13 years of age
Very long history of lameness front left, recurrent.
Localised in the distal interphalangeal joint (DIP joint), graded differently in different clinical examinations.
Radiographs of the region were taken.
Lateromedial view and dorso60°proximal-palmarodistal oblique view of the distal front left limb .
- There is severe soft tissue swelling in the area of the dorsoproximal outpouch of the DIP joint with some gas inclusions (arrows).
- There is an ill defined, irregular lucent area in the subchondral bone of the palmar third of P3 (arrow head).
- There are at least 2 widened synovial invaginations in the navicular bone and proximal elongation with enthesiophyte formation (empty arrows).
- There is remodelling of the periarticular bone of distal P2 and P3 (empty arrows).
- Mild long toe and broken digital axis.
Close up of the lateromedial view of the distal left front limb.
The radiographic diagnosis relative to the front left foot was:
- Severe synovitis of the DIP joint (joint effusion, capsular thickening) and degenerative joint disease.
- Subchondral defect in P3.
- Moderate navicular disease.
- The gas inclusions in the area of the DIP joint were interpreted as iatrogenic (post diagnostic anesthesia).
- For further assess the multiple lesions, a MRI study of the foot was performed.
Close up of the 3D T1w post contrast sequence, longitudinal plane on the left and dorsal on the right image. Lateral is on the right side.
- There is severe filling of the dorsal outpouch of the DIP joint, with strong contrast enhancement and capsular thickening, consisting in chronic proliferative synovitis (arrow).
- The subchondral bone defect was confirmed, sagittal and palmar, as identation of high signal intensity (arrow heads).
- There is marked signal enhancement in the synovial invaginations of the navicular bone (empty arrow).
- The other lesions were as well confirmed on multiple planes and sequences (not shown).