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"What Is Your Diagnosis?," Journal of Avian Medicine and Surgery, 32(2), 158-
163, (1 June 2018)

Article  in  Journal of Avian Medicine and Surgery · June 2018

DOI: 10.1647/2017-272

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 What Is Your Diagnosis?
Source: Journal of Avian Medicine and Surgery, 32(2) : 158-163
Published By: Association of Avian Veterinarians

URL: https://doi.org/10.1647/2017-272

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 Journal of Avian Medicine and Surgery 32(2):158–163, 2018
Ó 2018 by the Association of Avian Veterinarians

What Is Your Diagnosis?

History
A hatch-year, 1.32-kg, female red-tailed hawk
(Buteo jamaicencis) was presented to The Raptor
Center with a history of colliding with a window.
Physical examination at the time of admission
revealed the hawk was in good body condition
(body condition score, 3/5) and quiet, but alert
and responsive. A concavity of the caudal third of
the sternum was noted. The bird’s pulsating heart
was visible and palpable beneath the body wall
(Fig 1). Results of a complete blood count taken
at admission were within reference intervals
except for a few Leucocytozoon species organisms.
Serum biochemical abnormalities were hypopro-
teinemia (3.5 g/dL; reference interval, 3.9–6.7
g/dL) with hypoglobulinemia (1.2 g/dL; reference
interval, 2.1–2.9 g/dL), elevated aspartate amino-
transferase concentration (617 U/L; reference
interval, 76–492 U/L), and elevated creatine
kinase concentration (5298 U/L; reference inter-
val, 262–2400 U/L).1 Results of a flotation fecal
examination revealed Capillaria species, after
which the bird was treated with fenbendazole
(30 mg/kg PO q24h) for 5 days. Conventional
digital radiographs of the whole body were
obtained (Figs 2 and 3). A computed tomography
(CT) study was performed without radiographic
contrast. Transverse images at 0.3–0.5-mm slice
thickness and 3-dimensional reconstruction imag-
es were obtained (Fig 4).

Figure 1. Photograph depicting concavity of the caudal third of the sternum in the chest of a hatch-year red-tailed
hawk.

158

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 WHAT IS YOUR DIAGNOSIS? 159

Figure 3. Lateral radiographic view of the hatch-year

red-tailed hawk with an abnormal sternum described in
Fig 1.

Figure 2. Ventrodorsal radiographic view of the hatch-

year red-tailed hawk with an abnormal sternum.

Figure 4. Computed tomography scan of the cranial

coelom of the red-tailed hawk described in Figure 1,
scanned transversely at 3.0-mm slice thickness,
demonstrating the caudal third of the sternum.

Please evaluate the history, physical examination findings, and Figures 1–4. Formulate a list of differential
diagnoses and consider other diagnostic tests before proceeding.

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 160 JOURNAL OF AVIAN MEDICINE AND SURGERY

Diagnosis
Radiographic findings show asymmetry on the
position of the pectoral girdle. The furcula
(clavicles) is fused to the most cranial and ventral
aspect of the sternum. There is a nonfusion of the
caudal third of the sternum. The hepatic silhouette
is enlarged. The coelomic cavity looks distended
with loss of radiographic detail (Fig 5).
Results of CT scans show differences between
the left and right sides of the pectoral girdle, with
asymetry of the articulation of the scapula,
coracoid, and furcula. The right side of the
pectoral girdle is more cranial compared with
the left side. The furcula is fused and articulates
with the cranial and ventral aspect of the sternum.
The articulation of the coracoids with the sternum
is asymmetric, with the right side more cranial
than the left. The sternum is only partially fused
at the cranial aspect where there is asymmetry.
Approximately 4 cm of the sternum is not fused,
and the ventral body wall has a concavity at the
sternal defect. (Fig 6). The liver is located more
cranial and dorsal with respect to the heart than
expected.
Figure 5. Same radiographic ventrodorsal image as
Based on results of diagnostic imaging, the final
Figure 2. Notice the lack of fusion of the caudal third of
diagnosis was congenital sternum bifurcation, or the sternum (black arrow) and the asymmetry of the
cleft sternum. pectoral girdle (white arrow)

