Equine MRI of MD, LLC

09/29/2020

I couldn’t love this announcement more! Horses are a staple to the state of Maryland. They have been for a long time...and their place in both our history and our future shall continue to flourish as we find more ways to recognize and respect the immeasurable contribution they give to our state, and the wonderful horsemen that occupy it. ❤️🐴🙏🏻

from the Maryland Office of Tourism GOVERNOR HOGAN PROCLAIMS OCTOBER ‘MARYLAND HORSE MONTH’ Key equestrian events, including Preakness Stakes, taking place throughout the month ANNAPOLIS, MD (September 29, 2020) – Today Governor Larry Hogan proclaimed October as Maryland Horse Month, recognizi...

09/28/2020

There has been no shortage of particularly interesting cases and exciting patients recently! Last week, we scanned our first foal (under general anesthesia). The patient was a 4 month old c**t from a well-known local racehorse farm who presented with a recurring lameness, after being treated for what was thought to be just a proximal medial sesamoid bone infection. On radiographs and ultrasound, no other abnormalities were identifiable. As you will read in the details of the case review, MRI allowed us to see the entire extent of the pathology and confirmed that the extent of the infection was much greater than conventional imaging revealed. So, here is our next case review!

MRI FINDINGS:

•Marked, diffuse STIR hyperintensity involving both the medial and lateral sesamoid bones.

•A focal defect is present in the articular surface of the medial proximal sesamoid bone. On the opposing surface of the metacarpal condyle there is apparent thinning of the overlying cartilage signal and a smooth concavity.

•Marked regional STIR hyperintensity is present in the palmar aspect of the sagittal ridge of the third metacarpal condyle. A thinner region of STIR hyperintensity extends around the sagittal ridge and is associated with mild subchondral irregularity in the dorsal portion of the condyle with a slight defect in the overlying cartilage.

•Moderate STIR hyperintensity is present in the palmar, sagittal epiphyseal bone of the proximal phalanx with a potential focal defect in the central subchondral bone of the sagittal groove.

•Laterally, there is regional fluid accumulation in the metaphyseal bone of the third metacarpal.

COMMENTS:

These findings are consistent with septic arthritis of the fetlock joint with focal osteolysis in the medial PSB.

Referred for surgical consult and inpatient medical management.

*Many thanks to Dr. Lauren Luedke, Manor Equine Hospital’s recent addition to staff, who ran anesthesia while I did the exam. Dr. Luedke is a board certified equine surgeon with a specialty in sports medicine. She’s an amazing addition to our equine community and I am grateful to have worked with her on this case!

09/18/2020

Equine MRI of MD, LLC had a pretty cool patient recently. I had the pleasure of seeing an eventing horse that is headed to Tokyo (post Covid, of course). He did not present with a lameness, but did have a waxing and waning left hind medial fetlock swelling. The concern was that the underlying cause of the swelling may worsen and prevent him from representing the US in the Tokyo Equestrian Olympic Games. Much to my excitement, he was referred to Equine MRI of MD by Virginia Equine Imaging for MRI evaluation of his LH fetlock. Keep reading for the case review!

HISTORY: Focal dorso-medial fetlock swelling.

MRI FINDINGS:
•6.5cm x 4cm x 1.7cm area of hyper intense signal along the dorsomedial aspect of the third metatarsal condyle. The joint capsule at this level is moderately thickened and irregular, consistent with focal disruption of the joint capsule with associated synovial herniation and subcutaneous fluid. This is likely traumatic in nature.
•Concurrent to the joint capsule disruption, there is mild osteoarthrosis and moderate synovitis.
•Mild medial suspensory branch enlargement.
•Mild osteophytes at the medial aspect of the fetlock joint with moderate fetlock joint effusion.

RECOMMENDATIONS:
•These types of lesions heal well with rest and rehabilitation. Intra-articular biologic therapy can be considered to help reduce regional synovitis.

The MRI in this case will prove to be instrumental in making sure this horse is sound and ready to compete and represent the US in Tokyo next year. If that’s not cool, I don’t know what is!

09/07/2020

INTERESTING NEW CASE REVIEW!

2 yo filly racehorse presented with a severe, non-weight bearing right hindlimb lameness. Initially she presented with a more mild lameness 2 weeks prior after racing. On examination she was found to have an abscess associated with a safety pin that was situated in the frog and aligned parallel to the sole of the foot. The safety pin was removed and the filly was started on Oxytetracycline for 3 days duration, and then transitioned to Penicillin/Gentamicin for 1 week duration. With this treatment, the filly improved and was relatively sound. Following the week of improvement she then acutely progressed and became non-weight bearing in the right hind. She was referred for MRI to evaluate for infectious involvement of the deep structures of the foot. Due to the severity of the lameness, a PD block was required for comfort during the MRI examination.

