by
location makes it difficult to see unless it has
curved bronchial walls and puhnonary
resulted in pneumothoraxf although often it
vessels and by lobar fissure linesf
will then have collapsed.
especially on DV or VD views.
5. Radiolucent structure with a thinf regular wall ­
b. Extrapuhnonary.
cysts and cyst-like structures; may rupture
- Gas-filled gastric fundus immediately
and cause spontaneous and recurrent
caudal to the left crusf superimposed over
pneumothorax. Congenital or acquired.
1
--- a. Bronchogenic cyst - smoothf thin-walled;
young animals.
b. Puhnonary cyst or pseudocyst.
Pneumatocele (secondary to pneumonia
or traumatized lung tissue) (note:
pneumatocele and bulla are often used as
synonymsf as they cannot be
differentiated radiographically).
Pneumohaematocele - traumatic
pneumatocele containing blood.
- Thin-walledf healed abscess.
Figure 6.1 6 Focal areas of hyperlucency in the lungs: 1 , - Paragonimus kellicotti* (lung fluke) -
cyst: 2, bulla: 3, cavitary lesion: and 4, cavitary lesion with septated or clusteredf with a thinf smooth
fluid contents seen using horizontal beam radiography. wall or an excentricf crescent-shaped wall
1 70 Handbook of Small Animal Radiology and U ltrasound

in dogs; cats are more likely to have a 6.27 INTRATHORACIC M I N ERALIZED
solidf nodularf granulomatous form. OPACITIES
- Hydatid cyst.
6. Radiolucent structure with a thick and 1. Artefactual superimposed opacities (see 8.20
and 8.21).
irregular waIt or cavitary lesion (an air-filled
2. Incidental mineralization seen as an ageing change.
region within abnormal lung tissue); may
develop from an apparently solid nodule or a. Pulmonary osteomata (heterotopic bone
mass (see 6.19 for causes). Sometimes multiple formation) in olderf larger-breed dogs
cavities are presentf especially in tumours. (see 6.4.6).
Rare in cats. b. Calcified pleural plaques - appear identical to
a. Abscess or granuloma. pulmonary osteomata (see 6.4.6).
c. Calcified tracheal rings and bronchif
- Bacterial.
especially in chondrodystrophic breeds.
- Fungal - often thinner walls and
3. Oesophageal foreign body.
associated hilar lymphadenopathy.
- Parasitic. 4. Aspirated contrast medium (barium) in alveoli
- Tuberculosis. or in hilar lymph nodes.
5. Pathological pulmonary mineralization.
b. Foreign bodYf especially aspirated grass
a. Healed fungal disease.
awns in working dogs; usually caudal lobes.
May be accompanied by pneumothoraxf - Histoplasmosis* - multiple small calcified
pleural effusion or pleural thickening. nodules similar to pulmonary osteomataf
c. Neoplasia. accompanied by hilar lymph node
calcification.
- Primary - various carcinomas.
b. Metastatic tumours from:
- Metastatic - rapidly growing metastases
- osteosarcoma
(e.g. secondary to mammary and
prostatic tumours and thyroid - chondrosarcoma
adenocarcinoma). - bone-forming mammary tumours.
d. Exogenous lipid or lipoid pneumonia c. Parasitic nodules.
(aspiration of mineral oit etc.). d. Primary lung tumoursf especially in cats.
e. Cavitary infarct - rare. e. Tracheal or bronchial hamartomas.
7. Emphysema (permanent enlargement of alveoli f. Chronic infectious disease.
due to breakdown of their walls) - usually g. Metastatic calcification.
multiple radiolucent foci associated with - Hyperadrenocorticism (Cushingfs disease)
overinflated lung: the affected lobe(s) may be or long-term corticosteroid administration;
markedly distendedf displacing other structures. mainly calcification of bronchial walls but
- Congenital lobar emphysema in young occasionally progresses to produce a
animals; right middle lobe most commonly calcified interstitial pattern.
affected. - Primary and secondary
- Multifocal congenital bullous emphysema hyperparathyroidism.
has also been described. - Hypervitaminosis D.
- Acquired emphysema with diseases that Chronic uraemia.
cause pulmonary air-trapping (e.g.
h. Idiopathic mineralization - tends to be
pneumoniaf feline asthma).
diffuse and extensive.
8. Lobar vesicular gas pattern - lung lobe torsion - Alveolar or bronchial microlithiasis.
(see 6.17.5 and Fig. 6.11).
- Puhnonary calcification.
9. Focal hyperlucent area peripheral to a
pulmonary thromboembolismf without - Puhnonary ossification.
evidence of overinflation. i. Cats - tuberculosis (may have skeletal lesions
10. Dynamic cervical lung hernia just cranial to too - see 1.20.2).
the thoracic inlet; secondary to increased j. Cats - calcified peribronchial mucous glands
respiratory rate and effort or chronic coughing. are seen very occasionally with chronic
bronchial disease.
Chapter 6 Lower respiratory tract 1 71

