The desmotomy of the palmar/plantar annular ligament (PAL) is recommended when it hinders the sliding motion of the flexor tendons in the sesamoidean canal, leading to persistent lameness that often does not improve with conservative treatment. Tenoscopic-assisted PAL desmotomy can be accomplished with various instruments via an intrathecal approach. However, severe constriction or adhesions within the fetlock canal can restrict manoeuvrability and access of instruments within the sheath, preventing safe and effective transection of the ligament. This case report describes the successful use of a hook knife via a subcutaneous approach to safely transect the PAL under tenoscopic visualisation in a horse where severe constriction of the fetlock canal prohibited the standard intrathecal approach. In similar chronic tenosynovitis cases, a subcutaneous approach to PAL transection at the start of the tenoscopic examination of the digital flexor tendon sheath may minimise iatrogenic injury to intrathecal structures.
A 20-year-old Irish Sport Horse gelding was presented to the Royal Veterinary College Equine Referral Hospital for investigation of left-sided epistaxis, depression and gait abnormalities of approximately 1 month duration. Physical examination and cranial nerve evaluation were unremarkable. A small amount of haemorrhagic discharge was noted from the left nostril. Gait evaluation was suggestive of proprioceptive deficits. Computed tomography (CT) identified a mass lesion within the left conchofrontal and sphenopalatine sinuses extending through the cribriform plate into the calvarium. Histopathology of the mass revealed a neuroendocrine neoplasm, for which a diagnosis of esthesioneuroblastoma was favoured. This case highlights the usefulness of CT for the identification and extent of an intracranial mass and therefore its prognosis, however, histopathological examination was necessary to confirm the diagnosis.
To the authors' knowledge there is only one report in the literature describing plasma cell paramedullary myeloma in horses as so-called ‘break out lesions’, originating from vertebral bone marrow and invading the epidural space. This report describes clinical and pathomorphological findings of such. An 8-month-old Warmblood colt exhibited acute tetraparesis and a cervical column spinal cord lesion was suspected. Computed tomography revealed C1 osteolytic lesions by a heterogeneous mass. By pathomorphological examination including transmission electron microscopy, a plasma cell myeloma was identified, locally compressing the spinal cord. In tetraparetic young horses traumatic spinal cord injuries, cervical vertebral malformations, and central nervous system infectious diseases represent common differentials. However, osteolytic tumours such as paramedullary (plasma cell) myelomas, as space occupying lesion due to vertebral canal intrusion, should be considered as a cause for severe neurological deficits.
Osseous cyst-like lesions (OCLLs) of the distal phalanx commonly occur around midline. The dorsopalmar location can be challenging to identify radiographically; however, advanced imaging has shown they are typically located in the central and palmar thirds of the bone. This study reports unusually located OCLLs in the dorsal, axial aspect of the palmar processes of the distal phalanx in three horses, with communication with the distal interphalangeal (DIP) joint confirmed by contrast arthrography in two horses. All horses were lame and had lameness localised to the distal limb with diagnostic anaesthesia. A rounded radiolucency with a surrounding rim of increased opacity was identified in the dorsal aspect of a palmar process on radiographs, with the palmaroproximal–palmarodistal oblique (PaPrPaDiO) view being most useful. On magnetic resonance imaging (MRI), the lesions were seen as hyperintense structure on T2*, T2 FSE and STIR sequences; a thin rim of intermediate signal surrounding a low signal centre was seen on T1 images. A rim of low T1/T2 FSE signal was seen in the surrounding bone in all cases, consistent with sclerosis, and mildly increased STIR signal was present in the surrounding trabecular bone in two cases. Two horses underwent standing cone-beam computed tomography (CT) examination of the affected foot, revealing a well-defined hypoattenuating region within the dorsal, axial aspect of the palmar process of the distal phalanx, with surrounding rim of increased attenuation. Contrast arthrography was performed in two cases, one using radiographs and the other CT, and confirmed communication of the cystic lesion with the DIP joint in both cases. Although advanced imaging provided further information and allowed other possible causes of lameness to be identified, careful assessment of radiographs allowed these unusually located OCLLs to be identified in all cases.
Uterine torsion (UT) is a common obstetrical problem in Straight Egyptian Arabian mares, causing a medical emergency for both the mare and the fetus. This case report describes, for the first time, the management of a case of UT in both directions during a single gestation period in a 5-year-old Straight Egyptian Arabian mare. The mare was 8 months pregnant and experienced intermittent unresponsive colic signs. Rectal examination revealed clockwise 180° UT and ultrasonography showed a viable fetus. The haematological findings were within the normal range. The mare was surgically treated immediately by standing flank laparotomy (SFL) on the right side. 4 days later, the mare was returned to the clinic with the same complaint. Rectal and ultrasonography examinations revealed counterclockwise 180° UT and a viable fetus. The animal was subjected again to SFL on the left side. After surgeries, the mare recovered well, foaled at term and gave birth to a viable filly. She was bred again and conceived. This case is documented to demonstrate the occurrence of a UT in both directions during the same gestation period in mares, as well as the efficacy of SFL in rectifying the condition and allowing both the mother and foal to survive.
Equine sarcoidosis (ES) is a rare disease characterised by granulomatous inflammation of one or multiple organs. The skin is most frequently affected in horses and the clinical presentation can range from scaling and crusting lesions to nodular or tumour-like masses. ES has been divided into three subtypes depending on the distribution of lesions in the body: the localised, partially generalised and generalised form. Overall, no breed or sex predilections have been consistently observed so far. Most affected horses are older than 3 years although the disease may occur at any age. While aetiology and pathogenesis of ES have not yet been fully determined, a chronic exaggerated immune response to one specific or multiple antigens is frequently hypothesised. Diagnosis is based upon history, clinical presentation, histopathology and exclusion of likely differential diagnoses. The treatment of choice in ES is initial anti-inflammatory to immunosuppressive doses of corticosteroids with subsequent tapering doses. Reported treatment success seems to be highly variable and prospective studies on the efficacy of corticosteroids or other agents are currently lacking in ES. Prognosis for survival is good for the localised form and poor for the other forms of ES. Complete remission of lesions in the localised form following treatment is less frequent and response to treatment is typically characterised by a slowdown or cessation of disease progression. There are scarce reports of spontaneous remission of this disease.
In this clinical commentary, the various pathologies occurring in the tail region of horses and foals are briefly summarised, followed by a discussion of angular deviations of the tail and the possibilities of their correction.
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