Case Studies

Bogie presented with recent episodes of epistaxis (bleeding from the nose) and a large submandibular lymph node. 

CT Results:

There is an aggressive left-sided sinonasal mass with intracranial and right nasal cavity extension. Differential diagnoses include carcinoma versus lymphoma. There is also extra-axial compressive encephalopathy secondary to nasal tumor invasion.

Murray presented with generalized pain, refusing to move from a sitting position and also experiencing shivering/trembling. He has been ataxic, has hyperextension of the left forelimb, and has imbalance on uneven surfaces at times.

CT Results:

The partially mineralized and heterogeneously contrast-enhancing material within the ventral and left lateral aspect of the vertebral canal at C2-3 is primarily thought to represent recently herniated intervertebral disc material causing secondary dorsal and right lateral spinal cord deviation ad compression and potentially left C2-3 foraminal stenosis and a component of contrast enhancement could be a manifestation of meningeal irritation/hypertrophy secondary to disc herniation noting that other disease processes, such as an atypical manifestation of a spinal neoplasm is not completely excluded though it is less likely consideration.

Motley presented for a CT scan after having a seizure.

CT Results:

There is a mass that has been identified in the region of the thyroid, most likely representing a thyroid carcinoma. A definitive cause for seizures has not been identified by this scan.

Rusty presented for a CT scan after exophthalmos was diagnosed of the right eye.

CT Results:

There is a primary malignant soft tissue neoplasm of the right palatine bone with retrobulbar, calvarial and right frontal sinus extension, causing a right exophthalmos, as well as a mild intra-cranial mass-effect. There is also evidence of ipsilateral mandibular ramus pressures necrosis and regional osseous invasion cannot be entirely excluded. Caudal transtentorial cerebral or cerebellar crowding/foraminal herniation cannot be excluded. The primary differential diagnosis includes a hemangiosarcoma, but a chondrosarcoma, fibrosarcoma, or osteosarcoma can also be considered.

Keke presented for exophthalmia and pain on retropulsion of the right eye as well as blindness. More recently, Keke also lost vision in the left eye.

CT Results:

Although there is concern for optic neuritis, the multifocal abnormal contrast enhancing structures within the supratentorial space raising concern for an inflammatory process such as granulomatous meningoencephalitis which could affect the optic nerves although French Bulldogs tend to be predisposed to development of necrotizing leukoencephalitis.

Winnie has a long history of ear and sinus issues.

CT Results:

There is an expansile locally aggressive and minimally contrast-enhancing mass-like lesion of the right tympanic cavity with rostral extension to involve the right temporomandibular joint. This lesion is thought most likely to represent a slow-growing aggressive lesion, particularly a cholesteatoma, noting that an adenoma or less likely a more malignant process such as a carcinoma is not completely excluded.

Larry has had a two-week history of his left eye becoming suddenly swollen and deviated.

CT Results:

There is a left-sided periorbital/retrobulbar mass ventral to the left globe causing leftsided exophthalmos. This mass is thought to represent a soft tissue neoplasm and could be potentially associated with infiltrating into the left ventral rectus muscle.

Ivy has been previously diagnosed with glaucoma. Upon referral, glaucoma was ruled out and exophthalmia of the right eye was diagnosed.

CT Results:

There is a right sided nasal mass with periorbital and cribriform plate defects with periorbital and cranial vault extension. Primary consideration for a nasal mass in an older patient of this species is given to a nasal adenocarcinoma or nasal carcinoma.

Smokey presented for progressive exophthalmia and orbital cellulitis for one month with no response to treatment.

CT Results:

There is a right frontal sinus centered mass lesion with cribriform plate and periorbital erosion as well as extension into the cranial vault. Primary consideration for a sinonasal mass in an older patient of this species is given to a nasal adenocarcinoma or nasal carcinoma.

Cooper has had a chronic draining abscess on the side of the face/head.

CT Results:

There is a large and locally aggressive mass of the right external ear canal with additional components extending into the tympanic cavity, right musculotubal canal and additional right periaural extension involving the right temporomandibular joining and caudal to the right globe. This mass is thought most likely to represent a neoplastic lesion and could represent a benign process such as a large chronic auditory adenoma, though a more malignant process such as a carcinoma is possible and additional lesion such as severe hyperplastic/proliferative nonneoplastic tissue or a cholesteatoma are considered less likely.

Praise has a history of nose bleeds over the past 8-9 months and having sneezing attacks.

CT Results:

There is a large right nasal mass extending to the left. The primary consideration for a nasal mass in an older patient is given to a nasal adenocarcinoma or nasal carcinoma.

Scully presents after being diagnosed with central blindness.

CT Results:

There is a well-circumscribed soft tissue mass in the mid ventral cranial cavity and the primary differential is a pituitary macroadenoma. A meningioma is considered less likely, but cannot be entirely ruled out. There is moderate secondary intracranial mass-effect as described.

Gracie has a 4-month history of slowly progressive exophthalmia of the left eye with concurrent nasal discharge

CT Results:

There is a large, aggressive mass arising from the left ethmoid region with extension into the left orbit, left cranial cavity, medial right ethmoid region, and both frontal sinuses. The lesion is almost certainly neoplastic. The rather large degree of mineralization would be atypical for nasal adenocarcinoma and squamous cell carcinoma. Therefore, a sarcoma such as osteosarcoma, myxosarcoma, or multilobular tumor off bone is considered more likely. There is secondary marked left exophthalmos and moderate extra-axial compression and displacement of the left frontal lobe.