6. Pathological mediastinal mineralization. lungsf which may appear scalloped in some dogs
a. Lymph nodes. on the lateral radiograph due to intrathoracic fat.
- Histoplasmosis*f especially during healing Increased visibility of the lung or lobar edges
phase. may be due to intrapulmonary diseasef thickening
- Tuberculosis. of the pleura or diseases of the pleural space. See
b. Osteosarcoma transformation of oesophageal 8.2, 8.3 and 8.6 for further details.
Spirocerca lupi* granuloma.
c. Thymic tumours. 6.30 LOWER RESPIRATORY TRACT
d. Metastatic mediastinal tumours. CLINICAL SIGNS BUT NORMAL
7. Cardiovascular mineralization. RADIOGRAPHS
a. Aorta (see 7.10.4). Some animals may show dyspnoea or coughing
b. Coronary vessels (incidental finding) - tend without radiographic signs being apparent. If the
to run caudoventrally from the aortic arch. condition does not resolve and structural lung dis­
Best seen on lateral viewsf as shortf wavy ease remains a possibilityf repeat radiography at
lines of mineralization. 24 h intervals is recommended.
c. Heart valves. 1. Lesions not apparent due to poor technique or
- Idiopathic. overlooked during interpretation.
- Bacterial endocarditis. 2. Respiratory signs arising from upper
d. Mineralized neoplasia (e.g. chondrosarcoma respiratory tract disease (e.g. nasat
of puhnonary artery has been reported). nasopharyngeal or cranial tracheal disease).
3. Tracheitis.
6.28 HILAR MASSES 4. Acute bronchitis or bronchospasm.
5. Acute pneumonia or pnemnonitis (e.g. virat
Hilar masses usually result in poorly defined radio­ mycoplasma).
pacities near the base of the heart. The increased
6. Early idiopathic pulmonary fibrosis.
thickness of the lungs at this level means that diffuse
7. Pulmonary thromboembolism.
puhnonary pathology may create a false impression
of a hilar mass. Genuine hilar masses are usually 8. Early para quat poisoningf prior to
within the mediastinum - see 8.11.3 for details. development of lung fibrosis (first 2-3 days).
9. Small or radiolucent foreign body in the early
stages.
6.29 INCREASED VI SIBI LITY O F LUNG O R 10. Anaemia.
LOBAR EDGES 11. Acidosis.
The lungs normally extend to the periphery of the 12. Central nervous system disease.
thoracic cavityf and individual lobe or lung edges 13. Pyrexia or heatstroke.
are not seen except in two locations: (a) in the cranio­ 14. Weakness of respiratory muscles.
ventral thoraxf where the mediastinum runs 15. Anaphylaxis.
obliquely and outlines the cranial segment of the left 16. Pain.
cranial lung lobe on a lateral radiograph (see 8.7 and
17. Fear.
Fig. 8.7); and (b) along the ventral margins of the
1 72 Handbook of Small Animal Radiology and U ltrasound

Further reading
Miscellaneous Egenvalt A, Hansson, K, Sateri, H., cases (1987 1997). j. Am. Vet.
Avner, A, Kirberger, RM., 2005. The Lord, P.F., Jonsson, L., 2003. Med. Assoc. 215, 1650 1654.
effect of the various thoracic Pulmonary oedema in Swedish Park,. R.D., 1984. Bronchoesophageal
views on the appearance of hunting dogs. J. Small Anim. fistula in the dog: literature
selected thoracic viscera. J. Small Pract. 44, 209 217. survey, case presentations, and
Anim. Pract. 46, 491 498. Godshalk, CP., 1994. Common radiographic manifestations.
Berry, CR, Gallaway, A, Thrall, D. pitfalls in radiographic Compend. Contin. Educ. Pract.
E., Carlisle, C, 1993. Thoracic interpretation of the thorax. Veterinarian (Small Animal) 6,
radiographic features of Compend. Contin. Educ. Pract. 669 677.
anticoagulant rodenticide toxicity Veterinarian (Small Animal) 16, Pechman, RD., 1987. Effect of
in fourteen dogs. Vet. Radiol. 731 738. dependency versus
Ultrasound 34, 391 396. Guglielmini, C, De Simone, A, nondependency on lung lesion
Berry, CR, Ackennan, N., Valbonetti, A, Diana, A, 2007. visualization. Vet. Radiol. 28,
Monce, K., 1994. Pulmonary Intermittent cranial lung 185 190.
mineralization in four dogs with herniation in two dogs. Schultz, RM., Zwingenberger, A,
Cushing's syndrome. Vet. Radiol. Vet. Radiol. Ultrasound 48, 2008. Radiographic, computed
Ultrasound 35, 10 16. 227 229. tomographic, and
Brinkman, L.E., Biller, D., Hayward, N.L Baines, S.L Baines, ultrasonographic findings with
Annbrust, L., 2006. The clinical E.A, Herrtage, M.E., 2004. The migrating intrathoracic grass
usefulness of the ventrodorsal radiographic appearance of the awns in dogs and cats. Vet.
versus dorsoventral thoracic pulmonary vasculature in the cat. Radiol. Ultrasound 49, 249 255.
radiograph in dogs. J. Am. Vet. Radiol. Ultrasound 45, Stafford Johnson, M., Martin, M.,
Anim. Hosp. Assoc. 42, 501 504. 2008. Investigation of dyspnoea in
440 449. Jones, D.L Norris, CR, Samii, V.F., dogs. In Pract. 30, 558 566.
Clerx, C, Reichler, I., Peeters, D., Griffey, S.M., 2000. Endogenous Watson, P.L Herrtage, M.E.,
McEntee, A., Gennan, A., lipid pneumonia in cats: 24 cases Peacock, M.A, Sargan, D.R, 1999.
Dubois, L et al., 2003. Rhinitis/ (1985 1998). j. Am. Vet. Med. Primary ciliary dyskinesia in
bronchopneumonia syndrome in Assoc. 216, 1347 1440. Newfoundland dogs. Vet. Rec.
Irish Wolfhounds. J. Vet. Intern. Kirberger, RM., Avner, A, 2006. 144, 718 725.
Med. 17, 843 849. The effect of positioning on the Winegardner, K, Scrivani, p.v.,
Cohn, L.A., Norris, CR, Hawkins, appearance of selected cranial Gleed, RD., 2008. Lung expansion
E.C, Dye, J.A, Johnson, CA, thoracic structures in the dog. Vet. in the diagnosis of lung disease.
Williams, KL 2004. Identification Radiol. Ultrasound 47, 61 68. Compend. Contin. Educ.
and characterization of an Lobetti, RG., :Milner, R, Lane, E., Veterinarians 30, 479 489.
idiopathic pulmonary fibrosis like 2001. Chronic idiopathic Wood, E.F., O'Brien, RT., Young,
condition in cats. J. Vet. Intern. pulmonary fibrosis in five dogs. K.M., 1998. Ultrasound guided
Med. 18, 632 641. J. Am. Anim. Hosp. Assoc. 37, fine needle aspiration of focal
Coleman, M.G., Wannan, CG.A., 119 127. parenchymal lesions of the lung
Robson, M.C, 2005. Dynamic Lora Michiels, M., Biller, D.S., in dogs and cats. J. Vet. Intern.
cervical lung hernia in a dog with Olsen, J.L Hoskinson, J.L Kraft, Med. 12, 338 342.
chronic airway disease. J. Vet. S.L., Jones, J.C, 2003. The
Intern. Med. 19, 103 105. accessory lung lobe in thoracic Trachea
Corcoran, B.M., Thoday, K.L., disease: a case series and Buchanan, J.W., 2004. Tracheal signs
Henfrey, J.I., Simpson, J.W., anatomical review. J. Am. Anim. and associated vascular anomalies
Burnie, AG., Mooney, CT., 1991. Hosp. Assoc. 39, 452 458. in dogs with persistent right
Pulmonary infiltrate with Lord, P.F., Gomez, J.A, 1985. Lung aortic arch. J. Vet. Intern. Med. 18,
eosinophils in 14 dogs. J. Small lobe collapse: pathophysiology 510 514.
Anim. Pract. 32, 494 502. and radiologic significance. Vet. Coyne, B.E., Fingland, RB., 1992.
D'Anjou, M., Tidwelt AS., Hecht, S., Radiol. 26, 187 195. Hypoplasia of the trachea in dogs:
2005. Radiographic diagnosis of Norris, CR, Griffey, S.M., Samii, 103 cases (1974 1990). j. Am. Vet.
lung lobe torsion. Vet. Radiol. V.F., 1999. Pulmonary Med. Assoc. 201, 768 772.
Ultrasound 46, 478 484. thromboembolism in cats: 29
Chapter 6 Lower respiratory tract 1 73

