Please join us for interactive thoracic radiology rounds! This time Dr. McCort will be featuring different cases for all attending doctors to review and discuss. The event information is as follows:

Date: Wednesday, September 8, 2010

Time: Drinks & Appetizers from 6:30pm-7pm; Rounds from 7pm-8pm

Topic: Thoracic Radiograph Review: Round Table Discussion

Location: VICSD, 7522 Clairemont Mesa Blvd, San Diego, CA 92111

Cost: FREE!

Space is limited to 40 people and we have been full every month, so please give our office a call to reserve your spot today! (858) 634-5430

Dr. Jonathan Hayles will be joining our practice on Monday, October 1, 2010. A San Diego native, Dr. Hayles obtained his undergraduate degree at the University of California, San Diego and his DVM from the University of California, Davis, School of Veterinary Medicine. He then completed a small animal rotating internship at the Veterinary Medical and Surgical Group in Ventura, CA. Dr. Hayles has also successfully completed the Radiology Residency Training Program with a concurrent Master’s degree in Veterinary Science at the Washington State University, Veterinary Teaching Hospital, a leader in MRI interpretation in the West, and will continue as an instructor there until his arrival in San Diego. He specializes in MRI interpretation and diagnosis.

Dr. Hayles is looking forward to returning to his home in Encinitas with his wife Andrea and their pets. And we are excited that he has chosen to join our practice and we eagerly await his arrival!

For our valued clients, more appointment availability means:

Working your cases up faster

Veterinarians have one month from the date of this posting to submit a diagnosis. Each entry will be reviewed at the end of the month by our two radiologists, and all those who answered correctly will be mentioned in the next month’s newsletter, regardless of location. Each month’s local winner will receive a pizza party for 20 people and recognition in our newsletter; and the hospital with the most correct answers at the end of 2010 will receive a holiday party, recognition in the VICSD newsletter, and a certificate of achievement from AAVR. In the event that there are multiple correct answers, then a raffle will determine that month’s winner.

This Month’s Case History

The patient is a 10-year-old Boston Terrier with a progressive left forelimb lameness for six weeks.

Please click on each radiograph and bone scan image below to view the full-size version.

History:
Chronic nasal discharge for ten months.

Findings:
Nasal CT: Contiguous 1.5mm and 3 mm slices were obtained through nasal passages. There is extensive nasal turbinate destruction on the left and less severe nasal turbinate destruction on the right. There is destruction of the nasal septum from I713.9 caudally to I725.9. Beginning at I728.9 and extending caudally within the right nasal passage there is thickening to the soft tissues consistent with plaque formation. There is near-complete soft tissue opacification of the frontal sinuses bilaterally with small foci of mineralization, loss of the frontal bone ventrally, frontal sinus septum and osseous thickening and irregularity dorsally. Lysis of the cribriform plate is noted dorsally at locations I767.0 and I767.8. The left maxillary M2 is absent.

Conclusion:
Extensive nasal turbinate destruction, frontal sinus opacifiction, evidence of frontal sinus osteomyelitis, frontal bone loss and high probability of cribriform lysis. These changes are highly characteristic of fungal rhinitis (aspergillosis).

Nasal passage biopsy was not performed at this time due to the characteristic changes consistent with fungal rhinitis and necessity for the owner to determine if treatment is even an option based on the extent of the changes. Based on the suspicion of cribriform involvement, clotrimazole therapy may not be an option.

Recommendations:
Consultation with an internal medicine specialist and/or surgeon regarding treatment options.

Keep your WYD submissions coming! Your staff will thank you for it.

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Last month’s case was a 10 y/o Shepherd with nasal discharge. The case and CT video can be found here.

Correct Diagnosis for WYD #3: Nasal Aspergillosis

CT Findings:

Nasal CT has characteristic changes associated with nasal aspergillosis, which are:

1) Extensive nasal turbinate destruction.
2) Thickening and irregularity to the involved bones (osteomyelitis)
3) Regions of soft tissue thickening, fungal plaque formation or fungal “balls” resulting in soft tissue masses.

In this case, there was extensive turbinate destruction on the left, moderate destruction on the right, nasal septal destruction, and involvement of both frontal sinuses. Additionally, there was destruction of the frontal sinus septum and bone reaction (osteomyelitis) affecting the inner surface of the frontal bone.

