SA Developmental Disease Part 2 Flashcards
Is developmental bone disease more common in dogs or cats?
Dogs have far more developmental bone disease than cats
What is the process of normal bone development?
How can abnormal bone development occur?
Abnormal development can occur due to diseases, toxins, inappropraite nutrition, trauma +/- genetic influences. IT IS OFTEN MULTIFACTORAL
What is the signalment for panosteitis?
PANOSTEITIS
- usually young dogs
- 5-12 mths (during active growth phase)
- reported from 2mth- 7yrs* (*rare in this age of dog but not impossible)
- Large breed dogs?
- breed predispositions
- –>23kg more common
- males>females
Are males or females more likely to get PANOSTEITIS?
What is it?
Males get it more than females
Panosteitis is a painful inflammation of the outer surface or shaft of one or more long bones of the legs. It is sometimes called “growing pains.” Panosteitis may occur in more than one bone at a time or may move around from area to area, cause a “shifting” lameness that goes from one bone or leg to another
What is the cause of panosteitis?
- currently aetiology is unknown
- genetic influence
- some seasonal and geographical variation in incidence
- it is not necessarily an “inflammation of bone” despite it’s name….
- Don’t take bone biopsies of these cases –> there isn’t actually any inflammation going on in the bone
What are the presenting signs of panosteitis?
- Shifting leg lameness (underlying medical problem rather than a traumatic cause)
- Pain on deep palpation of long bones (tends to be middle of the bones rather than the ends)
- Solitary lesion?
- Multiple sites in one bone?
- Multifocal i.e. multiple bones?
- Pain –> reluctance to walk, vocalising, loss of appetite (puppies tend to deal with pain quite poorly)
- Waxing and waning signs?
- Self-limiting disease but can take a few months to resolve
- Often affects radius and humerus but can affect any long bone. Think about how a dog with pain in > 1 leg might walk….
How can you diagnose PANOSTEITIS?
Radiography of multiple long bones:
- Normal in early stages
- No link between severity of radiographic signs and clinical signs
- Might need to repeat after 2-3 weeks
What is shown here?
Panosteitis
Red circle indicates a small thumb print lesion of increased opacity - very faint
What is the problem with using radiography to diagnose panosteitis?
- Can take a little while for this problem to become obvious on radiographs (in the beginning the bones can actually appear normal on radiographs)
- Panosteitis a good example of how we need to tie in all the aspects of a case. Signalment gives us an indication that panosteitisis a possibility, clinical history might identify helpful aspects such as a shifting lameness, physical exam helps to identify pain in the long bones rather than the joints (but beware of squeezing the long bones to manipulate a joint and getting a confusing response from the painful dog) and there are no joint effusions or enlarged LNs associated with panosteitis.
- If we radiograph very early in the disease we might not see any radiographic changes. More usually the dogs will have had NSAID/rest management initially and by the time radiographs are indicated (iethe disease is clearly not self limiting) then we will see radiological signs.
When using radiography to diagnose panosteitis, what are you looking for?
- diaphyseal medullary opacities
- “ thumbprint ”
- close to nutrient foramen
- Resolves to a coarse trabecular pattern
- +/-smooth periosteal reaction
- You would need to take radiographs of multiple long bones Eg R and L antebrachium (radius and ulna) and R and L humerus +/-femurs/tibia if pain is found squeezing the hind limbs
Describe what can be seen on this radiograph and what it is likely to be
Smooth periosteal reaction
Sometimes seen with panosteitis
What can be seen on these radiographs?
What else could be liekly if it is an elderly dog?
Panosteitis in the ulna
Increased opacity
Note that the increased opacity in these bones might make you think about panosteitis
BUT this is an older dog and the history will likely suggest a primary cancer elsewhere.
Occasionally we may see productive bone metastases –> signalment, clinical exam and history should indicate metastasis rather than panosteitis
Not every opacity in the medullary cavity will be panosteitis
What else could panosteitis be from looking at a physical exam?
Panosteitis: what else could it be?
- Careful physical exam in a dog with appropriate signalment should help differentiate this from other causes of lameness in young dogs such as:
- Elbow dysplasia
- Metaphyseal osteopathy
- IMPA-usually dogs are a little older and have joint pain (multiple) rather than long bone pain
- Septic arthritis-usually these dogs are significantly older and have joint pain (often only one)
What is the treatment for panosteitis?
- Self-limiting disease
- Supportive treatment is all that is needed
- Rest?
- Analgesia
- NSAIDs?
- Opioids?
- Extreme cases may need fluids/nutritional support but unlikely
- Relapse can occur but long term prognosis is excellent
- Advise owners about possible aggression especially if children are handling the dog?
- Owners can get disheartened when they have a lame, painful, miserable pup and the clinical signs persist or relapse….stick with it because the prognosis is great!
- If we can get on top of the pain then they should bounce back and resume normal lifestyle but if not then fluids/parenteral nutrition will be necessary
What is the prognosis like for panosteitis?
Relapse can occur but long term prognosis is excellent
Owners can get disheartened when they have a lame, painful, miserable pup and the clinical signs persist or relapse….stick with it because the prognosis is great!
