Hello
I have a 7 year old Newfie-x that has a mild intermittent lameness of the Rt forelimb. A palpable mass/swelling is present proximal to the accessory carpal bone. It is firm and non-painful. The foot does not appear to hyperextend greatly if at all.
X-rays showed a soft tissue swelling, a previous FNA was inconclusive.
Hello
I have a 7 year old Newfie-x that has a mild intermittent lameness of the Rt forelimb. A palpable mass/swelling is present proximal to the accessory carpal bone. It is firm and non-painful. The foot does not appear to hyperextend greatly if at all.
X-rays showed a soft tissue swelling, a previous FNA was inconclusive.
When we saw the dog we were thinking injury related swelling more than a mass. We ultrasounded the area to determine if there was a mass like appearence. None was seen and we were suspicious of a flexor carpi ulnaris tear/inflammation etc…
I attempted to ultrasound the tendon on the Lt (good leg) and Rt (bad leg); Easily palpable on the Lt and less so on the Right
I had researched previous images of a similar ultrasound and I placed the probe directly over the tendon but still had difficulty interpreting. My feeling is that the Rt shows inflammation but I was unsure where to get acurate measurements from. We are relatively certain of the diagnosis without the US but I was hoping for some guidance and interpretation of my US images.
I am very excited about adding ultrasound to orthopedic problems similar to the case of the month. Will definitely be following up with CE next year (currently have 2 large veterinary construction projects that take a vast majority of my time). Will find time next year for the orthopedic course. Appears incredibly interesting and very useful.
Thanks Brent
Comments
Hello
I have a 7 year old
Hello
I have a 7 year old Newfie-x that has a mild intermittent lameness of the Rt forelimb. A palpable mass/swelling is present proximal to the accessory carpal bone. It is firm and non-painful. The foot does not appear to hyperextend greatly if at all.
X-rays showed a soft tissue swelling, a previous FNA was inconclusive.
When we saw the dog we were thinking injury related swelling more than a mass. We ultrasounded the area to determine if there was a mass like appearence. None was seen and we were suspicious of a flexor carpi ulnaris tear/inflammation etc…
I attempted to ultrasound the tendon on the Lt (good leg) and Rt (bad leg); Easily palpable on the Lt and less so on the Right
I had researched previous images of a similar ultrasound and I placed the probe directly over the tendon but still had difficulty interpreting. My feeling is that the Rt shows inflammation but I was unsure where to get acurate measurements from. We are relatively certain of the diagnosis without the US but I was hoping for some guidance and interpretation of my US images.
I am very excited about adding ultrasound to orthopedic problems similar to the case of the month. Will definitely be following up with CE next year (currently have 2 large veterinary construction projects that take a vast majority of my time). Will find time next year for the orthopedic course. Appears incredibly interesting and very useful.
Thanks Brent
Looks like a partial tear and
Looks like a partial tear and edema pockets and maybe hematoma. You likely got mixed inflammatory cells and rbcs on fna. But I’ll ping Dr Ondreka who is much more poetic on ortho reads:)
Great thanks. I forgot to
Great thanks. I forgot to label them completely. The video and xray are of the bad Right leg and still is of the good left leg.
Accessory carpal and distal extermity is on the left of the screen. Not even sure of standard orientation. Lots of fun learning this stuff though. Thanks. Brent
Oh and yes you are correct
Oh and yes you are correct about the FNA results.
Hi Brent
Unfortunately the
Hi Brent
Unfortunately the findings are relatively unspecific. They principally match your tentative diagnosis. But to confirm a partial rupture I would need at least a dynamic scan that enables to see and assess the inact tendon/muscle portion this is connected with. I would also want to see power Doppler loops of the lesion to rule out a mass even if unlikely from what you describe and with bilateral chages.
Can you provide any info on this?
Appreciate the response!
Appreciate the response! Unfortunately I do not have much more information. I did use Doppler and found no blood flow to the area in question.
I attempted to scan the entire length of the tendon but really was not confident at what I was looking at. I really enjoyed the experience and want to pursue orthopedic imaging as I do perform orthopedic surgery but I realize I will need some training.
We have splinted the leg for the time being and our plan is to monitor for progression. If the area in question increases in size we will US and x-ray again to rule out a mass and may consider biopsies but the clinical presentation , exam, FNA results and xrays support our diagnosis for now.
Thanks again for the post and hope to see you soon at a CE seminar. Brent
sounds reasonable to me –
sounds reasonable to me – analogue to Achilles’ tendon rupture where we use US to monitor tendon healing I would suggest a recheck US in 4 weeks latest. Maybe rescan both sides and compare with current stage. loops in transverse and longitudinal plane, make sure to be perpendicular on the region of interest and cover everything from sound to diseased tissue. Would appreciate to hear the result.
I will make a point of
I will make a point of posting an update in the future. Thanks again. Happy Halloween and enjoy the rest of your weekend. Brent