Case Report Rapport de cas Circumferential cervical rubber band foreign body diagnosis in a dog using computed tomography Dainna Stelmach, Ajay Sharma, Desiree Rosselli, Chad Schmiedt Abstract — Computed tomography (CT) of a dog with a cervical concentric wound and ventral chronic draining tract revealed a hyper-attenuating, concentric foreign body and contrast-enhancing tract. This is the first descriptive report of rubber band syndrome in a dog and CT characteristics of a subcutaneous rubber band foreign body. Résumé — Diagnostic d’une bande élastique cervicale circonférentielle comme corps étranger chez un chien à l’aide de tomodensitométrie. La tomodensitométrie (TD) d’un chien avec une blessure concentrique cervicale et un faisceau de drainage ventral chronique a révélé un corps étranger concentrique hyper-atténuant et un faisceau accentué par contraste. Il s’agit du premier rapport sur un syndrome de la bande élastique chez un chien et sur les caractéristiques d’une TD d’une bande élastique sous-cutanée comme corps étranger. Can Vet J 2014;55:961–964
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ubcutaneous rubber band foreign bodies have been described in humans, particularly in children and the elderly, when a rubber band is worn around a wrist or digit and is forgotten (1–3). This has been described as rubber band syndrome and has clinical features that aid in the diagnosis. One report describes a characteristic constricting scar in a person with a draining tract as a key clinical feature that should alert clinicians to the possibility of rubber band syndrome (3). Another report describes radiographic evidence of bony erosion secondary to the foreign body (2). Similar clinical and radiographic findings have been reported in a cat (4). In these previous reports, the definitive diagnosis was made after surgical exploration. To the authors’ knowledge, no reports exist describing the appearance of a constricting rubber band foreign body using computed tomography (CT). The purpose of this report is to present the clinical presentation, diagnostic imaging features, and outcome of rubber band syndrome in a dog.
Case description A 3-year-old, spayed female Chihuahua mixed breed dog was presented to the University of Georgia, Veterinary Teaching Department of Veterinary Biosciences and Diagnostic Imaging (Stelmach, Sharma) and Department of Small Animal Medicine and Surgery (Rosselli, Schmiedt), College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, Georgia 30602, USA. Address all correspondence to Dr. Dainna Stelmach; e-mail: [email protected] Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. CVJ / VOL 55 / OCTOBER 2014
(Traduit par Isabelle Vallières)
Hospital with a 1-year history of a recurrent draining wound on the left ventral neck. At the time of adoption from a shelter, a circumferential scar identified on her neck was suspected to be from a previously embedded collar. On presentation, clear fluid was draining from a 1.5 cm 3 1.5 cm open wound on the left ventral aspect of the neck. There was mild alopecia around the scar and along the area of the right scapula. The mandibular lymph nodes were mildly enlarged. No other abnormalities were noted on physical examination. Minimum database included a complete blood cell count, a serum biochemistry profile, an impression smear of the wound, and thoracic radiographs. Blood work revealed a mild eosinophilia (1.584 3 103/mL, reference range: 0 to 1.3 3 103/mL). No other blood abnormalities were detected. Cytologic evaluation of the impression smear revealed increased eosinophils, neutrophils, and a moderate amount of spherical bacteria (cocci). Three-view thoracic radiographs showed a well-defined, 0.7 cm 3 0.3 cm, ovoid lucency, surrounded by mild sclerosis in the mid-aspect of the right scapular spine (Figure 1). The lateral margin of the scapular spine was mildly undulant. The intra-thoracic structures were normal. Computed tomography was performed for surgical planning and to identify a potential cause for the chronic draining wound. Images were acquired using a dual slice, CT scanner (GE Healthcare, Fairfield, Connecticut, USA) in 2 mm, continuous helical slices. Images were acquired in soft tissue and bone algorithms using a kVp of 120, mAs 200 and 0.7 s rotation time. Post-contrast images were acquired after intravenous Omnipaque (Iohexol 350 mg I/mL; GE Healthcare) administered at a dose of 800 mg iodine/kg body weight via a catheter in the left cephalic vein. Dorsal and sagittal plane reformations were made through standard available CT software (HiSpeed Nx/I, series 11.00; GE Healthcare). Curved multiplanar reconstruction, 3-dimensional maximum intensity 961
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Figure 2. Pre-contrast computed tomography maximum intensity projection. The circumferential linear foreign body can be seen eroding through the spine of the right scapula (white arrow).