What should you warn owners about with panosteitis and its conservative treatment?
It is treated supportively, so the animal is often left to try and get over it with the necesary pain relief. So will be at home but advise owners about possible aggression especially if children are handling the dog, due to the pain
What is hypertrophic osteodystrophy also known as?
Metaphyseal osteopathy
What is the signalment for metaphyseal osteopathy?
Metaphyseal osteopathy: who gets it?
- usually young dogs
- 2-7mths
- large % giant breed dogs
- Weimeraners
- ?inherited disesae
- Weimeraners
- males>females
- (usually up to 7 months is as old as the disease can develop)
Are males or females more likely to get metaphyseal osteopathy?
Males more commonly get it than females
What causes metaphyseal osteopathy?
- Currently aetiology is unknown
- Geographic and seasonal distribution reported
- Considered to be a systemic disease and possible causes being investigated include:
- Viral (distemper)
- Bacteria (haematogenous osteomyelitis??)
- In rare cases you might consider a blood culture in your diagnostic plan
- Nutritional (over supplemented diets?)
- Possible but doesn’t seem to be as straight forward as just that
- Rarely has anything actually been able to be cultured from these cases –most cases will be sterile
What are the presenting signs of metaphyseal osteopathy?
- Often severe lameness
- Pyrexia/fever –> poor appetite and reluctance to move, GI signs can occur
- “Poorly pups” -don’t miss the sore legs!
- Bilaterally symmetrical, painful metaphyseal swellings affecting long bones –can be tricky because a large breed puppy will happy slightly ‘bumpy’ legs anyway (if just swelling and no pain then won’t be metaphyseal osteopathy)
- There are so many inflammatory cytokines within their circulation that they are contributing to pyrexia
- Often affects distal radius, ulna and tibia but can affect ribs and/or metacarpal/metatarsal bones.
Which bones are most commonly affected with metaphyseal osteopathy?
Bilaterally symmetrical, painful metaphyseal swellings affecting long bones
Often affects distal radius, ulna and tibia but can affect ribs and/or metacarpal/tarsal bones
What is the diagnosis for metaphyseal osteopathy?
Radiography of both legs:
- Subtle –> severe signs
- Metaphyseal lucent lines parallel to the physis
- “ Double physis ”
- Adjacent sclerotic line= collapse of necrotic trabeculae physis
- Subperiosteal haemorrhage –> periosteal new bone
- Bridging of the physis –> premature closure and ALD
- In severe cases we can see collars of new bone developing in the distal portion of the limb
What do you see on radiography with metaphyseal osteopathy?
Label the arrows on this radiograph with regards to metaphyseal osteopathy
Examples of much more subtle disease but still obviously abnormal
Again can see 3 segments:
physis (red arrow),
sclerotic region (blue arrow),
and then radiolucent band (yellow arrow)
What disease can be seen in this radiographs?
Hypertrophic osteopathy
Hypertrophic osteopathy is a diffuse periosteal proliferative condition of long bones in dogs secondary to neoplastic or infectious masses in the thoracic or abdominal cavity. … Radiography reveals the primary masses and peripheral bone reactions.
What can be seen in this radiograph
Really significant new bone deposited along the mandible
Seen with craniomandibular osteopathy
What can be seen on this radiograph?
(Normal on right for comparison)
‘Rubber jaw’ ‘ Floating teeth’
Teeth are much more opaque than the rest of the skull (normal on bottom right for comparison)
What can be seen on these radiographs and what is the likely cause?
- Poor radiographic contrast between bone and soft tissue -it won’t always be poor radiographic technique!
- Bones are very osteopenicand similar opacity to the soft tissues
- Seen with secondary nutritional hyperparathyroidism
What can be seen on these radiographs and what is likely the problem?
Can see bending that shouldn’t be happening
Can tell these radiographs are from a young animal because of the open physis
Seen with secondary nutritional hyperparathyroidism
Bandit
- A young (3-4 mthold cat) referred for weight loss, poor appetite, extreme “lethargy” and maybe because he was very bad tempered? Has only been fed chicken.
- Actual findings: pain on palpation almost everywhere, severe osteopenia
- Looking at his radiographs, what can be seen? What is it likely to do with?
- Significant loss of contrast between bone and soft tissue is real i.e. this is not due to poor radiographic technique.
- Lordosis and collapsed vertebra
- This cat was only fed chicken so needed more balanced diet
What radigraphic signs do you see with Legg-Calve Perthes Disease (LCP)?
Radiological signs:
- Depend on stage of disease
- Irregular bone opacity in femoral head and neck
- Collapse of the femoral neck
- Fragmentation of bone
- Distortion of femoral head
- Femoral neck is abnormal in these cases (irregular opacity and bone can appear fragmented) rather than acetabular changes
- Femoral head can appear like a distorted ball
Compare the following 2 radiographs
One is LCP disease and one is HD. Which is why and why?
Beware of confusing LCP and hip dysplasia
- LCP vs HD: breed predisposition should help
- Less distortion of the femoral head and neck in HD.
- End stages may appear similar.
- HD on left and LCP on right