Fujita, M., Miura, H., Yasuda, D., pulmonary disease. J. Am. Vet. pulmonary tumours. Compend.
Orima, H., 2004. Tracheal Radiol. Soc. 20, 10 14. Contin. Educ. Pract. Veterinarian
narrowing secondary to airway Myer, CW., 1980. Radiography (Small Animal) I, 131 139.
obstruction in two cats. J. Small review: The vascular and
Anim. Pract. 45, 29 31. bronchial patterns of pulmonary Infectious
Jakubiak, M.L Siedleccki, CT., disease. Vet. Radiol. 21, 156 160. Baumann, D., Fliickiger, M., 2001.
Zenger, M.L., Matteucci, M.L., Myer, W., 1980. Radiography review: Radiographic findings in the
Bruskiewicz, K.A, Rohn, D.A, The interstitial pattern of thorax of dogs with leptospiral
et al., 2005. Laryngeal, pulmonary disease. Vet. Radiol. infection. Vet. Radiol. Ultrasound
laryngotracheal, and tracheal 21, 18 23. 42, 305 307.
masses in cats: 27 cases Myer, W., Burt, J.K., 1973. Boag, AG., Lamb, CR, Chapman,
(1998 2003). j. Am. Anim. Hasp. Bronchiectasis in the dog: its P.S., Boswood, A, 2004.
Asoc. 41, 310 316. radiographic appearance. J. Am . Radiographic findings in 16 dogs
RudorC H., Herrtage, M.K, White, Vet. Radiol. Soc. 14, 3 12. infected with Angiostrongylus
R.AS., 1997. Use of Nykamp, S.G., Scrivani, p.v., vasorum. Vet. Rec. 154, 426 430.
ultrasonography in the diagnosis Dykes, N.L., 2002. Radiographic Bolt, G., Monrad, L Koch, L
of tracheal collapse. J. Small signs of pulmonary disease: an Jensen, AL., 1994. Canine
Anim. Pract. 38, 513 518. alternative approach. Compend. angiostrongylosis: a review. Vet.
White, R.N., :Milner, H.R, 1995. Conin. Educ. Pract. Veterinarian Rec. 135, 447 452.
Intrathoracic tracheal avulsion in (Small Animal) 24, 25 35. Burk, RL., Codey, KA, Corwin, A,
three cats. J. Small Anim. Pract. Silvennan, S., Poulos, P.W., Suter, 1978. The radiographic
36, 343 347. P.F., 1976. Cavitary pulmonary appearance of pulmonary
lesions in animals. J. Am. Vet. histoplasmosis in the dog and cat:
Lung patterns Radiol. Soc. 17, 134 146. a review of 37 case histories.
Dennis, R, 2008. Radiological J. Am. Vet. Radiol. Soc. 9, 2 6.
assessment of lung disease in Lung neoplasia Kirberger, RM., Lobetti, RG., 1998.
small animals 1. Bronchial and Ballegeer, KA, Forrest, L.L Radiographic aspects of
vascular patterns. In Pract. 3D, Stephen, RL., 2002. Radiographic Pneumocystis cannii pneumonia in
182 189. appearance of bronchoalveolar the miniature dachshund. Vet.
Dennis, R, 2008. Radiological carcinoma in nine cats. Vet. Radiol. Ultrasound 39, 313 317.
assessment of lung disease in Radiol. Ultrasound 43, 267 271. Millman, T.M., O'Brien, T.R,
small animals 2. Alveolar, Barr, F., Gruffydd Jones, T.L Suter, P.F., WolC AM., 1979.
interstitial and mixed lung Brown, P.L Gibbs, C, 1987. Coccidioidomycosis in the dog: its
patterns. In Pract. 3D, 262 270. Primary lung tumours in the cat. radiographic diagnosis. J. Am.
Gadbois, L d'Anjou, M.A., Dunn, M., J. Small Anim. Pract. 28, Vet. Radiol. Soc. 20, 50 65.
Alexander, G., Beauregard, G., 1115 1125. Schmidt, M., Wolvekamp, P., 1991.
D'Astous, L et al., 2009. Forrest, L.L Graybush, CA, 1998. Radiographic findings in ten dogs
Radiographic abnonnalities in Radiographic patterns of with thoracic actinomycosis. Vet.
cats with feline bronchial disease pulmonary metastasis in 25 cats. Radial. 32, 301 306.
and intra and interobserver Vet. Radiol. Ultrasound 39, 4 8. Shaiken, L.C, Evans, S.M.,
variability in radiographic Koblik, P.D., 1986. Radiographic Goldschmidt, M.H., 1991.
interpretation. J. Am. Vet. Med. appearance of primary lung Radiographic findings in canine
Assoc. 234, 367 375. tumours in cats: a review of malignant histiocytosis. Vet.
Kramer, RW., 1992. Radiology 41 cases. Vet. Radiol. 27, 66 73. Radial. 32, 237 242.
corner: The nodular pulmonary :Miles, K.G., 1988. A review of Walker, M.A., 1981. Thoracic
opacity is it real? Vet. Radiol. primary lung tumors in the dog, blastomycosis: a review of its
Ultrasound 33, 187 188. cat. Vet. Radiol. 29, 122 128. radiographic manifestations in
Myer, W., 1979. Radiography review: Thralt D.E., 1979. Radiographic 40 dogs. Vet. Radiol. 22, 22 26.
The alveolar pattern of diagnosis of metastatic
1 75

