This week we have a 5 year old male neutered Dalmatian with proprioceptive deficits in the hind limbs. Post your interpretations in the comments section.
5 year old Dalmatian
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{ 4 comments… read them below or add one }
The C3-4 intervertebral disc space is markedly narrowed and there is osteolysis as well as sclerosis of the endplates at C3-4. Smoothly margined osseous production is present at the ventral aspect of C3-4 as well as multiple other intervertebral disc spaces. On the lateral projection of the thoracic spine the trachea is deviated dorsally and there is a diffuse interstitial pattern of the visible portions of the lung. Also on the lateral projeciotn, a rounded opacity is observed superimposed on the dorsal aspect of the 6th ribs and is though to represent a summation artifact. On the VD projection of the thoracic spine, there is a bulge in the cardiac silhouette in the region of the left auricle and mild abaxial deviation of the mainstem bronchi. The pulmonary parenchyma looks okay on the VD projection.
Dx: Discospondylitis at C3-4 with multiple additional sites of spondylosis deformans. Cardiomegaly with left atrial enlargement. Endocarditis of the mitral valve should be ruled out. Recommendations: CSF tap and fluoro or CT guided aspirate of the C3-4 intervertebral disc with cytology and culture to definitively diagnose discospondylitis and determine the infectious agent (i.e. bacterial vs. fungal). Careful auscultation of the heart, thoracic radiographs and echocardiogram to more fully evaluate the pulmonary parenchyma and heart. Blood culture if evidence of endocarditis is observed on echocardiogram or if the patient has a history of fever. Urinalysis and culture to evaluate for bacterial cystitis as a potential source of the infection.
Regarding to the first radio-graphical picture for latro-medial view of pelvic area there is no evidence of any abnormality (inter-vertebral disc space appear normal and equal in all) except the radio-opacity demarcation for the vertebral column which may indicate active process of inflammation (Discospondylitis).
Regarding to the second radio-graphical picture for latro-medial view of chest and abdominal area there is slightly evident of inter-vertebral space narrowing which may refer to bad position of animal during exposure to X-ray and I think it need more extension, all visceral organ appear normal.
Regarding to the third radio-graphical picture for latro-medial view of chest and neck area the sign of radio-opacity still evident and narrowing space appear more especially in C3 area. The trachea appears normal with some deviation upside pushed from other organ which is most likely the heart and this may give indication for Cardiomegaly unless the history of case indicate other.
Regarding to the fourth radio-graphical picture for latro-medial view of neck area which is good quality image seen the tracheal ring and also revealed the radio-opacity and multi focal area of radio-lucent which may indicate the necrosis process.
Regarding to the fifth radio-graphical picture for ventro-dorsal view of caudal part of chest and all abdomen which give good picture about the inter-vertebral disc space in subjected area and revealed there is no evidence of any abnormality (inter-vertebral disc space appear normal and equal in all) except the radio-opacity demarcation, in addition to impacted colon which may due to narrowing inter-vertebral disc space in cervical area which may lead to nerve paralysis unless animal history indicate other findings.
Regarding to the sixth radio-graphical picture for ventro-dorsal view of caudal part of chest and cranial abdomen showing cardiomegaly which can’t indicate any thing because the DFP (distance focal point) is more than other pictures which lead to magnification picture.
Regarding to the seventh radio-graphical picture for ventro-dorsal view of neck and chest area which is good quality image seen radio-opacity and multi focal radio-lucent area which may indicate the necrosis process, inter-vertebral disc space in cervical area is over imposed with other structure. The heart is slightly enlarged which may indicate demand caused by systemic inflammation some where.
Regarding to the eighth radio-graphical picture for ventro-dorsal view of head, neck and chest area the sign of radio-opacity still evident and narrowing space appear more especially in C3 area, the head structure normally appeared.
Recommendation: Myelography is highly recommended looking for narrowing inter-vertebral disc space and if positive result obtained euthanasia is recommended.
Dcissell is correct of course, there is a discospondylitis lesion at C3-4. This infectious process is generally treated with antibiotics. A myelogram is not necessary for further diagnostics.
Was a source of infection identified? I’d be interested to know if the heart looked enlarged on thoracic radiographs, or if that’s a fake-out on the lateral thoracic spine radiograph.
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