Case Study 
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History: P3 Edema
Patient is a twelve year old Quarter Horse gelding that presented to Animal Imaging for an MRI of the left hind foot.  The horse originally presented to the referring veterinarian two months prior for a grade I/V left hind lameness that had progressively worsened to a grade IV.  Ultrasound of the distal limb was unremarkable.  Radiographs revealed proliferative bone on the cranial aspect of P2, which was not articular.  The lameness was 80 percent alleviated with a posterior digital nerve block and blocked 100 percent to an abaxial nerve block. 
  Articular cyst in P3                                                       
There is an articular osseous cyst like lesion with a small fragment associated with the plantar aspect of the coffin joint (P3).  Signal changes in the coffin bone and navicular bone are consistent with moderate to severe bone edema.  Bone bruising is considered the most likely etiology.  Increased fluid within the digital tendon sheath and coffin joint are consistent with synovitis. 
Articular cyst in P3 
Impressions and Recommendations:
The primary pathology appears to be the articular cyst that formed on the plantar aspect of the coffin bone.  There was evidence of contrast enhancement on an axial image post gadolinium administration.  The lesion does not appear to be surgical given its location.  Prognosis is guarded given the size and location of the lesion.  The articular cyst may have a traumatic origin.  Consider intra articular IRAP or stem cell therapy.  Extended athletic rest is recommended.  Coffin joint anesthesia may help differentiate the pain caused by the cystic lesion versus the pain caused due to the bone bruising.  The extended stall rest will likely resolve the marked pedal osteitis or bone bruising noted in P3.  Tildren may be a course of therapy given the bone pathology noted in multiple locations. 
Animal Imaging 
Animal Imaging is a veterinary referral diagnostic center in Irving offering MRI, Scintigraphy, Radiology, Fluoroscopy and Ultrasound for companion animals and equine patients. 

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Jake Hersman, DVM            Robert Cole, DVM, DACVR           Susan Willenbrock
Managing Partner                 Imaging Director                           Office Manager
(972) 869-2180                     (972) 869-2180                             (972) 869-2180