Chapter 7

Card i ovascular system

7.21 Contrast echocardiography:
CHAPTER CONTENTS right heart 1 94
7.1 Normal radiographic appearance of the 7.22 Doppler flow abnormalities:

heart 1 75 mitral valve 1 94
7.2 Normal cardiac silhouette with cardiac 7.23 Doppler flow abnormalities:

pathology 1 76 aortic valve 1 95
7.3 Cardiac malposition 1 77 7.24 Doppler flow abnormalities:

7.4 Reduction in heart size: microcardia 1 78 tricuspid valve 1 95
7.5 Generalized enlargement of the cardiac 7.25 Doppler flow abnormalities:

silhouette 1 78 pulmonic valve 1 96
7.6 Pericardial disease 1 79
7.7 Ultrasonography of pericardial
disease 1 81
7.8 Left atrial enlargement 18 1 7 . 1 NORMAL RADIOGRAPHIC APPEARANCE
OF THE HEART
7.9 Left ventricular enlargement 1 82
7. 1 0 Aortic abnormalities 1 83 The cardiac silhouette consists of pericardiumf
7. 1 1 Right atrial enlargement 1 84 pericardial fluidf myocardium (including epicar­
7. 1 2 Right ventricular enlargement 1 85 dium and endocardium)f the origins of the major
7. 1 3 Pulmonary artery trunk abnormalities 1 86 vessels and blood. Its size may change with the car­
7. 1 4 Changes in pulmonary arteries and veins 1 86 diac cyclef and it may be slightly larger during
7. 1 5 Caudal vena cava abnormalities 1 86 expiration than inspiration. Its appearance is
7. 1 6 Cardiac neoplasia 18 7 slightly different between right and left lateral
recumbency and between sternal and dorsal
Angiography 1 88
recumbencYf and so a consistent technique should
7. 1 7 Angiography: left heart 1 88
be adopted. Radiographic signs of heart disease
7. 1 8 Angiography: right heart 1 89
include change in size or shape of the heart and
Cardiac ultrasonography 1 89 evidence of right- or left-sided heart failure. Alter­
7. 1 9 Two-dimensional and M-mode ation in size or shape of the cardiac silhouette
echocardiography: left heart 1 89 may be due to enlargement of any of its compo­
7.20 Two-dimensional and M-mode nents and can often be distinguished only by angi­
echocardiography: right heart 1 92 ography or ultrasonography; plain radiographs
may be misleading. Conformation is the single

© 2010 Els�yi�r Ltd.
1 76 Handbook of Small Animal Radiology and U ltrasound

- - -l
-','.:" -�'

\ .
4 �:§.
___

:bt��
.-.",�.,;:".
- ,
: l'
" r' w
\, 1::' · :Z·:
)(::]"�) C:J'i'"
-,.,,,
, , �.,>'
_

Figure 7.1 Cardiac measurement using the vertebral heart
scale system. L, maxi m u m length of heart; T4, fourth thoracic
vertebra; W, maxi m u m width of heart.

A = 1 1 to 1 o'clock
most important cause for apparent cardiomegaly in PA = 1 10 2
LAA = 2 10 3
barrel-chested dogs such as the Bulldogf Yorkshire LV = 3 10 5
Terrier and Dachshillldf which have a relatively RV = 5 10 9
large heart with elevated trachea on lateral radio­ RV RA = 9 10 1 1
graphs. The Golden Retriever also has an appar­ LV
ently large and square-shaped heart on the lateral
radiograph. Generalized cardiomegaly may be ®
evaluated in dogs by means of the vertebral heart Figure 7.2 (A) Clock face analogy of cardiac anatomy (lateral
scale measurement (Fig. 7.1); on the lateral recum­ view); (8) dock-face analogy of cardiac anatomy (dorsoventral
bent radiographf the distance between the ventral view). A, aorta; LA, left atri u m ; LAA, left auricular appendage;
aspect of the carina and the cardiac apex is taken LV, left ventricle; PA, pulmonary artery; RA, right atri u m ; RV,
as a length valuef and the maximum width of the right ventricle.
heart perpendicular to the length line is taken as
the wid th of the heart. Starting at the cranial aspect
of the fourth thoracic vertebraf the number of ver­ 7 .2 NORMAL CARDIAC SILHOU ETTE WITH
tebral lengths is determined for each measurement. CARDIAC PATHOLOGY
In 100 clinically normal adult dogs, the mean (± SO) A normal cardiac silhouette may be present in
vertebral heart size was 9.7 ± 0.5. Cardiomegaly is spite of severe cardiac disease. Echocardiography
usually considered present when the combined mea­ and an electrocardiogram are essential diagnostic
surement exceeds 10.6 thoracic vertebraef although in components of the cardiac examination for com­
some breeds (e.g. Labradorf Golden Retrieverf Boxerf plete cardiac evaluation.
Cavalier King Charles Spaniel, Greyhound, Whippet,
1. Conduction disturbances and arrhythmias.
Lurcher) this value is commonly exceeded in normal
dogs. Reference ranges for some popular breeds 2. Over-treated heart disease (e.g. excessive use
have been published. In catsf the same technique of diuretics).
can be used with a mean of 7.5 ± 0.3 and 8.1 being 3. Concentric ventricular hypertrophy.
the cut-off point above which the heart is considered a. Secondary to congenital heart disease.
enlarged. Localized cardiac enlargement may be - (Sub)aortic stenosis (left ventricular
described according to the clock face analogy hypertrophy).
(Fig. 7.2). - Pulmonic stenosis (right ventricular
It should be noted that radiography is an insen­ hypertrophy).
sitive and relatively inaccurate method for diagno­ b. Acquired.
sis of heart diseases (especially congenital)f and - Idiopathic hypertrophic cardiomyopathy
echocardiography is a much more efficient modal­ in cats and dogs.
ity. Neverthelessf radiography is extremely impor­ - Hypertrophic cardiomyopathy secondary
tant for assessment of signs of heart failuref to hyperthyroidism in older cats.
especially in the lungs. - Systemic or puhnonary hypertension.
Chapter 7 Cardiovascular system 1 77

