Interactive Case Tutorial

 Review the history and signalment for the client  Evaluate the radiographs provided  Explore the interactive images and compare the answers given with your own interpretations. When you’ve clicked on the image, click the same spot again to make the label disappear.  Answer the questions regarding a diagnosis and recommendations  Review the radiologist’s findings

 Signalment: 8 week old Arabian filly  History: puncture wound to the right carpus 11 days prior to presentation; waxing and waning carpal swelling and lameness  Study: standard views of the right carpus

Dorsal displacement of carpal fat pad due to intracapsular selling of radiocarpal joint Marked extracapsular swelling Normal chestnut Lysis and fragmentation of lateral styloid process Intra- and extracapsular swelling Intracapsular swelling of radiocarpal joint Normal physis Normal vestigial ulna (not periosteal reaction)

Displaced carpal fat pad (not gas) Marked extracapsular swelling (intracapsular swelling is also present Normal physis Normal vestigial ulna (not periosteal reaction) Lysis of the lateral styloid process

 Provide a diagnosis based on your findings. Submit Findings are consistent with septic arthritis of the radiocarpal (antebrachiocarpal) joint and osteomyelitis of the lateral styloid process with diffuse cellulitis secondary to the puncture wound Feedback Continue

 Provide your recommendation for this client. Submit Ultrasound of the carpus Joint fluid analysis for cytology and culture Feedback Continue

 Marked extracapsular soft tissue swelling is present in the distal antebrachium through the carpus mainly at the caudal and lateral aspect  The radiocarpal (antebrachiocarpal) joint has marked intracapsular soft tissue swelling with dorsal displacement of the carpal fat pad  The lateral styloid process has lysis at the lateral and dorsomedial aspect; there is articular involvement and one associated fragment

 Surgical exploratory (arthroscopy), debridement of the lateral styloid process was performed, and the joint was flushed  Antibiotic therapy (intravenous, intra-articular, and regional limb perfusions) was instituted