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Equine Imaging

Equine Imaging. LeeAnn Pack DVM Diplomate ACVR. Shoulder – Supraglenoid Tubercle Fx. Carpus. Carpus (aka “knee”). Standard views Lateral Flexed lateral DP DLPMO DMPLO Optional Skyline of distal row (most commonly shot) Skyline of proximal row Skyline of distal radius. Lateral.

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Equine Imaging

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  1. Equine Imaging LeeAnn Pack DVM Diplomate ACVR

  2. Shoulder – Supraglenoid Tubercle Fx

  3. Carpus

  4. Carpus (aka “knee”) • Standard views • Lateral • Flexed lateral • DP • DLPMO • DMPLO • Optional • Skyline of distal row (most commonly shot) • Skyline of proximal row • Skyline of distal radius

  5. Lateral • Antebrachiocarpal joint • Does not communicate • Middle carpal joint • Communicates with CMC joint • Carpometacarpal joint • Radial carpal bone has dorsal convex surface • Intermediate carpal bone has straight or concave dorsal surface

  6. Flexed Lateral • Non weight bearing • Used to separate out proximal row • “I” is high – radial drops • Intermediate carpal bone moves up (“ICU”) • 3rd also drops

  7. Flexed Lateral Carpus

  8. Dorsopalmar (DP) • Accessory carpal bone is lateral Dorsopalmar

  9. DLPMO Dorsolateral- palmaromedial • 55 degrees lateral of dorsal plane • Highlights dorsomedial and palmarolateral aspects • L can be drawn I U R

  10. DMPLO Dorsomedial- palmarolateral • 55 degrees medial of dorsal plane • Highlights dorsolateral and palmaromedial aspects • Splint and 2nd on top of each other

  11. Skyline of Distal Row • Carpus is flexed (non weight bearing) • Dorsoproximal dorsodistal oblique • 35 degrees from plane of cassette • 3rd carpal bone central • 2nd and 4th medial and lateral, respectively • 3rd carpal fractures, sclerosis L

  12. Skyline of Proximal Row • Same initial setup as for distal row • Steeper 55 degree angle from plane of cassette • Radial and intermediate chip fractures

  13. Skyline of Distal Radius • Even steeper (85 degrees) from plane of cassette • Chip fractures at craniodistal radius L

  14. DJD/ Soft Tissue Swelling • Soft tissue swelling common • Intracapsular (can’t see fat pads) vs. extracapsular • Antebrachiocarpal joint does not communicate • May be centered over a specific joint • DJD • Osteophytes • Entheseophytes

  15. Cyst-like Lucencies • Carpal bones • Distal radius • Often incidental

  16. Angular Limb Deformities • Physitis in distal radius • Asymmetric physeal growth • Incomplete ossification of the cuboidal bones • Young foals • Premature or twins • More rounded not cubelike • Can become malformed • Valgus or Varus

  17. Angular Limb Deformities

  18. ALD

  19. Chip Fractures • Small fragment at articular margin • **Dorsomedial aspect of radial carpal bone (proximal or distal) • **Proximal aspect of intermediate carpal bone • May need flexed lateral or skyline (proximal row) to distinguish • Dorsodistal radius • Radial facet of third carpal bone

  20. Slab Fractures • Involve proximal AND distal articular surface • **Dorsal aspect of third carpal bone • May be preceded by sclerosis on skyline distal row • Seen on lateral, oblique or skyline distal row • Less commonly radial or 4th carpal bones

  21. Slab Fx

  22. Tarsus

  23. Tarsus • Standard views • Lateral • DP • DLPMO • DMPLO • Optional • Flexed lateral • Skyline of calcaneus

  24. Lateral • Tibiotarsal (talocrural) joint • Proximal intertarsal joint • Communicates with talocrural joint • Distal intertarsal joint • Tarsometatarsal joint • Communicates with DIJ in 8-24 % of horses

