Captivating Cases

Issue 22 - July 2016

Please join us in welcoming Dr. Jared Sharp to the Animal Imaging team!

Dr. Sharp received his DVM from Oregon State University in 2015 and has a special interest in advanced imaging having had experience utilizing nuclear scintigraphy, MRI, radiology and ultrasonography during previous internships. Dr. Sharp is here to help assist in the management of both equine and companion animal cases.

Equipped for Success

Animal Imaging offers virtually every outpatient veterinary diagnostic imaging option available for small animal and equine, all in one location:

CT Scan
Fluoroscopy
MRI (3-Tesla)
Nuclear Medicine
Teleradiology
Ultrasound

MRI/CT of the Canine Skull

History and clinical complaint:

A 4-year-old neutered male Poodle was presented to Animal Imaging in April for an MRI of the skull. He has a history of chronic otitis. Stertorous breathing and dysphagia had been present since March. On examination at that time, an oropharyngeal mass was identified. Fine needle aspirates and exploratory surgery of the mass were non-diagnostic.

Findings:

Axial T2 of the skull. Material of mixed hyperintensity in the right tympanic bulla and right external ear canal. Normal left tympanic bulla (green arrow).Abnormal angulation of the right stylohyoid bone is seen with no definitive fractures.

Physical examination at Animal Imaging was unremarkable. An MRI of the skull and non-contrast CT was performed under general anesthesia. Mixed intensity material that showed evidence of differential contrast enhancement was identified filling the right tympanic bulla within associated mass effect. This material extended in to the adjacent horizontal external ear canal. An additional encapusalted cavity contiguous with the external ear canal was seen ventral to the right tympanic bulla. This cavity had peripheral/rim contrast enhancement and no internal enhancement supporting it being filled with cellular fluid/debris and mucus.

Axial T1 post contrast image showing peripheral rim enhancement of portions of the material in the right external ear canal and abnormal cavity (yellow arrow). Enhancement of tissues ventromedial to the right tympanic (green arrow).

The right tympanic bulla also had mixed mild lytic and proliferative changes along the ventral wall supporting osteitis/osteomyelitis. Mild contrast enhancement of the soft ventromedial to the right tympanic bulla and lateral to larynx were evident supportive associated localized soft tissue inflammation. No definitive abnormalities are appreciated associated with the right inner ear. No abnormalities were seen with the left tympanic bulla.

Mixed areas of mild bony lysis and proliferation.

Conclusion:

The changes seen are supportive of right otitis media with bulla osteitis/osteomyelitis and mild localized cellulitis. Primary differential and infectious and/or inflammatory otitis media/externa. The additional encapsulated cavity could represent a chronic abscess or unusual/rare traumatic or developmental diverticulum. Consultation with a board certified surgeon was advised and pursued. A right total ear canal ablation and lateral bulla osteotomy were performed. The diagnosis was chronic and mildly hyperplastic otitis externa and media. The dog is currently doing well.