10.8.18
Publication Date: 2018-10-04
History
11 year old labrador retriever. Came home 3days ago only using 3 legs
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Findings
Thorax: The cardiovascular structures are normal. There is a diffuse mild unstructured interstitial pattern of the pulmonary parenchyma. There is increased mineralization of the bronchial walls. There are a few faintly mineralized pinpoint foci within the ventral aspect of the lungs, consistent with incidental osteomata. There are multiple pinpoint metal foci throughout the tissues of the left thorax and caudal cervical region, consistent with small ballistic projectiles. There is mild diffuse enlargement of the liver.
Left brachium: There is a long oblique to spiral fracture of the mid-diaphysis of the left humerus with mild caudal and proximal displacement. The fracture margin travels in a proximocaudal to distocranial direction with gradual widening of the fracture gap distally. The fracture margins are sharp and well-defined with the exception of the proximal aspect which is mildly ill-defined with superimposition of the fracture margins. There is moderate irregular to amorphous osseous proliferation along the caudal aspect of the proximal humerus and proximal margin of the fracture. This proliferation extends approximately 1.6 cm into the soft tissues. There is smooth periosteal proliferation at the lateral and medial aspects of the proximal fracture segment. There is the impression of a focal radiolucency in the caudoproximal aspect of the humerus. There is mild to moderate extracapsular soft tissue swelling surrounding the fracture site. There is an ovoid region of moderate irregular osseous proliferation superimposed with the greater tubercle. There is mild periarticular new bone formation of the caudal aspect of the humeral head. There is mild periarticular osseous proliferation of the humeroantebrachial joint and moderate osseous proliferation of the humeral epicondyles. Similar to the thorax, there are multiple pinpoint metal foci scattered throughout the tissues of the left brachium, consistent with small ballistic projectiles.
Diagnosis
- Closed complete long oblique to spiral fracture of the left humerus as described. The osseous proliferation at the proximal aspect of this fracture is considered excessive and abnormal given the history leading to suspicion of an underlying pathologic fracture from a primary bone tumor or less likely fungal osteomyelitis. Fine-needle aspiration or biopsy of the region could be performed for further evaluation.
- Geriatric thorax with no radiographic evidence of metastasis.
Discussion
Osteosarcoma was confirmed on FNAs
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