Bizarre case of longstanding lameness

Re: Bizarre case of longstanding lameness

Anthony Dennison — Mon, 14 Jan 2013 13:08:35 GMT

So, letter back from the referral centre. They did thoracic rads which showed a soft tissue mass in the cranial thorax with association small volume of pleural effusion, ultrasound of this showed a 4.5cm diameter hypoechoic mass around the 1st 3 ribs, which were distorted and had some new bone growth on them also, the mass was very close to the heart. A Tru-cut biopsy was taken, which came back as a carcinoma.

The dog was hospitalised on i/v methadone as she was becoming very painful, but unfortunately crashed and couldn't be resuscitated. Pretty sad all round really, for such a lovely dog and an owner that would do anything!.

Apparently polyarthritis is a fairly uncommon paraneoplastic syndrome with carcinomas. Also, a carcinoma from the chest wall?!

Re: Bizarre case of longstanding lameness

mariette asselbergs — Sat, 05 Jan 2013 18:31:28 GMT

Yes as far as I have learned, read and seen it started always in the distal limbs, feet and up. The cases I have seen were always large dogs, and once a cow with extensive TB in enormous mediastinal lymphnodes. But it is also known in humans and I don't see a reason why it couldn't occur in small dogs. As far as I know the exact mechanism is unknown.

Mariette

Re: Bizarre case of longstanding lameness

Anthony Dennison — Sat, 05 Jan 2013 09:12:50 GMT

[quote user="mariette asselbergs"]

Space occupying things in the thorax can cause painful periosteal reaction in the limbs, but usually the lower limbs. Disease of Marie-Bamberger. However you can usually see this clearly on x rays.

Mariette

[/quote]

Thanks Mariette, never thought of that one! You're right though, you usually get new osteophytic growth, but we've never radiographed lower than the stifle, and it's disaly limb that it affects isn't it?

Re: Bizarre case of longstanding lameness

Claire McConnell — Fri, 04 Jan 2013 23:09:04 GMT

[quote user="mariette asselbergs"] Disease of Marie-Bamberger[/quote]

I vaguely remember this from uni now you have mentioned it!

Claire

Re: Bizarre case of longstanding lameness

mariette asselbergs — Fri, 04 Jan 2013 23:06:31 GMT

Space occupying things in the thorax can cause painful periosteal reaction in the limbs, but usually the lower limbs. Disease of Marie-Bamberger. However you can usually see this clearly on x rays.

Mariette

Re: Bizarre case of longstanding lameness

Claire McConnell — Fri, 04 Jan 2013 19:34:48 GMT

Please update us when you get referral report - this made an interesting read.

I was thinking (and its probably wrong, please excuse me if this is a silly suggestion) that since heart based tumours can lead to heart failure - could rt sided heart failure potentially cause joint effussions and therefore polyarthritis - just as it causes ascites, oedema etc?? I'msure I'm wrong.

Claire

Re: Bizarre case of longstanding lameness

Anthony Dennison — Fri, 04 Jan 2013 18:37:16 GMT

Not sure Rajat, I eagerly await the referral report!

Re: Bizarre case of longstanding lameness

Rajat — Fri, 04 Jan 2013 16:33:11 GMT

[quote user="Anthony Dennison"]Suppose that would explain the polyarthritis?[/quote]

I guess any neoplasia can - I would not have made this connection automatically - do they/you think the aetiology would be immune complex deposition of circulating antigens? Or a different paraneoplastic effect? Interesting though!

Re: Bizarre case of longstanding lameness

Anthony Dennison — Fri, 04 Jan 2013 11:59:01 GMT

At the beginning of the week the dog developed pitting oedema round her jowel's and was having difficulty swallowing. She's now at the referral centre, the owner passed a message to me to say Jessie has a heart base tumour and they're currently deciding the next course of action.

Suppose that would explain the polyarthritis?

Re: Bizarre case of longstanding lameness

Will McMullan — Wed, 02 Jan 2013 18:45:45 GMT

There looks to me to be an effusion in the left stifle. Has the dog had any joint taps yet? Are the stifles stable? Is there still pain on spinal manipulation? Immune-mediated polyarthritis could be a possibility +/- lumbosacral IVDD? Difficult case, don't envy you!

Re: Bizarre case of longstanding lameness

Anthony Dennison — Fri, 28 Dec 2012 12:01:25 GMT

Comprehensive haematology back - non-regenerative anaemia, possibly due to haemorrhage or anaemia of chronic illness/inflammation. Raised neutrophils with quite a large left shift (3 x upper ref range) suggesting active infection.

Unlikely haemorrhage so probably looking at the latter considering the case...

No tengo uno ideo!

Re: Bizarre case of longstanding lameness

Noweia — Thu, 27 Dec 2012 19:44:50 GMT

Is there something on the medial condyle of the tibia?

