This week I’ll be giving a talk on non-cardiac thoracic ultrasound at ACVIM, and teaching in the wet labs. Please come and say hello if you’re at the meeting!
The case for the week is a 4 month old male kitten presented for non-weight bearing lameness of the left forelimb. Post your interpretations in the comments section.
{ 3 comments… read them below or add one }
Severe soft tissue swelling is evident in images 1 and 2, consistent with cellulitis. The swelling seems greatest around the elbow. In image 1 there is some radiolucency in the swelling at the level of the elbow cranially, while in image 2 there is some radiolucency of soft tissue just caudal to the distal ulna. I would clip the hair off the entire leg to check for puncture wounds at this stage, and probably start on an empirical choice of antibiotic of amox/clav in a kitten of this age.
Images 3,4,5 4 weeks later show evidence of destruction of the proximal radius and possibly the adjacent medial humeral condyle also (impossibloe to tell if joint effusion present, but suspect synovial involvement). There is cortical destruction with periosteal proliferation distally on radius also. My radiographic diagnosis would be osteomyelitis, presumed bacterial (the soft tissue swelling seems to have reduced after, I presume, antibacterials) and I would consider either further empirical antibiotic treatment (e.g. clindamycin) or stopping the current amox/clav (if still on it) for 5 days prior to performing a FNA of the soft bone of the proximal radius into blood-culture medium for C&S while re-starting empirical treatment as above (though my experience of culturing in a situation like this if emiprical antibiotic therapy has already been given is pretty hopeless…)
(On image 4 I initially thought there was P1/P2 luxation on the first digit, but I think this must be artifactual)
In images 1 and 2, soft tissue swelling is evident around the elbow. Sclerotic changes and periosteal reaction are seen around proximal radius. Some radiolucency is seen in the metacarpal area especially MC 4 and 5.
In the recheck images the soft tissue swelling is no longer seen. However severe bony lesions are seen in the proximal radius. The radiolucency is still observed in the metacarpal area.
Since the lameness coincides with soft tissue swelling which then extends to bones, I am inclined to think that this is a case of osteomyelitis probably resulting from a systemic (fungal??) infection or focal puncture wound.
I was only focused on the bones, and didn’t even notice the redonculous swelling until I read the other comments. I agree with everything stated above, and would also add that in the original images, there seems to be a jagged shelf where the ulna and the radius come together to provide a surface for the humeral condyle. That seems like it could be a problem.
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