Soft tissues

image of Soft tissues
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Indications for radiography of the peripheral soft tissues of the body are numerous, and may include: Localized or diffuse soft tissue swelling; atrophy of one or more muscle groups; changes in texture of soft tissue on palpation; pain on palpation of soft tissue; and one or more discharging sinus tracts. This chapter looks at radiography; contrast studies; alternative imaging techniques and abnormal image findings.

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6.1 Mediolateral (ML) postoperative radiographs of the stifle and hock of a dog. (a) The soft tissues are clearly visible. Note that fat lying in the fascial planes (black arrows) and in the infrapatellar region (white arrow) is more radiolucent (darker) than other soft tissues. The infrapatellar fat pad has been reduced in size by a stifle joint effusion. (b) Both images have been overexposed, resulting in saturation of the image plate, and the soft tissues are no longer visible.
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6.2 Ultrasonographic images of the Achilles tendon in a middle-aged Dobermann with chronic pelvic limb lameness. The image depth is 3 cm. (a) Distal tendon. The curvilinear bright echo on the right of the image represents the surface of the calcaneus. A longitudinal section of the distal part of the Achilles tendon lies between the white arrows. There is some disturbance of the normal linear fibre pattern, and a single hyperechoic focus of dystrophic mineralization with mild acoustic shadowing is seen (black arrow). (b) Longitudinal ultrasonographic image at the musculotendinous junction of the gastrocnemius. There is a large, irregularly shaped accumulation of fluid (arrowed) indicating tearing of muscle bundles and subsequent haemorrhage.
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6.3 A 9-year-old Golden Retriever presented with unilateral elbow lameness and swelling. Ultrasonographic examination showed a heterogeneous soft tissue mass (black arrow) encircling the elbow joint. Irregularity of the surface of the humerus (white arrows) suggests bony involvement. The histological diagnosis was synovial cell sarcoma.
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6.4 An ultrasonographic image of a superficial soft tissue swelling in a cross-breed dog. Image depth is 2 cm. The characteristic spindle shape of a grass seed foreign body (labelled FB) is seen, surrounded by a narrow dark halo of fluid.
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6.5 T2W dorsal plane MRI of the head of a dog. There are multiple, ill-defined regions of high signal intensity in the left temporal and masseter muscles (viewer’s right; arrowed). These are regions of inflammation, in this instance secondary to para-aural abscessation.
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6.6 A T1W (post-gadolinium) dorsal plane MRI of the head of a dog presented with a right-sided maxillary swelling. The superficial swelling is clearly seen. Partial contrast uptake by the abnormal tissue reveals the full extent of the mass (arrowed) both medial and lateral to the vertical ramus of the mandible. The final diagnosis was a poorly differentiated sarcoma.
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6.7 A T1W (post-gadolinium) transverse MRI image of the caudal abdomen of a cat showing a spindle cell sarcoma which extends to involve the epaxial muscles on the right (viewer’s left). (Courtesy of N Hayward)
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6.8 Post-contrast CT images (soft tissue window) of the thorax of a dog. (a) Sagittal plane. Cranial is to the left of the image. A large amount of abnormal soft tissue attenuating material is present between the heart and sternum. Within this soft tissue, a linear structure is visible, dorsal to the 3 to the 6 sternebrae, that appears slightly hyperattenuating to soft tissue. A small volume of hypoattenuating material surrounds this, probably representing a pocket of fluid. A stick was found at surgery. (b) Transverse plane. The left of the patient is to the right of the image. The stick foreign body can be seen in cross-section as a hyperattenuating circle with a hypoattenuating centre dorsal to the sternum. New bone formation located to the right of the foreign body represents the result of chronic osteomyelitis secondary to the foreign material and subsequent infection.
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6.9 A transverse CT image (soft tissue window) through the thigh of a dog, showing an infiltrative lipoma centrally.
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6.10 A lateral radiograph of the hindquarters of a cat, showing large volumes of gas underneath the skin and separating the muscle bellies. There was also free gas within the peritoneal space secondary to perforation of the gastrointestinal tract.
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6.11 ML radiograph of the stifle and crus of a dog. Note the diffuse, broad-based soft tissue swelling on the cranial aspect of the mid-shaft tibia. Two bone plates have previously been applied to the proximal tibia. Spicular new bone is visible on the caudal aspect of the tibia at the level of the distal end of the plates, and further irregular new bone is seen cranially, extending into the soft tissue swelling. These changes are suggestive of neoplasia, which was subsequently confirmed at post-mortem examination. There is concurrent osteoarthrosis of the stifle.
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6.12 ML shoulder radiograph of an adult dog presenting with chronic thoracic limb lameness. Extensive dystrophic mineralization is seen in the tendon of insertion of the supraspinatus muscle (arrowed).
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6.13 ML view of the hock of a cross-breed dog. There is a soft tissue swelling on the plantar aspect of the hock (arrowed) with speckled mineralization in the proximal part (arrowhead). This proved to be a granuloma.
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6.14 (a) Neutral and (b) flexed ML views of the left elbow of a 15-month-old Staffordshire Bull Terrier. There is a well defined, triangular osseous body that presents a trabecular pattern and is located immediately proximal to the olecranon, in the region of the insertion of the triceps tendon. Although histopathology was not performed in this case, the appearance and location are most consistent with the heterotopic bone formation that is typically seen with myositis ossificans. Similar osseous bodies were also identified in the shoulder region of the same dog, adding further weight to the likely diagnosis of myositis ossificans.
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6.15 Lateral radiograph of the skull and pharynx of an adult dog presenting with episodic snorting. A metallic foreign body is present in the rostral nasopharynx.
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6.16 Ventrodorsal (VD) abdominal radiograph of an elderly collie-cross dog. A mass of fat opacity is visible on the right flank (arrowed) between the muscle planes. This was an incidental lipoma.
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6.17 Lateral view of the neck of a Labrador Retriever. There is a soft tissue swelling in the ventral pharyngeal region containing gas bubbles (arrowed). A metallic probe (P) shows the position of an oral wound and tract. This proved to be an abscess.
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6.18 Sinogram of a dog with a discharging sinus on the right side of the neck. There is a large subcutaneous accumulation of contrast medium ©, and streaks of contrast medium outline a stick foreign body (arrowed).
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6.19 ML view of the thoracic limb of a Basset Hound. A tortuous network of blood vessels outlined by contrast medium indicates an arteriovenous malformation.

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