Case Study

RADS – Nonspecific Digit Swelling, R/O Neoplasia vs Foreign Body vs Inflammation in a 13year old FS Lhasa Apso dog

Presenting Clinical signs: Acute RF lameness, was non weight bearing and now is partial weight bearing. Painful on palpation. Swollen and erythemic igit 5. Duration about 3-5 days.

Physical Exam: No discharge or penetrating foreign body seen on closer exam after fur is clipped away. Bears some weight on it now but growls when touched in this area.

CBC, chem and U/A WNL

Presenting Clinical signs: Acute RF lameness, was non weight bearing and now is partial weight bearing. Painful on palpation. Swollen and erythemic igit 5. Duration about 3-5 days.

Physical Exam: No discharge or penetrating foreign body seen on closer exam after fur is clipped away. Bears some weight on it now but growls when touched in this area.

CBC, chem and U/A WNL

Image Interpretation

dorsopalmar right front paw- There was a moderate soft tissue swelling circumferential to the 5th toe centered around the proximal interphalangeal joint. The joint presented normal.
There were no osteolytic lesions noted. A mild amount of periosteal new bone with even surface was present around the diaphysis of the middle phalanx (see arrows).
Mild to moderate periarticular osteophytes were noted at the metacarpophalangeal joints of the second and fourth toe and the carpal joint.

DX

The radiographic findings are unspecific. There is no sign of aggressive osteolysis at this point.

Comments

The character of the perioteal new bone formation is benign and may equally occur with neoplasia, chronic inflammation or chronic repetitive trauma. Possible differential diagnoses include soft tissue neoplasia – such as melanoma, fibroma/fibrosarcoma or other – inflammation/infection with or without foreign body, hematoma.

In case a foreign body within the soft tissues is to be ruled out ultrasonography by far has the highest diagnostic accuracy. Otherwise paralleling to diagnostic therapy sampling is strongly recommended by means of fine needle aspiration or biopsy.

There are incidental osteoarthritic changes at the metacarpophalangeal joints 2 and 4 as well as at the carpal joint of the right frint limb.

Clinical Differential Diagnosis

Rule out signs of boney destruction/digit involvement vs soft tissue only. The medial cortex of digit seems unclear as the lateral cortex appears more normal.

Patient Information

Patient Name : Dutchess Plumly, Perry Hall Animal Hospital

Gender : Female, Spayed

Species : Canine

Type of Imaging : Ultrasound

Status : Complete

Liz Wuz Here : Yes

Clinical Signs

Lameness

Images

Clinical Signs

Lameness