Re: Bizarre case of longstanding lameness

Anthony Dennison — Thu, 27 Dec 2012 19:07:42 GMT

As requested, these were taken today. I'm not brilliant at the delicate art of interpreting radiographs but the stifle looks grossly normal, yet from an inch above to an inch below the dog screams in pain and turns to bite (unlike her)

Re: Bizarre case of longstanding lameness

Anthony Dennison — Thu, 27 Dec 2012 13:16:40 GMT

Will do when I get access to a decent computer that has an internet connection that can cope with such things! I haven't seen them myself yet, but the vet who took them has told me some mild spondylosis of the lumbosacral spine, radiographs of the right stifle NAD.

This is the weird thing - there has never been any joint effusions. Having a good palpate of all the dog's limbs 1st thing this morning before I had to go to a branch practice the main thing of note is the pain in the right stifle seems to come about when palpating the distal femur rather than the stifle joint itself.

I spoke to one of the IDEXX medicine consultants this morning, who has recommended a comprehensive haematology to figure out whether the anaemia is regenerative, get some idea whether there is a left shift along with the high neutrophils. Serology for Borrelia antibodies would be more to rule it out than prove it - as it's been a chronic case it should have seroconverted by now, no point in going for PCRs apparently.

When the dog was placed into dorsal recumbency for a craniocaudal view of her stifle the enlarged submandibular seemed even bigger so they've taken FNAs of it, with a view to possibly send off for examination. Think I'm going to speak to someone at our local referral hospital for some further advice as well before speaking to the owner about further tests. The dog is insured, but as she's older the excess is bigger and she has to pay 20% of the final bill so I dont want to rack up too much!

Re: Bizarre case of longstanding lameness

James Laidlaw — Thu, 27 Dec 2012 09:04:56 GMT

Can you post the radiographs?

Re: Bizarre case of longstanding lameness

Malcolm Ness — Thu, 27 Dec 2012 08:50:42 GMT

How is the diagnosis of Lyme disease being made? If the criteria are sero-positivity and lameness, then I would expect many, many false positives. If you are including joint effusions; a genuinely consistent history; synovial fluid analysis to support an inflammatory arthropathy and radiographs to exclude other causes of lameness, then many of the provisional Lyme diagnoses fall away.

We are in a heavy tick area and we see a few orthopaedic cases but I reckon Lyme disease to be a very rare cause of lameness.

Re: Bizarre case of longstanding lameness

Dagmar Steele — Thu, 27 Dec 2012 08:41:29 GMT

Me again, 10 days would be too short to see improvement in some cases. Asking again if you get anaplasma in the UK. We do in northern Germany and they can make similar symptoms. My employees dog was positive and horribly lame, it took six weeks until it started to clear, we had nearly lost hope. No lameness left now, but was on Doxy for three months.

Re: Bizarre case of longstanding lameness

Michael Woodhouse — Thu, 27 Dec 2012 00:09:57 GMT

There is Lyme disease in parts of North Yorkshire. Rule that out first.

Re: Bizarre case of longstanding lameness

Chris Geddes — Wed, 26 Dec 2012 20:40:05 GMT

Oops sorry forgot about being dx so long ago. I'm which case yeah, test for Lyme!

Re: Bizarre case of longstanding lameness

Anthony Dennison — Wed, 26 Dec 2012 20:39:22 GMT

Another thing I forgot to mention in my gargantuan history is recently the dog seems to have lost most of the muscle mass on her neck - muscle atrophy from a steroid side effect? That might be why the enlarged lymph node hasn't been detected before

Re: Bizarre case of longstanding lameness

Anthony Dennison — Wed, 26 Dec 2012 20:32:58 GMT

Thanks for all the advice guys - I think I'll change the plan to bloods for Lyme disease, possibly also a comprehensive haematology to IDEXX as well to check if this anaemia is regenerative, and spinal rads as previously mentioned.

Will keep you updated!

Re: Bizarre case of longstanding lameness

Bibs — Wed, 26 Dec 2012 20:19:22 GMT

Maybe worth also ruling out discospondylitis?

Re: Bizarre case of longstanding lameness

Anthony Dennison — Wed, 26 Dec 2012 19:56:57 GMT

But there was no real improvement at all when the dog was on Ronaxan for 10 days, does it take longer than this to take effect, or is it a case of getting a higher dose?

Re: Bizarre case of longstanding lameness

Mark Hedberg — Wed, 26 Dec 2012 19:47:12 GMT

In which case 10 days isn't nearly enough - you'll want a month, easy.

Re: Bizarre case of longstanding lameness

mariette asselbergs — Wed, 26 Dec 2012 19:30:02 GMT

First seen beginning of September, August being perfect for licks. I would definitely test for Lyme.

Mariette