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  • Examination- January 2019
  • Pain on palpation of mid thoracic vertebrae and SI region
  • Mild 3/5 LF lameness on lunge in both directions
  • Under saddle, moderate 2/5 lameness on LH (tracking to the left)
  • Flexions: Mild positive on LF lower limb flexion, and moderately positive to LH and RH upper limb flexion
  • Prepurchase radiographs- July 2018
  • Moderate to severe osteoarthropathy of distal tarsal joints, bilaterally
  • Long toe, low heel LF and RF

 

Marked uptake in distal tarsi bilaterally

Moderate sacroiliac uptake bilaterally

Mild to moderate uptake of left and right proximal palmar/medial metacarpi- more pronounced on the right

Focal intense uptake lateral to left fore distal P1

Approximately 1.4cm, irregularly margined osseous proliferation of lateral cortex of distal p1

No evidence of impingement on the origin of the lateral collateral ligament of the proximal interphalangeal joint

Proximal interphalangeal joint margins normal

LF Pastern

• Osseous proliferation of the lateral cortex of the distal aspect of p1

• Progressive since purchase 7 months prior • Differentials

• Severe focal periosteal proliferation, dystrophic soft tissue mineralization (calcinosis circumscripta)

Pathophysiology

Calcinosis circumscripta

  • Usually traumatic origin
  • Histology- calcified material within a tissue with surrounding fibrous tissue reaction
  • Rarely causes lameness or discomfort on palpation
  • Uncommon syndrome of ectopic mineralization • Pathogenesis not completely understood
  • Calcium salts are deposited in soft tissues in the form of hydroxyapatite or amorphous calcium phosphate
  • Classified into four major types according to the type of calcification process and etiology — Dystrophic, metastatic, idiopathic, iatrogenic

Dystrophic

Normal serum calcium and phosphate levels
Calcification localized to a specific area of tissue damage
Primary lesion due to injury, necrosis, inflammation or neoplasia

Metastatic

Abnormal calcium or phosphate metabolism- hypercalcaemia and/or hyperphosphataemia

  • chronic renal failure, end stage kidney disease, vitamin D toxicosis
  • Few reports in the veterinary literature describe calcinosis circumscripta in association with renal failure
  • calcification of foot pads
  • widespread visceral and vascular mineralization also reported

Idiopathic

Occurs in the absence of known tissue injury or systemic metabolic defectBreed and familial predilection can occur Can be inherited as an autosomal recessive trait in humans

  • Hereditary predilection has been suggested in dogs

Calcinosis Circumscripta in Horses

  • Most commonly lateral aspect of femorotibial joint
  • Occasionally bilaterally
  • Can be closely associated with joint capsule
  • Neck, carpus and tarsus
  • Documented invasion in middle carpal joint and antebrachiocarpal joint
  • Thought to be of traumatic origin resulting in dystrophic mineralization

References

  • Calcinosis Circumscripta in the Dog: A Retrospective Pathological Study A. K. Tafti, P. Hanna, A. C. Bourque. J. Vet. Med. A(2005) 52: 13–17
  • Calcinosis circumscripta in the horse, P. I. Milner Equine vet. Educ. (2009) 21 (11): 589
  • Calcinosis Circumscripta of the Tongue S. W. Douglas, D. F. Kelly. small anim. Pract. (1966) 7:441 -443.
  • Calcinosis Circumscripta (Calcium Gout) in related Irish Wolfhounds L. N. Owen. small Anim. Pract. (1967) 8: 291-292.
  • Calcinosis circumscripta following an injection of proligestone in a Burmese cat CR O’Brien, JS Wilkie. Aust Vet J (2001)79:187-189