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History
Right front limb weight-bearing lameness first noted 3 months prior. Carpus radiographs reportedly normal. RDVM prescribed Rimadyl and exercise restriction for 2 weeks. Some response to therapy but then lameness would sporadically recur. Now presents with non-weight bearing right front limb lameness localized to the elbow region.
Physical Exam Findings: Weight: 23.4 kg, Temp: 101.2°F, Pulse: 132, Resp rate: 36, mm: pink. CRT: <2 sec, BAR, hydration normal
Radiographic Exam Findings: Unremarkable elbows and shoulders
CT technique
- Thoracic limbs imaged simultaneously with the patient in sternal recumbency and the thoracic limbs cranially extended.
- Helically-acquired 1.25 mm (bone algorithm) transverse images from the mid antebrachii to the shoulders
- Images reformatted in dorsal and sagittal planes
- Images reconstructed in soft tissue (standard) algorithm
- Post-IV contrast series not acquired
CT of the elbows, bone window
Right elbow sagittal and dorsal reconstructions, bone window
Left elbow sagittal and dorsal reconstructions, bone window
CT of the shoulders, soft tissue (left) and bone (right) windows
There is patchy intramedullary bone density in the proximal to mid right humerus and in the mid right radius. The left thoracic limb long bones are unremarkable. The shoulders and elbows are within normal limits.
Diagnosis
Panosteitis of the right humerus and radius
Panosteitis a self-limiting disease of the long bones characterized by increased medullary bone opacity and bone pain. It typically effects large and giant breed dogs though it has been reported in the bassett hound, Scottish terrier and miniature schnauzer. There is a higher incidence noted in German shepherd dogs and males are more commonly affected. The average age at presentation is between 5 – 12 months. In one study, 20% of dogs initially presented at the age of 1.5 years so later onsets are possible. Panosteitis has been documented to occur in German shepherd dogs as old as 5 years. Recurrence of the disease in a previously affected bone is reportedly rare.
Reference:
Newton CD, Nynamaker DM. Chapter 49: Canine Panosteitis. In: Textbook of Small Animal Orthopaedics. JB Lippincott, 1985