Hi all,
Hi all,
- 6-7 year old FS GSD
- 2-3 day hx of severe RF lameness (weightbearing, but holds off the ground when standing).
- Pain on deep palp of axillary region and medial elbow
- Cannot palpate mass in axilla
- Rads of leg and neck are NSF
- U/S images attached (scanning with dog, bad side down, in axillary region. Bone is a rib most likely).
Question: This looks like a mass to me. I’m thinking ddx: nerve sheath tumor, hemangiosarcoma, other soft tissue sarcoma. Agreed? Anyone know if it looks resectable without amputation?
Thanks, Liz
Comments
I still can’t seem to post
I still can’t seem to post the video I have…
I still can’t seem to post
I still can’t seem to post the video I have…
Yes Liz surely a mass and
Yes Liz surely a mass and looks like a sarcoma. 22 g fna should be fruitful. If you get blood artifact go with a 25g. Aggresssive owing to the ill defined hyperechoic inflammation around it but there is in tact capsule at 8 o’clock. resection and radiation +/- chemo depending on what it is. No overt bony involvement so my not have to amputate. CT ideal here.
Yes Liz surely a mass and
Yes Liz surely a mass and looks like a sarcoma. 22 g fna should be fruitful. If you get blood artifact go with a 25g. Aggresssive owing to the ill defined hyperechoic inflammation around it but there is in tact capsule at 8 o’clock. resection and radiation +/- chemo depending on what it is. No overt bony involvement so my not have to amputate. CT ideal here.
Hi Eric and Liz
Just a
Hi Eric and Liz
Just a technical question about scanning the axillary region. Is there an optimum position to place the dog in to do this or is anyway that you can get into the region acceptable?
I have a dog that I am currently working up for a chronic front limb lameness as well and so far x-rays and orthopedic consult have not come up with anything specific. The next option would be to scope but I think u/s is worth a shot first. The thought is possibly biceps tenosynovitis but maybe good to try and rule out a soft tissue tumor in the region as well.
Jacquie
Jacquie
Hi Eric and Liz
Just a
Hi Eric and Liz
Just a technical question about scanning the axillary region. Is there an optimum position to place the dog in to do this or is anyway that you can get into the region acceptable?
I have a dog that I am currently working up for a chronic front limb lameness as well and so far x-rays and orthopedic consult have not come up with anything specific. The next option would be to scope but I think u/s is worth a shot first. The thought is possibly biceps tenosynovitis but maybe good to try and rule out a soft tissue tumor in the region as well.
Jacquie
Jacquie
Peter is better at this an I
Peter is better at this an I but I just palpate the joint capsule and put the probe there.
Peter?
Peter is better at this an I
Peter is better at this an I but I just palpate the joint capsule and put the probe there.
Peter?
@Pankatz
Hey Jacquie
@Pankatz
Hey Jacquie –
This dog presented like a nerve sheath tumor. No improvement on meds, knuckling while standing still, and atrophy of the forequarter musculature. I put her in lateral with her bad side down, rolled her slightly onto her back, and then shaved her armpit and just stuck the probe up there and fanned medial and lateral. It was very easy. The tumor was pretty obvious, but was not palpable at all.
Owner cannot afford CT/MR but will probably be going for sx with the local surgeon to see if he can cut the thing out or needs to amp.
Best,
Liz
@Pankatz
Hey Jacquie
@Pankatz
Hey Jacquie –
This dog presented like a nerve sheath tumor. No improvement on meds, knuckling while standing still, and atrophy of the forequarter musculature. I put her in lateral with her bad side down, rolled her slightly onto her back, and then shaved her armpit and just stuck the probe up there and fanned medial and lateral. It was very easy. The tumor was pretty obvious, but was not palpable at all.
Owner cannot afford CT/MR but will probably be going for sx with the local surgeon to see if he can cut the thing out or needs to amp.
Best,
Liz
HI!
Regarding shoulder
HI!
Regarding shoulder ultrasound:
I usually have the dog in lateral recumbency with the affected leg up. Then palpate the greater tubercle and go medially with your probe (after shaving of course). You should see the biceps tendon in a longitudinal way beginning at the supraglenoid tubercle (onset). Note that there can be a synovial structure close to the insertion that looks like the inner part of the tendon is ruptured (looks like a triangle attached to the proximal part of the tendon facing towards the joint)! Look also at the extent of synovial filling. Then switch to cross sectional views. Your focus should be on ruptures, core lesions, calcifications and increased synovial filling. And then compare to the contralateral joint.