Evaluation of the cribriform plate with CT is essential prior to treatment since anti-fungal medications entering the cranial vault have been associated with seizures and patient death.

A full radiologist report from the time of the CT is available here.

To read more about canine aspergillosis imaging click here:

To read more about treatment of canine aspergillosis click here:

If you want to learn more about how to integrate outpatient CT services and our CT Rhinoscopy Package into your practice, give us a call at (858) 634-5430 or register and use the Chat Live feature on our website.

Date: Wednesday, August 4th, 2010
Time: Drinks & Appetizers from 6:30pm-7pm; Rounds from 7pm-8pm
Topic: Thoracic Radiographs: The D-Listers: Plural Space, Mediastinum Thoracic Wall & Diaphragm
Location: VICSD, 7522 Clairemont Mesa Blvd, San Diego, CA 92111
Cost: FREE!

Space is limited to 40 people and we have been full every month, so please give our office a call to reserve your spot today! (858) 634-5430

Location: 124 Aberdeen Dr., Cardiff by the Sea, 92007

Click on the image below for details or visit the event website:

Meet Becky (a.k.a. Sunshine, Sunny D, Sunny Girl, Kitty Cat).

Previously homeless, Becky was taken in by one of our referring clinics out in the desert a week or two prior to coming to our facility to be pre-screened for hyperthyroid treatment. While she was here, she made herself right at home and managed to convey to us that San Diego was where she wanted to stay. How could we resist? With all that hair she must have been trying to escape the desert heat. Crafty, Becky. Very crafty. It must be hard to hitchhike when you don’t have opposable thumbs. Our client was already overloaded with other in-house pets, so they were more than happy to let us keep her.

Becky now wanders around our clinic looking for places to nap and scoffs at our staff’s dogs with an air of superiority when they disturb her slumber. She is quite a delight and we are glad to have her here!

Pre-contrast, the liver and gallbladder appeared normal. The spleen contained a 3.0 cm x 1.9 cm hypoechoic nodule dorsally. Both kidneys had a thickened and hyperechoic cortex with decreased corticomedullary definition and trivial renal pelvic dilation. The adrenal glands were normal and the urinary bladder contained an irregular mucosal mass craniodorsally. The prostate was enlarged, measuring 4.0 cm in diameter. The stomach, bowel, and region of the pancreas were normal.

Post-contrast, the filling within the spleen and the splenic nodule were different. Additionally, there was contrast accumulation within the medial half of the splenic nodule while the lateral half of the nodule remained hyperechoic. The ventral half of the prostate was contrast enhancing. A triangular region dorsally was non-contrast enhancing. And the sublumbar nodules were non-contrast enhancing.

Five separate biopsies of the prostate (two of the left lobe ventral, one of the right lobe ventral, and two of the dorsal) were performed. FNA of the splenic nodule was briefly attempted but aborted.

Conclusions from Images:

1. Prostatic mineralization with sublumbar lymphadenopathy. Heterogeneous enhancement. This finding suggests abnormal (potentially cancerous) tissue.

2. Heterogeneously-enhancing splenic nodule was seen with an interesting pattern – that similar to a sliver of a moon. We could see the contrast flowing through most of the area but sticking to a smaller area, indicating that this portion may contain cellular atypia.

Biopsy Results:

The biopsy results confirmed cellular atypia in the contrast enhancing regions of both the spleen and the ventral half of prostate.

Implications:

As diagnosticians, we’re constantly faced with whether an area is infectious, cancerous, or pre-cancerous. Both studies so far have revealed that contrast-enhancing ultrasound can be a reliable method for distinguishing inflammation from cancer.

The implications of both studies may be far-reaching, allowing for early detection of prostate cancer in both dogs and people using noninvasive ultrasound coupled with targeted ultrasound contrast. Historically, medical testing and imaging were initially performed on healthy small animals such as rats and mice during clinical trials, with findings later applied to humans. However, a new clinical research philosophy is beginning to emerge where cutting-edge diagnostics and medical care are being offered to both humans and pets afflicted with similar conditions. This comparative testing model may offer a better understanding of cancer in both humans and animals.