4. Small shunting lesions. 3. Acquired causes of dextrocardia.
a. Small atrial and ventricular septal defects a. Cardiac disease with left heart enlargement.
(ASDs and VSDs). b. Mediastinal shift (see 8.8).
b. Small patent ductus arteriosus (FDA). 4. Congenital extracardiac abnormalities.
s. Endocarditis. a. Pectus excavatum (see 8.23.1 and
6. Acute myocardial failure. Fig. 8.15).
7. Pericardial disease. b. Vertebral abnormalities resulting in an
a. Constrictive pericarditis. abnormally wide and shallow thorax.
b. Acute traumatic haemopericardium. S. Congenital cardiac abnormalities.

8. Acute ruptured chordae tendineae. a. Primary dextrocardia with situs inversus
9. Myocardial neoplasia. (see Fig. 7.3C) - the cardiac apex, left
ventriclef aortic arch and gastric fundus
10. Early or mild myocarditis.
all lie on the right side and the CdVC is
on the left.
7 .3 CARDIAC MALPOSITION - Part of Kartagenees syndrome (also
includes rhinosinusitis and bronchiectasis
Term inology due to ciliary dyskinesia).
Levocardia - Heart lies in a normal left-sided posi­ b. Dextrocardia with situs solitus - cardiac
tion (Fig. 7.3A). chambers normal but apex to right of
Dextrocardia - Heart lying predominantly in the midline.
right thorax with the cardiac apex pointing to the c. Levocardia with partial abdominal situs
right (Fig. 7.3B). inversus has also been described.
Situs solitus - Normal position of thoracic and
abdominal organs. Dorsal displacement of the heart
Situs inversus - Reversal of the normal thoracic
6. Fat in the pericardium or ventral mediastinum.
and abdominal organs - mirror image (Fig. 7.3C).
7. Sternal abnormalities (see 8.23).
Dextrocardia 8. Pneumothorax on a lateral recumbent
radiograph (see 8.2.2).
1. Artefact - incorrectly labelled dorsoventral 9. Mediastinal shift (see 8.8).
(DV) or ventrodorsal (VD) radiograph; check
10. Cranioventral thoracic masses (see 8.11.1).
the position of the caudal vena cava (CdVC)
and descending aortaf or the gastric air bubble The heart may also be displaced craniallYf cau­
and spleen in the cranial abdomen. dally, ventrally or further to the left by herniated
2. Normal variant in wide-chested dogs and abdominal viscera or by a variety of mass lesions
occasionally in the cat. or bony abnormalities.

A

RV LAA
RV

.-----=- �P
LV
fAP
, , ----,
---..

0 � ® :� ©
Figure 7.3 (A) Normal location of the heart (dorsoventral view): (8) dextrocardia; (C) dextrocardia with situs inversus. A, aorta;
AP, apex; lAA, left au ricu lar appendage; LV, left ventricle; RAA, right auricular appendage; RV, right ventricle; 5, stomach.
1 78 Handbook of Small Animal Radiology and U ltrasound

7 .4 REDUCTION IN HEART SIZE: MICROCARDIA dilation and heart wall hypertrophy cannot be dis­
tinguished radiographicallYf and myocardial
The heart silhouette is abnormally small and
pathology is much more readily diagnosed by
pointedf the ventricles appear narrower and the
means of two-dimensional and M-mode
apex loses contact with the sternum. Thoracic
echocardiography.
blood vessels may appear smaller and the lungs
Because it is hard to differentiate the left and
hyperlucent (see hypovascular pattern, 6.23.5).
right sides of the heart radiographicallYf disease
The CdVC is also reduced in size (Fig. 7.4).
that is confined to one side may nevertheless
1. Artefactual reduction in heart size. appear radiographically as generalized heart
a. Deep-chested dogs - narrowf upright heart enlargement (see 7.8, 7.9, 7.11 and 7.12); the list
with straight caudal border. below includes only diseases that genuinely affect
b. Deep inspiration. both right and left sides. Assessment of pulmonary
c. Pulmonary overinflation (see 6.25.4 and 6.25.6). vasculature is also important in radiographic
d. Heart displaced from the sternum. assessment of cardiac disease (see 6.23).
- Pnemnothorax. 1. Normal.
- Mediastinal shift. a. Athletic breeds (e.g. Greyhound and other
2. Hypovolaemia. sight hounds).
a. Shock. b. Some young animals.
b. Dehydration. 2. Artefactual.
c. Hypoadrenocorticism (Addisonfs disease) - a. Intrapericardial and mediastinal fat (see 7.6.1).
may be accompanied by megaoesophagus. b. Expiratory radiograph.
3. Muscle mass loss. 3. Fluid overload.
a. Emaciation. 4. Bradycardia (e.g. due to sedation), allowing
- Chronic systemic disease. increased diastolic filling.
- Malnutrition. S. End-stagef left-heart failure due to mitral valve