When there is suspicion of tendon damage you can go to scoping +/- cutting through the tendon or – if you are unsure – inject Triamcinolone and Lidocaine into the joint. In my experience this is a good test to find out if you´re dealing with the right thing. If the dog improves and then worsens again, I would do the surgery.
How old is the dog? (Biceps tendon problems usually occure in middle age to old dogs). If it is young and there´s nothing to see on rads, I would still take the ellbow into account (general rule), particularly if it´s a Labrador or similarly affected breed. There can be FCPs even if there is no suspicion in rads! Other possibility is panostitis in young dogs of course.
In many cases you can find an OCD in the shoulder with ultrasound. Still, it is only indicated if the rads are positive for OCD and you want to know if it is still attached or loose.
Best Regards
Peter
HI!
Regarding shoulder
HI!
Regarding shoulder ultrasound:
I usually have the dog in lateral recumbency with the affected leg up. Then palpate the greater tubercle and go medially with your probe (after shaving of course). You should see the biceps tendon in a longitudinal way beginning at the supraglenoid tubercle (onset). Note that there can be a synovial structure close to the insertion that looks like the inner part of the tendon is ruptured (looks like a triangle attached to the proximal part of the tendon facing towards the joint)! Look also at the extent of synovial filling. Then switch to cross sectional views. Your focus should be on ruptures, core lesions, calcifications and increased synovial filling. And then compare to the contralateral joint.
When there is suspicion of tendon damage you can go to scoping +/- cutting through the tendon or – if you are unsure – inject Triamcinolone and Lidocaine into the joint. In my experience this is a good test to find out if you´re dealing with the right thing. If the dog improves and then worsens again, I would do the surgery.
How old is the dog? (Biceps tendon problems usually occure in middle age to old dogs). If it is young and there´s nothing to see on rads, I would still take the ellbow into account (general rule), particularly if it´s a Labrador or similarly affected breed. There can be FCPs even if there is no suspicion in rads! Other possibility is panostitis in young dogs of course.
In many cases you can find an OCD in the shoulder with ultrasound. Still, it is only indicated if the rads are positive for OCD and you want to know if it is still attached or loose.
Best Regards
Peter
Wow Peter! Great information.
Wow Peter! Great information. Not only a great cardiologist, but you know your ortho stuff. This pet is only 3 years old – no evidence of OCD on x-ray. I suspect tumor would also be lower on the list due to age.
I like the idea of injecting the joint as a test – will consider this.
Thanks!
Jacquie
Wow Peter! Great information.
Wow Peter! Great information. Not only a great cardiologist, but you know your ortho stuff. This pet is only 3 years old – no evidence of OCD on x-ray. I suspect tumor would also be lower on the list due to age.
I like the idea of injecting the joint as a test – will consider this.
Thanks!
Jacquie
Yeh I knew Peter would answer
Yeh I knew Peter would answer this better than I for sure. Peter does it all. I call him McGyver and imagine he could build a Porche with a garden hose and gigli wire… or at least make a mitral valve replacement out of it:)
Quite an amazing guy…. and beside Austria just sounds like an intelligent place:)
Yeh I knew Peter would answer
Yeh I knew Peter would answer this better than I for sure. Peter does it all. I call him McGyver and imagine he could build a Porche with a garden hose and gigli wire… or at least make a mitral valve replacement out of it:)
Quite an amazing guy…. and beside Austria just sounds like an intelligent place:)
Thanks 🙂
Jacquie, I hope
Thanks 🙂
Jacquie, I hope you´ll find out what´s wrong with the dog. If there are any questions, just post them.
Best Regards
Peter
Thanks 🙂
Jacquie, I hope
Thanks 🙂
Jacquie, I hope you´ll find out what´s wrong with the dog. If there are any questions, just post them.
Best Regards
Peter
Hi all –
I just wanted to
Hi all –
I just wanted to update on the above case. I sent the dog to the surgeon to see if the mass could be resected without amputation. The answer was no. The leg was amputated, and the mass came back as a grade 2-3 neurofibrosarcoma. Lymph nodes were taken at the same time and came back clean. Dog is currently doing well.
Liz
Hi all –
I just wanted to
Hi all –
I just wanted to update on the above case. I sent the dog to the surgeon to see if the mass could be resected without amputation. The answer was no. The leg was amputated, and the mass came back as a grade 2-3 neurofibrosarcoma. Lymph nodes were taken at the same time and came back clean. Dog is currently doing well.
Liz