Buster is a 10-year-old Boxer that presented for asymmetry of the head.

CT Results:

In the region of the right trigeminal canal and oval foramen, a soft tissue contrast enhancing mass is present. Asymmetry of the head is related to the atrophy of the muscles of mastication. This is seen in association with a contrast-enhancing mass in the region of the right trigeminal nerve.

Elvira is a 10-month-old cat that presented for a left sided head tilt and mild ataxia.

CT Results:

The left ear bulla margin is thick with internal contents consistent with an inner ear infection. Bulla osteitis is present. Elvira was referred back to her primary veterinarian for a cytology and culture of her inner ear infection and appropriate treatment.

Jack is a 4-year-old Terrier that has had a head tilt for several weeks. Neurologically he was not acting normal. He was initially on antibiotics which did not help and steroids for a little while which did help.

CT Results:

There are numerous contrast-enhancing nodules throughout the cerebellum. There is
mild dilation of the 3rd and lateral ventricles secondary to compression of the 4th ventricle associated with the numerous cerebellar nodules. These lesions are most consistent with mineralized granulomas. Fungal or parasitic disease is suspected. Jack was referred back to his primary veterinarian for further work-up of fungal and parasitic disease.

Frankie is a 10-year-old cat with a large, firm, immobile growth on the right mandible.

CT Results:

The alveolar bone is generally irregular. Associated with the right mandible, from the level of the socket or the right mandibular canine tooth to the level of the ramus and adjacent to the mandibular condyle a mass lesion is present. The appearance of the right mandibular lesion and an older patient raises high concern for an invasive neoplasm such as a squamous cell carcinoma. Frankie was referred back to his primary veterinarian for a surgical biopsy and potential to see an oncologist.

Marmalade is a six-year-old female spayed domestic longhair cat. A month prior to presentation, Marmalade was treated for an upper respiratory infection that did not resolve. Over the past two weeks, her left eye seemed to be swelling.

CT Results:

The left nasal cavity is filled with a markedly contrast enhancing mass filling the mid and caudal nasal cavity, causing osteolysis of the left orbital plate and extending into the left orbit as a broad-based contrast enhancing mass. The mass extends across the caudal bony nasal septum as a contrast enhancing lesion within the causal right nasal cavity. The mass causes osteolysis of the bilateral ventral cribriform plate extending intracranially as a broad-based extra-axial mass. The intracranial mass causes marked mass effect, midline shift to the right with intra-axial perilesional hypodensity consistent with edema.

Butters is a 7-year-old neutered male domestic shorthair cat that presented for facial nerve paralysis of his right eye. Butters was previously seen by a neurologist who prescribed a course of Baytril, Clavamox, Clindaymcin, and Prednisolone with no improvement.

CT Results:

There is what appears to be an infectious etiology associated with the right tympanic bulla and horizontal ear canal extending into the regional soft tissues. It is possible that this is a neoplastic lesion or neoplasm with abscess. Biopsy and culture are recommended for definitive diagnosis. The lesion is associated with the right tympanic bulla surrounding the stylomastoid foramen and is likely affecting the facial nerve.

Spec is a 9-month-old male neutered Border Collie that presented with severe mucoid discharge from the right eye. He has been treated with topical neopolydex and oral cephalexin with no improvement. Initially, Spec was sedated and a nasolacrimal irrigation was performed. Purulent discharge was irrigated from the nasolacrimal duct.

CT Results:

There is bone expansion of the right nasolacrimal duct with communication between the focal dilation and the nasolacrimal injection. A prior infection in this region with expansile lysis is possible to account for the size. A ruptured nasolacrimal cyst could also account for the communication of the contrast material with this focal dilation.

Rory is an 11-year-old Boxer that presented for acute blindness. He was initially prescribed prednisone, which helped him see, but then he went blind again shortly thereafter. An electroretinogram was initially performed which showed normal retinal activity.

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CT Results:

The left mid and caudal nasal cavity has a ventral, heterogeneously contrast-enhancing soft tissue density mass. The rostral extent of the mass is within the left ventral nasal cavity. The mass fills the left choana and the majority of the left maxillary recess. The mass bulges into the rostral left nasopharynx. The mass causes left orbital plate osteolysis. The mass causes extensive osteolysis of the left and bilateral ventral cribriform plate and extensive osteolysis of the pre-sphenoid bone. The mass has intracranial extension as a peripherally contrast-enhancing, centrally poorly contrast-enhancing mass affecting the bilateral olfactory lobes and ventral frontal lobes extending to the presumed level of the optic chiasm and causing widening and patchy osteolysis of the bilateral optic canals.

Skylar is an 8-year-old female spayed Pitbull that presented with decreased vision and dilated pupils for the past month. Skylar initially was prescribed prednisone which showed no improvement. An electroretinogram was performed which showed normal retinal activity.

CT Results:

There is a moderately contrast medium enhancing mass in the ventral cranial cavity, for which the primary differential is a meningioma. The Shape and slightly rostral location are less typical of a pituitary macroadenoma, but this cannot be entirely ruled out. A granuloma and intra-axial neoplasm are less likely. Secondary extra-axial compression of the hypothalamus and presumably, the optic chiasm, is evident and worse on the right. This lesion is considered to be responsible for the patient’s blindness. There is no evidence of foraminal/orbital extension.