? panosteitis in 4 year old Boston Terrier

RE: ? panosteitis in 4 year old Boston Terrier

Malcolm Ness — Wed, 13 Jul 2016 12:51:54 GMT

[quote user="Noweia"]Any chance someone could mark the osteophytosis on the x-ray for educational purposes?[/quote]

Not clever enough to do that on the images but if you compare first the left and right laterals - there is a "tide-mark" appearance across the femoral epiphysis someway caudal to, but not parallel with the trochlear ridge. Similarly, comparing the cause-cranial views, on the right there is a patchy area of radio-density apparent between the trochlear ridges, just cranial to the top of the inter-condylar notch and just distal to the patella.

RE: ? panosteitis in 4 year old Boston Terrier

Noweia — Tue, 12 Jul 2016 23:28:26 GMT

Any chance someone could mark the osteophytosis on the x-ray for educational purposes?

RE: ? panosteitis in 4 year old Boston Terrier

Rob Davis — Mon, 11 Jul 2016 16:57:47 GMT

[quote user="J G Wray"]

Is that a politeal lymph node I see on the R mediolateral view?

[/quote]

Yes, I think it is, but it is not enlarged and the left one was also visible, although I seem to have saved them at slightly different magnifications and cropping.

RE: ? panosteitis in 4 year old Boston Terrier

Rob Davis — Mon, 11 Jul 2016 16:55:30 GMT

Many thanks, Malcolm, I'm glad you agree with my assessment!

[quote user="Malcolm Ness"]There is also some evidence of osteophytosis around the right stifle so we might also have a chronically failing cruciate. Be careful to evaluate this at follow up and consider the possibility that the femoral lesion is incidental to a stifle lameness.[/quote]

There is a grade 1 medially luxating patella in the right limb, but there was no cruciate instability palpable under GA. I have told the owners that I suspect this is not relevent, but will have another good feel of both stifle and femur next time I see him.

I will post updates (hopefully including follow-up radiographs) in due course.

RE: ? panosteitis in 4 year old Boston Terrier

J G Wray — Mon, 11 Jul 2016 15:57:10 GMT

Is that a politeal lymph node I see on the R mediolateral view?

RE: ? panosteitis in 4 year old Boston Terrier

Malcolm Ness — Mon, 11 Jul 2016 15:44:16 GMT

Interesting!

There is certainly a fairly diffuse periosteal reaction in the mid to distal part of the femoral diaphysis with the appearance of some patchy intra-medullary opacification. I say appearance because of the possibility that this is artifactual arising from the superimposition of the bony periosteal reaction. On balance, I think a panosteitis-like intramedullary lesion with an associated, 'secondary' periosteal reaction is more likely. The precise aetiology is unclear and this is a very unusual presentation. The pathogenesis of panosteitis involves vascular compromise and tissue death within the bone and occasionally we will see similar patterns following an infarct. But that, too, raises the question of what and why.

I would manage this conservatively - normal activity, NSAIDs and repeat rads in 6-8 weeks time.

There is also some evidence of osteophytosis around the right stifle so we might also have a chronically failing cruciate. Be careful to evaluate this at follow up and consider the possibility that the femoral lesion is incidental to a stifle lameness.

I wouldn't be in a hurry to biopsy this just yet - you will probably just harvest "reactive bone" though if the clinical picture changes then that decision can be revisited.

RE: ? panosteitis in 4 year old Boston Terrier

Rob Davis — Mon, 11 Jul 2016 09:05:58 GMT

Thanks Chris, that was my plan. I've just never seen it with this signalment before. I have warned that I can't rule out neoplasia, though it doesn't look typical and I don't feel that biopsy is justified at this stage.

RE: ? panosteitis in 4 year old Boston Terrier

Chris Barker — Sun, 10 Jul 2016 20:35:42 GMT

I would think panosteitis remains the most likely diagnosis; apparently there are some late onset cases. There's no evidence of lysis/bone destruction (there is some loss of definition of the inner edge of the cortical bone though this may be the result of blurring by deposition rather than destruction), the dorsal periosteal reaction is smooth and well formed. I see no sclerotic reaction around the lesion so osteomyelitis seems unlikely and though neoplasia remains a possibility you may have to sit tight and await further radiographic change, especially if nsaids offer no significant relief