Project Description

AUGUST 2013

Case Notes: This month’s case was a 6-year-old warmblood gelding that was referred in for a Nuclear Scan of the distal forelimbs and solar views. The soft tissue request was for the left fore foot. The horse’s history reflected a LF lameness that was grade 1/5 on straight line, 3/5 circle right and 2/5 circle left. The lameness resolved following PDNB or IA coffin joint block.

Diagnostics: The radiologist found the following areas to have Increased Radiopharmaceutical Uptake (IRU):

Soft Tissue Phase:

    • Right and left front feet
      • Left distal phalanx, mild to moderate and diffuse, medial aspect
      • Right distal phalanx, mild to moderate and diffuse

Bone Phase:

    • Right and left distal phalanges, mild to moderate and diffuse
    • Right and left fore navicular bones, mild to moderate and diffuse

Below are the images to support these findings:

case082013-1
Diagnostics (continued): The radiologist suggested that the findings from the nuclear Scintigraphy should be clinically correlated with an MRI examination of the front feet. The radiologist found the following from the MR study:

    Left Fore:

    • There was mild to moderate fluid in the navicular bone indicating edema, contusion and/or osteonecrosis (fig 5 & 6).
    • There was moderate synovitis in the distal interphalangeal joint characterized by increased fluid and synovial proliferation. The fluid was slightly more prominent compared to the right forelimb (fig 5 & 6).
    • There was moderate chronic bursitis in the navicular bursa characterized by increased fluid and synovial membrane thickening with synovial proliferation. At this level there was a small area of mild to moderate injury in the deep digital flexor tendon with possible adhesions to the navicular bursa (fig 1,2,3,4).

Below are the images of the left fore, signaling these findings:

case082013-2