b. Hypoadrenocorticism (Addisonfs disease). insufficiency.
a. Myxomatous atrioventricular valvular
c. Atrophic myopathies.
degeneration (endocardiosis).
4. Constrictive pericarditis. b. Valvular dysplasia.
S. Post thoracotomy.
c. Bacterial endocarditis.
6. Congenital cardiac disease (see 7.Sf 7.9f 7.11
7 .5 GENERALIZED E N LARG E ME NT O F THE and 7.12) - although specific chambers may be
CARDIAC SILHOU ETTE particularly enlargedf generalized
cardiomegaly is often seen radiographically.
Some of the following diseases may only cause
7. Non-inflammatory myocardial disease.
mild cardiomegaly or cardiomegaly only in
a. Unknown aetiology.
advanced stages of the condition. Chamber lumen
- Idiopathic dilated cardiomyopathy -
large and giant breed mainly male dogsf
2-7 years old - especially Dobermannf
Great Danef Irish Wolfhoundf Scottish
Deerhoundf Boxerf Dalmatian and
Spaniels; juvenile dilated
cardiomyopathy in Portuguese Water
Dogs. Occasionally seen in cats.
Hypertrophic cardiomyopathy - rare in
dogs (Rottweilerf Dalmatian and German
Shepherd dogs may be predisposed);
more common in adult male cats.
Figure 7.4 Microcardia, pulmonary hypoperfusion and small - Restrictive cardiomyopathy - YOilllger
caudal vena cava. catsf rare; differential diagnosis
Chapter 7 Cardiovascular system 1 79

endocardial fibroelastosisf a congenital - Parasitic.
condition in Siamese and Burmese kittens - Fungal.
and cats under 1 year old. b. Non-infectious.
b. Secondary to a known aetiology. - Immune-mediated (e.g. rheumatoid
- End-stage mitral valve insufficiency. arthritis).
- Nutritional deficiency (e.g. carnitine). 10. Ischaemic myocardial disease.
- Toxic (e.g. cytotoxic drugs such as a. Arteriosclerosis and thrombosis of large
doxorubicin)f heavy metals and coronary artery branches.
toxaemia. b. Arteriosclerosisf amyloidosis or hyalinosis
- Metabolic disordersf for example of intramural coronary arteries.
hypertrophic cardiomyopathy secondary c. Angiopathies secondary to congenital heart
to hyperthyroidism (especially in older disease.
cats) and hyperadrenocorticism. 11. Chronic anaemia.
- Arrhytlunogenic right ventricular
12. Hyperviscosity syndrome (e.g. multiple
cardiomyopathy - Boxersf inherited;
myeloma).
also cats: massively dilated right
13. Phaeochromocytoma - due to excessive
chambers.
catecholamine production.
- Cats - dilated cardiomyopathy;
14. Pericardial disease - see 7.6.
nutritional deficiency such as taurinef
now rare due to dietary supplementation.
- Cats - dilated cardiomyopathy possibly 7.6 PERICARDIAL DISEASE
genetic in Siamesef Burmese and
Pericardial disease may be difficult to distinguish
Abyssinian.
from generalized cardiomegaly radiographically.
- Cats - hypertrophic cardiomyopathy is
The main difference is that most cases of cardio­
genetic in Maine Coon cats.
megaly have left atrial enlargementf whereas
- Cats - acromegaly (hypersomatotropism)
pericardial effusion produces an enlargedf globu­
may cause hypertrophicf occasionally
lar cardiac silhouette lacking specific chamber
dilated, cardiomyopathy.
enlargement (Fig. 7.5). Its margins may be sharp
- Cats - hypertrophic feline muscular
due to reduced movement blur. Pericardial effu­
dystrophy; also diaphragmatic changes.
sion may also often be differentiated from
- Neuromuscular disorders.
generalized cardiomegaly by the type of failure
- Amyloidosis.
that resultsf which is right-sidedf whereas left­
- Lipidosis. sided or generalized failure is seen with the most
- Mucopolysaccharidosis. common cause of generalized cardiomegalYf car­
- Infiltrative disease (e.g. neoplasia and diomyopathy. Ultrasonography is the imaging
glycogen storage diseases). modality of choice to evaluate pericardial pathol­
- Physical agents (e.g. heat and trauma). ogy (see 7.7).
- Old age. 1. Artefactual appearance of pericardial effusion -
S. Concurrent left and right heart valvular obese animals may have large amounts of
insufficiency. intrapericardial and mediastinal fat mimicking
a. Myxomatous atrioventricular valvular an enlarged cardiac silhouette and possible
degeneration (endocardiosis). pericardial effusion. Fat is less radiopaque than
b. Valvular dysplasia. soft tissue such as the myocardiumf and on
c. Bacterial endocarditis. good-quality radiographs the pericardial fat
9. Inflammatory myocardial disease. can be distinguished from the myocardimn;
contrast can be enhanced by obtaining
a. Infectious.
radiographs using lower kVp exposures.
- Viral (e.g. parvovirus in puppies).
Normal pericardial fat often demonstrates
- Bacterial. the cardiac contour in animals with pleural
- Mycoplasma. effusion in which the heart is otherwise
- Protozoal (e.g. trypanosomiasis*). obscured.
1 80 H a n d book of S m a l l An i m a l Rad i o l ogy a n d U l traso u n d

®
Fi g u re 7 . 5 Perica rd i a l effu sion - the h e a rt is e n l a rged a n d very ro u n ded i n s h a p e : (A) l a tera l view; (B) dorsove ntra l view. I n the
case of perica rd i o perito n ea l d i a p h rag matic hernia, gas-fi l led l o o ps of the gastro i n testi n a l tract may a l so be seen with i n the
perica rd i a l s i l h o u ette.