***X-RAYS WERE NORMAL IN THIS HORSE!

MRI FINDINGS:
-severe acute abnormal fluid is present within the navicular bone
-in the flexor surface of the navicular bone, there is a focal, shallow region measuring 7mm x 5mm
-overlying the Osseous defect (mentioned above), there is a localized split lesion in the lateral lobe of the deep digital flexor tendon. From this region, a fluid-filled tract extends to the distal portion of the central sulcus of the frog (this would correspond to the tract the safety pin took upon initial puncture)
-Asymmetric distribution of navicular bursa fluid is present with associated synovial tissue thickening
-Diffuse abnormal fluid is present in the distal phalanx.
-Marked distal interphalangeal joint (coffin joint) effusion

POST MRI:
The filly was discharged from MRI service and immediately admitted to surgical service. Options were operative treatment of infection versus trial regional limb perfusion. Regional limb perfusion was immediately initiated and the filly responded favorably, therefore surgical intervention was avoided.

Future soundness with eventual return to work is favorable.

08/04/2020

NEW CASE REVIEW!
6 yo Fox-Hunter prospect (in training) presents with a persistent right forelimb lameness of at least 3-6 months duration, progressing and quite severe at the time of presentation to the MRI clinic. The lameness was noted to be worse when tracking to the right and resolved following a PD nerve block, consistent with a lameness originating from the foot region. X-rays were within normal limits. Ultrasound showed concern for a collateral ligament tear. The patient was referred to MRI to
evaluate for the source of this persistent and slowly progressing lameness.
MRI FINDINGS:
•The medial and lateral lobe of the deep digital flexor tendon (DDFT) have mild dorsal margin fibrillation and tearing at the level of mid P2.
•Just medial to midline, the flexor surface of the navicular bone has a 3 mm area of erosion in its cortex. The DDFT adjacent to this region is moderately fibrillated (secondary to the erosion).
•Mild to moderate diffuse abnormal bone fluid signal is present in the navicular bone. Particularly, there is an area of intense bone fluid surrounding the flexor cortex erosion.
•There is moderate effusion of the navicular bursa with associated synovial proliferation.
•The medial palmar surface of P3 is moderately sclerotic.
•The distal aspect of P3 has moderate diffuse bone fluid signal.
•Mild effusion of the distal interphalangeal joint (coffin joint).
•The collateral ligaments of the DIP joint are normal. There is no tearing or other abnormal findings.

COMMENTS/RECOMMENDATIONS:
The most likely source of the current lameness is the flexor cortex erosion, changes to the navicular apparatus, and the associated DDFT tearing and tendon fibrillation, as well as the abnormal bone fluid in P3.
Due to the nature of the pathology, it is unlikely this horse will have the ability to perform the intended job. Long-term soundness is unlikely given the findings on MRI.

07/31/2020

I know it has been some time since I’ve posted to the page. My most sincere apologies to my loyal followers. To be honest, the business hit a cross-roads secondary to Covid in late spring. I genuinely believed I was going to have to close clinic doors and did not want to give my followers a false sense of security. So, I chose to stay quiet and see how things played out. I don’t know what the distant future holds as I am still working VERY hard to get my head back above water. That being said, I am happy to say I’ve somehow scrambled and managed to officially say that for now, Equine MRI of MD is not going anywhere. What I need from you is your help in continuing to spread the word about the benefits of MRI in the equine population. Your vets need to hear from you that if your horse can benefit from MRI, you’re willing to see it through. The ONLY chance I have of weathering the storm is by having my clients, followers, and supporters rallying behind me and helping me promote this essential service that our local equine community needs to keep. During the Marion DuPont shutdown in April, I saw a number of clients for Dr. Kent Allen at VEI and many other VA region vets. I noticed some trends, and definitely have some
valuable take-aways these strange and vulnerable times have brought me. Please, help me keep this service here for our equestrian community. Every horse I’ve seen in the last year has benefited immensely from MRI. Some to not be tortured with therapies that have no chance of working, and others to be targeted with ones that absolutely will put them back to work and save them from early and unnecessary retirement. I’m also working to try and get the racing industry to be more accepting of adding MRI to their diagnostic tool box, as I truly believe that industry has a significant amount to gain by promoting its use. I know that together, we can change this dynamic of mostly looking to MRI when it’s “too late” for the horse to gain the most benefit. I know that together we can save Equine MRI of MD. PLEASE-if you or someone you know have had an experience with me SHARE IT! You can PM me your review or “check-in” at Equine MRI of MD and post it directly to the page. Word of mouth is the biggest way to make changes! Also, encourage your horse friends to discuss MRI with their vet and let them know they want MRI offered to them when it may be of value in their horses case. Meanwhile, look for a new case review soon as I get back into the groove of giving my followers what they are looking for! Thank you in advance for your continued support! PLEASE SHARE THIS POST!!! 🙏🏻❤️🐴

