Advanced Diagnostics at Work

An MRI cross sectional image shows a light grey infiltrative mass seen on outer and inner aspects of the intervertebral disc space (double arrow). The mass is compressing the dark grey spinal cord (single arrow).

Since animals can't tell us where or how it hurts, veterinarians often rely on advanced diagnostics and specialist teamwork to determine a diagnosis and treatment plan. In this case, a senior golden retriever was referred to the hospital for evaluation of weakness in the forelimbs that rapidly progressed to severe weakness in all four legs. Sometimes the cause of lameness is clear-cut. Other times, the cause is illusive, and it takes a team of experienced specialists and advanced technology to come to the correct conclusion.

In this case, the neurologic examination suggested a compressive spinal cord lesion in the cervical (neck) region. The physical examination also revealed multiple enlarged superficial lymph nodes.

A second mass (double arrow) is found on the MRI study further down the spinal column, and is resulting in severe compression of the dark grey spinal cord (single arrow).

An MRI of the cervical spine was performed to determine the location of the suspected compressive lesion. Special contrast was used to further define the lesion. The MRI showed 2 large compressive lesions. One lesion was resulting in about 50% compression of the spinal cord at C2-3 and the second lesion was resulting in about 75% compression of the cord at the junction of the cervical and thoracic spinal segments (C7-T1). Both lesions extended out of the canal into the surrounding tissues.

Based on the multiple sites and the appearance of the lesions a tentative diagnosis of lymphoma was made. The decision was made to move the patient to the CT (CAT or computerized tomography) scanner to rapidly evaluate the remaining spine. The CT scan showed severe enlargement of the lymph nodes beneath the lumbar spine. No other compressive lesions were seen.

In order to obtain a definitive diagnosis fluoroscopic guidance was used to acquire a biopsy of the cranial cervical mass and ultrasound was used to acquire an aspirate of the lumbar lymph nodes. Based on these samples the tentative diagnosis of lymphoma was confirmed.

CT scan of the lumbar spine demonstrates markedly enlarged sub-lumbar lymph nodes (arrows).

This study demonstrates the benefits of combining specialists from multiple disciplines (Neurology, Radiology, Internal Medicine, Surgery) with the necessary tools (in this case MRI, CT, ultrasound and fluoroscopy) to make an efficient diagnosis. Most importantly, the diagnostic team includes the client, so that informed choices can be made at each step along the way. When patients are referred to us from other veterinarians, the referring vet is kept in the loop, too.

When it comes to complex cases, a team approach and advanced technology work hand-in-hand when it comes to choosing the right care for your pet.