2. Pericardial effusion - usually male dogs over 6 - Mesothelioma.
years old and weighing more than 20 kg. - Metastatic neoplasia.
a. Non-inflammatory pericardial effusions. - Lymphoma, especially cats.
- Idiopathic benign effusion, especially in Thyroid carcinoma.
the St Bernard and Golden Retriever; often
- Rhabdomyosarcoma.
haemorrhagic.
d. Haemopericardium.
- Hypoalbuminaemia.
Right-sided congestive heart failure, - Bleeding tumour.
particularly feline hypertrophic - Trauma (e.g. gunshot, bite wound, sequel
cardiomyopathy. to pericardiocentesis).
Toxaemia. - Rupture of the left atrium by a severe jet
- Uraemia. lesion secondary to mitral valve
insufficiency - especially Dachshund,
- Trauma.
Poodle and Cocker Spaniel.
- Neoplastic obstruction of lymph and blood
- Coagulopathy.
vessels at the heart base.
e. Chylous pericardial effusion - very rare and
- Associated with a peritoneopericardial
diaphragmatic hernia. of unknown aetiology.
b. Inflammatory pericardial effusions. 3. Congenital peritoneopericardial diaphragmatic

- Idiopathic benign effusion. hernia (PPDH) - may be accompanied by sternal
abnormalities and an umbilical hernia.
- Foreign body.
Gas-filled intestinal loops or faecal material may
- Septic, purulent process sometimes be seen within the cardiac silhouette; sternal
secondary to perforating wounds. abnormalities may also be present. Often
- Tuberculosis. diagnosed only later in life.
- Coccidioidomycosis*. 4. Pneumopericardium - rare, usually due to
- Steatitis. trauma and not clinically significant; also
- Cats - feline infectious peritonitis is the reported secondary to positive-pressure
most common cause. ventilation and due to communication with lung
c. Neoplastic pericardial effusions - usually bulla.
haemorrhagic (rare in the cat) . 5. Intrapericardial cyst - rare. If large, mimics a
- Right atrial haemangiosarcoma, especially pericardial effusion and may cause tamponade.
in the German Shepherd dog and often Young animals; may be associated with a
associated with pulmonary, splenic or peritoneopericardial diaphragmatic hernia.
hepatic haemangiosarcoma. 6. Pericardial neoplasia - rare; may extend
- Heart base tumours (see 7.16.2). externally (e.g. lipoma).
Chapter 7 Cardiovascular system 1 81

7 .7 U LTRASONOGRAPHY OF PERICARDIAL 3. Thickening of the epicardium or pericardium -
DISEASE may lead to a restrictive state in which complete
filling of the cardiac chambers is prevented.
1. Pericardial fluid (see 7.6.2 above). Usually a. Mesothelioma.
anechoic or hypoechoic fluid. Swirling echoes b. Reactive or inflammatory changes.
within the fluid are suggestive of large numbers
of cellsf debris or gas bubbles. The pericardium
may be thickened and distorted if the fluid is 7.B LEFT ATRIAL ENLARGEMENT
inflammatory. It is important to check for the The lateral view shows bulging of the cardiac
presence of cardiac tamponade secondary to the silhouette at 12-2 dclockf with elevation and com­
fluid accumulation; in the early stages this is pression of the left main stem bronchus. The caudal
indicated by collapse of the right atrial wall
border of the heart is abnormally straight and upright
during systolef and in more advanced cases by
or even slopes caudodorsallYf and the caudal cardiac
abnormal motion of the right ventricular free
waist is lost (Fig. 7.7A). On the DV view, atrial
wall (Fig. 7.6). Right atrial collapse due to
enlargement may push the main stern bronchi further
pericardial effusion maYf howeverf be mimicked apart (to > 60 ) and the enlarged left auricular
0

by severe pleural effusion. appendage creates a bulge at 2-3 o'clock (Fig. 7.7B).
2. Intrapericardial mass. The increased opacity of the dilated left atrium may
a. Neoplasia. be mistaken as lymphadenopathy or a hmg mass on
- Right atrial haemangiosarcoma; seen best either view. Secondary pulmonary changes in the
on a right-sided long-axis four-chamber form of vascular congestion or puhnonary oedema
viewf usually at the junction of the atrium may be present (see 6.14 and 6.24).
and ventricle and extending into the
pericardial sac (Fig. 7.6). Volume overload
- Heart base tumour; seen best on a right­
sided short-axis view just dorsal to the 1. Mitral valve insufficiency.
aortic valve. a. Myxomatous atrioventricular valvular
- Others, listed in 7.6.2c. degeneration (endocardiosis) - olderf small­
b. Thrombus. breed dogs.
c. Abdominal organs in a peritoneopericardial b. Secondary to left ventricular failure when the
diaphragmatic hernia. enlarging ventricle results in dilation of the
d. Intrapericardial cyst. annular ring (e.g. dilated cardiomyopathy).
c. Bacterial endocarditis.
d. Ruptured left ventricular chordae tendineae.
e. Congenital mitral valve dysplasia -
especially Great Danef German Shepherd
dogf Bull Terrier and cats.
f. Ruptured papillary muscle.
2. Diastolic dysfunction of the left ventricle
resulting in pooling of blood in the left atrium.
3. Patent ductus arteriosus with left to right
shunting - especially German Shepherd dog,
Spanielsf Border Collief Keeshondf
Pomeranianf Miniature Poodle and Irish Setter.
Figure 7.6 Right parasternal long-axis u ltrasonogram of About 25% of cases show a classic triad of
pericardial effusion, showing an echoic to hypoechoic fluid aorticf pulmonary artery and left auricular
accumulation within the pericardial sac, with collapse of the appendage bulges on the DV view (Fig. 7.8).
right atrial wall during systole (cardiac tamponade). A mass is 4. Ventricular septal defect with left to right
also seen at the ju nction of the right atrium and ventricle, shunting - especially Border Collief Springer
most likely to be a haemangiosarcoma. Ao, aorta; LA, left Spaniet West Highland White Terrierf Beaglef
atri u m ; LV, left ventricle; M, mass; PE, pericardial effusion; Bulldog, German Shepherd dog, Keeshond,
RA, right atri u m ; RV, right ventricle. Mastift Siberian Husky and cats.
1 82 Handbook of Small Animal Radiology and U ltrasound

®
Figure 7.7 Left-sided cardiomegaly: (A) lateral view showing a tall heart and an en larged left atri u m ; (8) dorsoventral view
showing the enlarged left auricular appendage at 2-3 o'clock and the left atrium as a mass between the main stem bronchi.
The heart apex is displaced to the right due to marked left ventricular en largement. Signs of left-sided heart failure (pulmonary
hyperperfusion and oedema) may also be present. LA, left atri u m ; lAA, left auricular appendage; LV, left ventricle.