Figure 1. Ventrodorsal thoracic radiograph. There is a welldefined ovoid lucent defect in the mid aspect of the right scapula (white arrow).
projections and 3-dimensional volume rendering images were created post-processing in OsiriX (version 5.0.2, 64-bit; Pixmeo, Geneva, Switzerland). Computed tomography findings included a circumferential, linear foreign body embedded in the musculature of the caudal cervical region and penetrating through the spinous process of the right scapula (Figure 2). The foreign body was markedly hyper-attenuating, making it easily identifiable on pre-contrast images (Figure 3). On post-contrast images, there was moderate contrast enhancement adjacent to the foreign body along its entire length. The foreign body was continuous with a fluid to soft tissue attenuating fistulous tract extending to the skin surface, consistent with the reported draining tract. Additional, multifocal, smaller pockets of non-enhancing fluid to soft tissue attenuating material were noted along the length of the foreign body tract (Figure 4). The right superficial cervical lymph node was mildly enlarged. The imaging findings were consistent with an embedded concentric linear foreign body surrounded by an abscessated fistulous tract, focal pressure necrosis of the right scapula, and reactive hyperplasia of the regional lymph node. Based on the CT images, exploratory surgery was performed to remove the foreign body. With the patient in dorsal recumbency, an incision was made parallel with the scar and draining tract on the caudoventral neck. The draining tract was traced caudolaterally towards the right thoracic limb. A separate approach was made caudodor962
sal to the right scapula. With digital palpation of the area, a thin fibrous tract could be traced to the ventral aspect of the draining tract. The area between the 2 surgical approaches was explored until the foreign body, which was a large, red rubber band, was identified. The rubber band was transected and easily pulled from the tract. A tissue sample of the tract was obtained for microbial culture and sensitivity. The surgical wound was copiously lavaged. A Jackson-Pratt drain was placed within the wound, exiting lateral to the scar. Both incisions were closed in a 2-layer fashion. The dog was sent home with the broad-spectrum antibiotic, cephalexin (Kefavet; Orion, Espoo, Finland), 250 mg, PO, q12h, and buprenorphine (Buprenex; Reckitt & Colman, Berkshire, England), 0.09 mg, PO, q8h, for pain relief. The culture revealed heavy growth of Staphylococcus intermedius group, which was susceptible to the chosen antibiotic. The patient healed without complications and there have not been any recurrent draining tracts in 5 months since the surgery.
Discussion Pre-surgical diagnosis of foreign bodies using routine radiography can be difficult due to small size, potential for being obscured by adjacent structures, and, in non-mineral or metallic foreign bodies, their relative lack of contrast compared to adjacent soft tissues. The utility of diagnostic imaging for diagnosing foreign bodies has been described in veterinary medicine (5–12). Non-metallic foreign bodies, such as wooden splinters or sticks may be common, but are generally not visible on radiographs. In descriptions of rubber band syndrome in veterinary and human patients, radiographic evidence of osteolysis in association with a concentric scar may suggest the presence of a constricting foreign body (2–4). In our patient, radiographically evident osteolysis of the scapular spine was secondary to pressure necrosis associated with the rubber band foreign body. Sinography or fistulography, the injection of iodinated contrast material into a draining tract or sinus, has proven useful in diagnosing some cases of foreign body migration in small and large animal patients (13,14). If pulmonary communication is CVJ / VOL 55 / OCTOBER 2014
CA S E R E P O R T
Figure 3. Pre-contrast computed tomography maximum intensity projection. There is an ovoid lucent defect in the spine of the right scapula (black arrow). A hyperattenuating circumferential linear foreign body surrounds the deep cervical musculature (white arrow).
Figure 4. Post-contrast computed tomography curved multiplanar reconstruction. There is a concentric, contrastenhancing tract that follows the foreign body. Multiple fluidattenuating pockets are present along the length of the tract (black arrow) and in the area of the chronic draining tract of the ventral neck (white arrow).