  25. Anatomy Lateral and DP • 1. Tibia • 2. Medial malleolus • 3. Lateral malleolus • 4. Calcaneus • 5. Talus • 6. Central tarsal bone • 7. 3rd tarsal bone • 8. 4th tarsal bone • 9. MT3 • 10. MT2 • 11. MT4

  26. Dorsoplantar (DP) • Best for assessing width of joint spaces • Fused 1st and 2nd tarsal bones

  27. DLPMO • 45 degrees lateral of dorsal plane • Highlights dorsomedial and plantarolateral aspects of tarsus • Medial malleolus of tibia • Medial trochlear ridge of talus • Dorsomedial aspects of 3rd and central tarsal bones • MT IV

  28. Anatomy DLPMO • 1. Tibia • 2. Talus-medial trochlear ridge • 3. Lateral trochlear ridge • 4. Base of talus • 5. Calcaneus • 6. Central tarsal bone • 7. 3rd tarsal bone • 8. 4th tarsal bone • 9. MT3 • 10. MT4

  29. DMPLO • 45 degrees medial of dorsal plane • May be obtained from plantar position (PLDMO) • Highlights dorsolateral and plantaromedial aspects of tarsus • Lateral trochlear ridge of tarsus (“Larrys nose”) • Intemediate ridge of distal tibia • DL aspects of proximal and distal intertarsal joints • Sustentaculum tali

  30. Anatomy DMPLO • 1. Tibia • 2. Calcaneous • 3. Sustentaculum tali • 4. Talus – lateral trochlear ridge • 5. Talus- medial trochlear ridge • 6. Central tarsal bone • 7. 3rd tarsal bone • 8. Fused 1st and 2nd tarsal bone • 9. MT3 • 10. MT4 • 11. MT2

  31. Flexed Lateral • Non weight bearing • May improve visualization of plantar aspect of talocrural joint

  32. Skyline of Calcaneus (Proximoplantar- distoplantar) • Non weight bearing • Sustentaculum tali • Tarsal groove (DDF and sheath pass thru) • Tuber calcanei (tuber calcis) • Proximal aspect of medial trochlear ridge of talus

  33. Variations in Medial Trochlea

  34. Tarsal DJD (“Bone Spavin”) • DIJ or TMTJ affected most commonly • Often bilateral and may be incidental • Proximal intertarsal joint less commonly • Talocrural joint may have effusion due to communication (“bog spavin”)

  35. Osteophytes - DJD

  36. DJD

  37. Normal Variants of Medial Trochlear Ridge

  38. Common sites **Distal intermediate ridge of tibia (“DIRT” lesion) Cranial aspect **Lateral and (less common) medial trochlear ridges of talus Medial malleolus of tibia Osteochondrosis or Osteochondritis Dissecans (Fragment often present)

  39. DIRT

  40. DIRT

  41. DIRT

  42. DIRT close up

  43. Lateral Trochlear Ridge OCD

  44. Fractures • Uncommon • Slab fractures • Very difficult to see, may need multiple obliques • Third and central tarsal bones • Avulsion of malleoli

  45. Tarsal Bone Collapse • Incomplete cuboidal bone ossification • Rounded, with granular opacity • Premature, twins • If limb support not provided • Compression of third and central tarsal bones • Bones become wedge shaped, may fragment • Excess flexion of hock or valgus

  46. What happens over time

  47. Stifle

  48. Stifle • Standard views • Lateral • Caudolateral-craniomedial oblique • Caudocranial (CC) • Optional • Flexed lateral • Skyline of patella

  49. Lateral • Medial trochlear ridge is larger and more cranial • Femoropatellar joint • Medial and lateral femorotibial joints • FPJ and Med FTJ usually communicate • FPJ and Lat FTJ may communicate

  50. Caudolateral Craniomedial Oblique • 30 degrees lateral of caudal plane • Highlights lateral trochlear ridge of femur (more cranial distally)and medial femoral condyle (more caudal)

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