- Idiopathic hypertrophic cardiomyopathy;
cats and dogs.
- Hypertrophic cardiomyopathy secondary
to hyperthyroidism in older cats.
c. Cats - restrictive cardiomyopathy -
valentine heart on the DV view.
S. Congenital mitral valve stenosis - especially
Newfoundlandf Bull Terrier and cats - rare.
9. Cor triatriatum sinister - membranous septum
in the left atrium.
10. Atrial or ventricular neoplasia interfering with
Figure 7.8 Dorsoventral view of a heart with patent ductus transvalvular flow - rare.
arteriosus, showing a classic triad of three bu lges,
representing an en larged aortic arch (Aa, at 1 1 - 1 o'clock), an
en larged pulmonary artery (PA, at 1-2 o'clock) and an 7 . 9 LEFT VENTRICULAR ENLARGE M ENT
en larged left auricular appendage (LAA, at 2-3 o'clock). Left
On the lateral viewf cardiac enlargement is seen at
ventricular enlargement causes the cardiac apex to lie on the
right. There is also pulmonary hyperperfusion. 2-5/6 o'clockf with increased height of the heart
and elevation of the trachea (Fig. 7.7A). Left atrial
enlargement is usually also present. On the DV
5. Aorticopuhnonary septal defect with left to
viewf the heart may appear elongated and enlarge­
right shunting.
ment is seen at 3-5 o'clock; in severe cases this
6. Endocardial fibroelastosis - Siamese and
displaces the cardiac apex to the right (Fig. 7.7B)
Burmese kittens.
(right heart enlargement due tOf for examplef
pulmonic stenosis may displace the cardiac apex
Pressure overload
further to the left on the DV radiographf mimick­
7. Left ventricular hypertrophy leading to mitral ing left ventricular enlargement).
insufficiency.
a. (Sub )aortic stenosis - especially Boxerf Volume overload
Golden Retrieverf German Shepherd dogf
Newfoundlandf Pointerf Rottweilerf Bulldog 1. Mitral valve insufficiency (see 7.8.1).
and Bull Terriers. 2. Aortic insufficiency.
b. Hypertrophic cardiomyopathy - rare in 3. Patent ductus arteriosus with left to right
dogs; in cats a 'valentine'-shaped heart is shunting - the most common congenital
seen on the DV view due to atrial cardiac condition in the dog but far less
enlargement. common in cats.
Chapter 7 Cardiovascular system 1 83

4. Ventricular septal defect with left to right 7 . 1 0 AORTIC ABNORMALITIES
shunting.
5. Endocardial cushion defects (persistent 1. Enlargement of the aortic arch or
atrioventricular canal). descending aorta. On the lateral viewf
enlargement of the aortic arch may be seen
6. Aorticopulmonary septal defect.
at 11-12 ofclockf with reduction or possibly
7. Arteriovenous fistula.
obliteration of the cranial cardiac waist
(Fig. 7.9A). On the DV view, an aortic
Pressure overload 'knuckle' is seen from 11 to 1 o'clock with
Results in concentric hypertrophy and often does mediastinal wideningf and there is an apparent
not cause ventricular silhouette enlargement. increase in the craniocaudal length of the heart
(Fig. 7.9B).
S. (Sub)aortic stenosis.
a. Post-aortic stenosis dilation - entire aortic
9. Systemic hypertension.
arch.
a. Chronic renal failuref especially in cats.
b. Large left to right shunting PDA due to
b. Hyperthyroidism. increase in aortic circulating blood volume
c. Hyperadrenocorticism (Cushingfs disease). and inherent aortic wall weakness -
10. Hypertrophic cardiomyopathy - rare in dogs. predominantly descending part of aortic arch.
In catsf a valentine-shaped heart is seen on the c. Aneurysms.
DV view due to atrial enlargement. - Secondary to Spirocerca lupi*' migration or
a. Idiopathic hypertrophic cardiomyopathy; granulomas - seen as left-sided
cats and dogs. illldulations of the descending aorta on a
b. Hypertrophic cardiomyopathy secondary to DV or VD view.
hyperthyroidism in older cats. - Idiopathicf with aortic dissection.
c. Acromegaly in cats. - Ductus aneurysm or diverticulum.
11. Coarctation (narrowing) of the aorta - very rare. - Secondary to coarctation (narrowing of the
aortic istlunusf between the left subclavian
Myocardial failure (see 7.5) artery and the insertion of the ductus
arteriosus) .
12. Dilated cardiomyopathy.
d. Aortic body tumour (chemodectoma).
13. Myocarditis.
e. Systemic hypertension in cats.
14. Myocardial neoplasia (see 7.16).
f. Coarctation (narrowing) of the aorta with
post-stenotic dilation.
Miscellaneous
2. Redundant (tortuous or bulging) aorta.
15. Ventricular aneurysm - localized protrusion of a. Brachycephalic breedsf especially the
the left ventricle. Bulldog.
16. Thickened walls due to muscular dystrophy - b. Some older dogs.
Golden Retriever and cats. c. Congenital hypothyroidism.

®
Figure 7.9 Location of an en larged aortic arch: (A) lateral view; (8) dorsoventral view.
1 84 Handbook of Small Animal Radiology and U ltrasound

d. Systemic hypertension in cats. outline may have a square or angular appearance
e. Common in old catsf accompanied by a more on VD radiographsf due to pericardial fat rather
horizontal heart - aorta bulges cranially and than genuine chamber enlargement.
to the left.
3. Right-sided aorta. Volume overload
a. Congenital persistent right aortic arch; a
1. Tricuspid valve insufficiency.
vascular ring anomaly with secondary
oesophageal dilation (see 8.17.6 and Fig. 8.12). a. Myxomatous atrioventricular valvular
b. Situs inversus (see Fig. 7.3C). degeneration (endocardiosis).
b. Congenital tricuspid valve dysplasia - more
4. Calcification or mineralization of the aorta -
common in cats than dogs; also Labrador
uncommon and usually an incidental finding.