Radiology Case
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Radiographic findings: There
is mild soft tissue swelling of the antebrachii. There is severe, somewhat
palisading periosteal proliferation of several phalanges, the metacarpal
bones, the radii, and the ulnas (arrows). There is severe soft tissue
swelling at the level of the tarsi. There are similar findings on the
metatarsal bones, the calcanei, tibias, and likely fibulae.
A thoracic radiograph reveals multiple pulmonary nodules consistent with metastatic neoplasia. (the primary tumor is likely in the abdomen). Arrows point out two of the nodules.
Radiographic diagnosis: Hypertrophic osteopathy (Hypertrophic Osteoarthropathy).
Comments: Hypertrophic osteopathy is a disorder that usually affects middle age to older dogs. It is characterized by new periosteal bone formation that affects the abaxial surfaces of the second and fifth metacarpal and metatarsal bones first. The bony changes are typically bilateral and will generally progress to affect the distal limb but can be seen in the proximal limbs, pelvis and spine. The presenting clinical signs are lameness and commonly pain and swelling in the distal limbs with reluctance to move. The radiographic changes may have the classic "palisading" shaped periosteal proliferation that is perpendicular to the bone or it may be a smooth or irregular proliferation. In the majority of cases the disorder is related to either primary or metastatic pulmonary neoplasia. It is also reported with Spirocerca Lupi esophageal granulomas, other thoracic infections, and abdominal neoplasia. Dogs infected with Leishmaniasis and Hepatazooan Canis can have similar periosteal reactions. 1,2 The cause of Hypertrophic Osteopathy is unknown and treatment should be guided toward a primary neoplasia or infection in the thorax or abdomen. With treatment of the primary disease, the periosteal changes usually slowly regress; however, some bone proliferation may persist. 3
References
- Panciera RJ, Mathew JS, Ewing SA, et al. Skeletal
lesions of canine hepatozoonosis caused by Hepatozoon americanum. Vet
Pathol 2000;37:225-230.
- Barr S. Leishmaniasis In: Tilly L, Smith Jr, FWK, ed. The 5-minute Veterinary Consult. second ed: Lippincott Williams and Wilkins, 2000;892.
- Johnson KA, Watson ADJ, Page RL. Skeletal Diseases In: Ettinger SJ and Feldman EC, eds. Textbook of Veterinary Internal Medicine. 4th ed. Philadelphia: W.B. Saunders Co., 2000;2091-2092.
Dr. John Feleciano, DVM, DACVR
Dr. Renee Leveille, DVM, DACVR