Diagnostic efficiency™ is about adaptation… sticking and moving just like how Sugar Ray Leonard boxed in the 1980s, the veterinarian must mentally adjust to what is presented and find the correct modality that fits the clinical sign(s).
Dr. Eric Lindquist has always said, “If the problem in an “ADR” patient isn’t in the abdomen or the chest with the probe, then it must be orthopedic, metabolic or in the CNS“. This is a perfect example of one of those stick and move cases.
This patient presented for a tense abdomen. The complete sonogram was innocuous but the sonographer noted a positive Murphy sign (pain upon imaging) in the cranial abdomen caudal to the ribs. This is often referred back pain where the clinical sonographer can feel the difference of body wall tension upon the scanning hand between superficial tenseness owing to referred disc pain versus the deeper visceral pain such as that of pancreatitis. This clinical sign along with a clean abdominal ultrasound says >>> CT the spine and boom…we have our answer!
Patient Information:
Age: 11-year old
Gender: Male, Neutered
Species: Canine
Breed: Yorkshire Terrier
Presenting Clinical Signs:
- Presented for a second opinion for a 4-week history of back pain.
- Previous treatments were Gabapentin and Tramadol, but the patient showed no improvement.
- Patient was still very painful, reluctant to move, and baring teeth when owner tried to pick him up.
- Suspected L2 lesion, but the area of L2 appeared normal on radiographs.
- Lab Results:
- Alk. Phos. of 187
- PSA Lipase of 528
- CBC were WNL
- UA – 2+ Protein
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Abdominal Ultrasound:
Above: Liver Mass
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Ultrasound Interpretation:
- A left medial liver nodule, likely lipogranuloma or benign lesion with minor renal mineralization was seen on ultrasound.
- The sonographic findings were not contributing to this patient’s pain and there was no evidence of visceral disease that could be contributing to the clinical signs.
- A CT of the spine with contrast was strongly recommended given the patient’s symptoms.
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CT of the Lumbar Spine:
 
Above: Aggressive Osteolysis
Above: Spinal Cord Compression |
CT Interpretation:
- An aggressive osteolytic lesion of L2 vertebral body is noted occupying two thirds of the vertebral body.
- The dorsal cortex of the vertebral body of L2 is lost.
- There is a contrast enhancing soft tissue component of the lesion causing an extradural mass effect on the spinal cord from the ventral and right ventrolateral aspect.
- The soft tissue component of the mass occupies approximately 70% of the vertebral canal cross sectional area at maximum and causes deviation and severe compression of the spinal cord at the same level.
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