06/06/2020

CASE REVIEW: Right forelimb lameness, persistent since April 2020. Mildly lame at the walk, and severe Grade 8/10 lame jogging in hand. No swelling or effusions present. Digital pulses within normal limits and hoof testers negative. No appreciable improvement following a low PD block. 90% improvement following a basisesamoid block. Horse was stall rested with hand grazing for 5 days and when veterinarian returned for re-evaluation the lameness had significantly improved to Grade 2/10. Horse was put back on turnout and lameness immediately recurred, Grade 6/10. A distal interphalangeal joint (coffin joint) block was performed at this visit and the horse went 90% sound at 10 minutes. At this time horse was referred for MRI to evaluate for soft-tissue pathology. (*X-rays and ultrasounds performed were within normal limits).

MRI Findings:
•Deep digital flexor tendon, medial lobe, has a large, oblique, full-thickness lesion (tear) at the level of the proximal navicular bursa that causes disruption of the dorsal and palmar margins.
•The initial lesion extends distally and spirals in orientation evolving into a parasagittal orientation and extends to the insertion on the distal phalanx (P3).
•Proximal to the navicular bursa, multiple smaller cross-sectional lesions (tears) are present, extending up to the level of the proximal middle phalanx (P2).
•A dorsal surface lesion is present in the lateral lobe of the deep digital flexor tendon in the bursa with disruption of the dorsal margin.
•Distention of the navicular bursa with effusion. The navicular bursa synovium is abnormally thick and taut. The collateral sesamoidean ligament is enlarged with abnormal hyperintensity.
•The navicular bone surface is irregular, and there is moderate to marked, localized intra-osseous fluid and sclerosis. This may reflect early osteolysis and/or adhesion formation.

Prognosis is poor for this horse to return to work.

05/17/2020

CASE REVIEW. Please note this horse was lame for 1 full year, and had multiple sets of x-rays, ultrasounds, as well as failed treatments. The improved outcome a horse owner stands to gain from utilizing MRI has a direct relationship with how early in the lameness diagnosis process the MRI is performed. (Additionally, this client spent the cost of the MRI more than 2 times over and most importantly, it took over a year to get an accurate diagnosis). I don’t say this to shame any client that can not afford the scan...because it is expensive. I’m just reminding people that though it is costly, almost 100% of my clients have spent well over the MRI fee by the time I see them and still don’t have a diagnosis. Many times this means the outcome for the horse is greatly decreased. So, in FACT, not getting the MRI costs them more (and in more ways than one). The diagnosis for this horse couldn’t be made with the x-rays, ultrasound, or
bone scan. This is typical of foot pathology. Early diagnosis➡️Improved prognosis.

History: 15 yo Lusitano Mare, primary discipline currently pleasure, presents with history of chronic intermittent left forelimb lameness for approximately 1 year. The lameness has progressed and become persistent since December 2019. Owner states she now stands with her left forelimb extended in front of her while at rest. At the time of the December 2019 lameness exam, she improved following an abaxial nerve block and her LF coffin joint was treated with bethamethasone, amikacin, and HA on 12/4/2019. The owner reported a short response to therapy.
On 4/27/2020 the patient was re-evaluated due to her persistent, unresolved lameness, now Grade 2.5/5 when trotted on the straight. At that time a LF mid-pastern nerve block improved the LF lameness to a Grade 1/5. Following a LF basi-sesamoid nerve block the LF lameness improved to a Grade 1/5 circle left and then resolved fully after trotting a circle. A Grade 1/5 RF lameness circle right was now apparent.
Nuclear scintigraphy, radiographs, and ultrasound were performed on 4/27/2020 and there remains concern for an underlying soft-tissue injury and subsequently the patient was referred for MRI.

MRI FINDINGS:

Left front foot:
•Palmar P3 cortical bone fluid. This represents bone remodeling and enthesopathy of the deep digital flexor tendon and distal impar ligament.
•Parasagittal medial lobe deep digital flexor tendon tear from mid P2 to the navicular bone.
•Chronic navicular bursitis.
•P3 medial palmar process contusion.
•Navicular bone fluid, palmar aspect. This may represent bone edema/inflammation or remodeling.
•Mild distal interphalangeal osteoarthrosis.

Right front foot:
•Mild distal P3 contusion/bone inflammation.

COMMENTS/RECOMMENDATIONS:
The most relevant findings to explain the LF lameness are the bone contusion/inflammation and the deep digital flexor tendon tear associated with the navicular apparatus. Consider intra-bursal injections, shoeing that supports the heal and improves break-over, and potentially bisphosphonate therapy.