Discussion
There are few reports of congenital skeletal
malformations in raptors. Developmental malfor-
mations in birds mainly occur during the prehatch-
ing period.2 The development of musculoskeletal
structures associated with the trunk is a multistep
process involving differential gene expression, as
well as cell interactions and cell signaling between
precursor tissues. The musculoskeletal system
associated with the trunk develops from paraxial
and lateral mesoderm. The paraxial mesoderm in
the trunk is transiently organized into tissue blocks
alongside the neural tube, known as somites. The
sternum is derived from somatic mesoderm. The
paired sternal bars fuse in the midline to form a
cartilaginous sternal plate. This fusion occurs in a
cranial-to-caudal direction, and failure of this
fusion leads to the congenital anomaly of sternal
bifurcation, or cleft sternum.3
Several skeletal abnormalities have been report-
ed in birds, but a specific cause is difficult to prove,
especially when the number of cases is small.2,3
Grewal et al4 reported a bifurcation of a 22-week-
old white Leghorn hen on postmortem examina-
tion. The caudal medial projection of the sternum
was bifurcated into 2 small projections. On a
second study done by Grewal et al,5 asymmetries
of the sternum and shoulder girdle were described
in domestic chickens.5
In humans and other animal species, congenital
malformations of the sternum have been associated
with cardiac, intra-abdominal, and respiratory
defects.4,6,7
Imaging tools including radiography and CT
scans contribute to our antemortem knowledge of
anatomy and allow us to assess skeletal malfor-
mations.8,9 Conventional radiography has limita-
tions because of the overlapping structures.10,11 A
CT generates multiple views without interference
of adjacent and overlying structures.11–13 In this
particular case, conventional radiographs allowed
us to diagnose the malformation of the sternum,
fusion of the furcula to the sternum, and asymme-
try of the pectoral girdle but did not allow us to
evaluate in detail the junctions between the
scapula, coracoids, furcula, and sternum. A CT
also revealed an abnormal location of the liver
with respect to the heart.
The red-tailed hawk in this report was in good
body condition. Because the bird was a juvenile in
its first year, we do not know if this skeletal
abnormality will be an impediment to survival.

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 WHAT IS YOUR DIAGNOSIS?
Figure 6. Computed tomography scan, ventral view, of a
3-dimmensional musculoskeletal reconstruction
demonstrating the sternum bifurcation (white arrow)
and the fusion of the furcula and the sternum (black
arrow) of the hatch-year red-tailed hawk described in
Fig 1.
During reconditioning, the bird exhibited no
inability to fly well. After reconditioning, the bird
was banded and released. If the band is subse-
quently recovered, additional information about
the impact of this type of congenital abnormality
may be obtained.
Treatment options have been reported in Afri-
can grey parrots (Psittacus erithicus) and in an
orange-winged Amazon parrot (Amazona amazon-
ica).14,15 Indications for the defect repair are
aesthetic and to protect the heart. Surgical options
are limited once the skeleton is fully ossified. The
surgical treatment consists of elevating and appos-
ing the pectoral muscles, and removing the cleft
portion of the sternum, providing protection to the
subcutaneously located heart. Special care needs to
be taken when the skin is incised to prevent
damage to the pericardium and the heart. An
alternate technique includes applying a mesh
implant on the defect that may or may not protect
the heart.14,15 In this particular case, the hawk was
too old for the bone and muscle repair to be
performed. In a risk/benefit analysis, the risks
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161
outweighed the benefits of trying a relatively novel
treatment.
Systematic recording of developmental abnor-
malities in wild animals presented for rehabilita-
tion could further define the frequency, impact,
and possible causes of congenital diseases in
wildlife.16
This case was submitted by Ernesto Domı́nguez-
Villegas, DVM, and Kari L. Anderson, DVM, Dipl
ACVR, from The Raptor Center, College of
Veterinary Medicine-University of Minnesota,
1920 Fitch Avenue, St. Paul, MN 55108, USA
(Domı́nguez-Villegas), and Veterinary Clinical
Sciences Department, College of Veterinary Med-
icine-University of Minnesota, 1352 Boyd Avenue,
St. Paul, MN 55108, USA (Anderson).
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