CT/MRI Society Case of the Month
December 2006
Sponsored by Eklin Medical Systems
Patient Identification Number: CTMRSOC1
Patient Surname Code: CTMRSOC
Patient First Name Code: GAVIN
Accession Number: DEC06
Contributor: Pat Gavin and John Haburjak
Contributor’s Affiliation: Wash. St. Univ
Species: Canine
Breed: Golden Retriver
Age at exam: 2 years
Gender: Neutered male
Presenting signs and pertinent history:
Draining tract carpus, explored 3 times and "stick" material was found but no resolution.
Clinical/Neuro Findings:
Draining tracts LF.
Relevant Laboratory data:
Primary clinical rule-out pre imaging:
Foreign Body.
Modality: MR
Manufacturer: Seimens
Model/Field Strength: 1.5 T Symphony
Sequences Acquired:
STIR in all planes T1 pre and T1 post fat sat in all three planes.
CT/MR Findings:
An abnormality is seen in the soft tissues of the left forefoot. This is a hyperintense lesion on STIR sequences. This hyperintensity is due to a fluid collection. The draining fistulas tracts can be seen, which appear to be in the dew claw region and possibly also at the palmar aspect of the paw, just distal to the pad for the accessory carpal bone. In the center of this fluid channel is a hypointense structure that measures 3.5 cm in length by approximately 5 mm in width. There appears to be a center to this material. This would appear to be a stick with a form of soft core that is soaking up fluid. This lesion is deep to the flexor tendons of the foot, but palmar to the metacarpals. The lesion is virtually midline between the third and fourth metacarpal.
The presence of a hypointense lesion surrounded by fluid that is draining through the fistulous tracts is virtually certain to be a foreign object. This appears to be a long stick within the soft tissues. The lesion is well visualized on virtually all STIR sequences and the T1 post-contrast study and should be an aid in the surgical approach.
CT/MR Assessment:
Foreign body
Post Imaging Management:
Surgery
Outcome:
Large stick removed and images attached.
Final Diagnosis based on all diagnostic tests and outcome:
Comments:
Surgery for foreign bodies is helped with a clear visual road map; previous 3 attempts stopped short of the goal as the stick was deep to the flexor tendons.