Enostosis like lesions
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Enostosis -like lesions. Katie Phillips. Hanz accession 147214. 12 yr old warmblood gelding Used for dressage 2 week history of lameness Presented for evaluation of a sore back. 3/5 Lame RF & LH. No change with flexion Could not be blocked . Hanz RF.

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Enostosis -like lesions

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Enostosis-like lesions

Katie Phillips


Hanzaccession 147214

  • 12 yr old warmblood gelding

  • Used for dressage

  • 2 week history of lameness

  • Presented for evaluation of a sore back.

  • 3/5 Lame RF & LH.

  • No change with flexion

  • Could not be blocked


Hanz RF

Differentials: enostosis-like lesion, or less likely fracture, osteomyelitis, bone infarct, osteonecrosis. VRUS 2009


Hanz RH


Enostosis

  • Scintigraphically as focal or multifocal areas of intense increased radioisotope uptake within the medullary cavity of long bones.

  • Radiographically as one or multiple round to irregular shaped opacities within the medullary cavity.

  • A mass of proliferating bone within a bone. –Stedman

  • A morbid bony growth developed within the cavity of a bone or on the internal surface of the bone cortex. -Dorland


Hanz radiographs


Hanz radiographs

Well circumscribed intramedullary sclerosis with no apparent involvement of the cortex.


Enostosis-like lesions in the literature

  • Case reports and clusters of case reports, only.

  • All describe similar scintigraphy and radiographic findings.

  • Etiology is unknown

  • Often considered incidental

  • If no other cause of lameness is identified they are considered the cause.

  • O’Neil 2011 – report 15/21 cases where enostosis-like lesions were considered the cause of lameness.


Features

  • Multiple breeds and disciplines described.

  • May be single or multiple lesions, often multiple limbs.

  • Frequently associated with dorsal endocortexdirectly across from nutrient foramen.

  • Lameness and lesions resolve with time.


Speculation

Similarities to Canine Panosteitis

  • Radiopharmacutical uptake & medullary sclerosis

  • Nidus in vicinity of nutrient foramen

  • Radiographic changes don’t always correlate with lameness.

  • Similar temporal changes

  • Histologically the same

  • But… case reports are all horses in work (skeletally mature).

Human enostosis

  • AKA bone islands

  • Typically not scintigraphically active

  • Asymptomatic, static, solitary

  • Usually metaphyseal or epiphyseal

  • Bone Infarct

  • Case report in horse- showed colic like pain, then lameness.

  • Time line is different for scintigraphy changes and radiographic lag.


IMAGING DIAGNOSIS—ENOSTOSIS-LIKE LESION IN THE FEMUROF A HORSESUSANNE M. STIEGER-VANEGAS, HEGE KIPPENES-SKOGMO, EBBA NILSSONVeterinary Radiology & Ultrasound, Vol. 50, No.5, 2009, pp 509–512.

  • Case report 15yr WB

  • Only case in literature with histology!!

  • 4/5 lame LH localization was not possible.

  • Histo: No inflammatory cells, no thrombus, no evidence of bone necrosis. Similar to panosteitis of young dogs.

  • No histological involvement of endosteum.


References

  • Stieger-Vanegas, Kippenes-Skogmo, Nilsson. Imaging diagnosis- Enostosis-like lesion in the femur of a horse. 2009.VRUS.50(5) 509-512

  • Bassage, Ross. Enostosis-like lesions in the long bones of 10 horses:scintigraphic and radiographic features. 1998.Equine vet j. 30(1) 35-42

  • Ramzan.Equine enostosis-like lesions:12 cases 2002 EVE14(3) 143-148.

  • Jones & McDiarmid. Case report:Multiple enostosis-like lesions in a racing thoroughbred. 2005.eve. 17(2 92-95

  • O’Neil & Bladon.Retrospective study of scintigraphic and radiological findings in 21 cases of enostosis-like lesions in horses. 2011 veterinary record. 168:326


MRI – Travis 147695

There are regions of intense medullary T2-hyperintensity in the third metatarsal bone at the level of the nutrient artery.  This appearance is consistent with enostosis but hematogenous osteomyelitis could also have this appearance.


Hanz – follow up

  • One dose IV Tildren

  • 2 months rest

  • Re-check: grade 1/5 lame RF, mildly positive to flexion LH.


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