suspected, sinography/fistulography may be contraindicated due to the risk of severe pulmonary edema (15). This risk may be minimized, however, with the use of non-ionic, iodinated contrast agents (16). Reports on humans have indicated that ultrasound is an accurate imaging modality for detecting and diagnosing radiolucent foreign bodies (17). Ultrasonographically, foreign bodies have been described as linear, hyperechoic structures with variable distal acoustic shadowing and/or reverberation artifact (18,19). However, ultrasound may be limited at increased depths as well as in cases where overlying gas-filled, osseous, or dense anatomical structures impede or attenuate the ultrasound beam. A recent study compared the accuracy of ultrasonography, CT, and magnetic resonance imaging (MRI) for the diagnosis of a wooden foreign body in the canine manus. In this study, there were limitations when using ultrasound, especially in the area of the metacarpal pad. The distal acoustic shadow associated with the pad tended to obscure the underlying foreign body. In that study, CT was the most accurate diagnostic imaging modality in detecting wooden foreign bodies in the canine manus (11). Magnetic resonance imaging is generally less useful for identifying the actual foreign body than it is for detecting the resultant surrounding soft tissue inflammation. Reports in human medicine have determined MRI characteristics of foreign bodies. On MRI, non-metallic foreign bodies have been identified as linear areas of decreased signal intensity on T1- and T2-weighted images. There may be ill-defined, increased signal intensity in the surrounding soft tissues on T2-weighted and T2-STIR sequences associated with inflammation. Depending on severity, this inflammation may completely obscure the foreign body (20). Because of the limitations of other imaging modalities, as well as the speed of acquisition and general affordability of
CT, pre- and post- contrast, CT was the imaging modality of choice in our patient. In this case, the foreign body was easily detectable as a hyper-attenuating, thin, circular structure, prior to contrast administration. With intravenous contrast administration, areas of increased perfusion or vascularity, such as inflammation, are more easily delineated from normal tissue. In this case, post-contrast images delineated the entire tract that corresponded to the superficial, circumferential scar, and demonstrated communication with the external draining wound. Three-dimensional reconstructions of the area were useful for surgical planning. To the authors’ knowledge, this is the first report of the CT characteristics of a rubber band foreign body and rubber band syndrome in a dog. CVJ
CVJ / VOL 55 / OCTOBER 2014
References 1. Kumar P, Kumar B, Singh K. A constriction ring of the thigh secondary to a rubber band. Plast Reconstr Surg 1995;95:209–210. 2. Saour S, Mohanna PN, James M. An elastic band foreign body circumferentially around the proximal phalanx, detected 2 years post injury. J Plast Reconstr Aesthet Surg 2010;63:e199–200. 3. Aggarwal AN, Kini SG, Arora A, Singh AP, Gupta S, Gulati D. Rubber band syndrome — High accuracy of clinical diagnosis. J Pediatr Orthop 2010;30:e1–4. 4. Brisson BA, Theoret MC. Osteolysis of the radius and ulna induced by a circumferential foreign body in a cat. J Am Vet Med Assoc 2008; 233:1117–1120. 5. Mahajan SK, Anand A, Sangwan V, Mohindroo J, Singh K. Surgical retrieval of a metallic foreign body from the spleen of a dog. Can Vet J 2012;53:399–401. 6. Goldsworthy SJ, Burton C, Guilherme S. Parotid duct foreign body in a dog diagnosed with CT. J Am Anim Hosp Assoc 2013;49:250–254. 7. Shanaman MM, Schwarz T, Gal A, O’Brien RT. Comparison between survey radiography, b-mode ultrasonography, contrast-enhanced ultrasonography and contrast-enhanced multi-detector computed tomography findings in dogs with acute abdominal signs. Vet Radiol Ultrasound 2013;54:591–604. 8. Johnson-Neitman JL, Bahr RJ, Broaddus KD. Fistula formation secondary to a nylon cable band in a dog. Vet Radiol Ultrasound 2006;47:355–357.
963
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9. Lefebvre J, Kuehn NF, Wortinger A. Computed tomography as an aid in the diagnosis of chronic nasal disease in dogs. J Small Anim Pract 2005; 46:280–285. 10. Llabres-Diaz FJ, Brissot H, Ibarrola P. Imaging diagnosis — Celiac artery pseudoaneurysm associated with a migrating grass awn. Vet Radiol Ultrasound 2010;51:508–511. 11. Ober CP, Jones JC, Larson MM, Lanz OI, Werre SR. Comparison of ultrasound, computed tomography, and magnetic resonance imaging in detection of acute wooden foreign bodies in the canine manus. Vet Radiol Ultrasound 2008;49:411–418. 12. Schultz RM, Zwingenberger A. Radiographic, computed tomographic, and ultrasonographic findings with migrating intrathoracic grass awns in dogs and cats. Vet Radiol Ultrasound 2008;49:249–255. 13. Jackson AH, Degner DA. Cutaneopulmonary fistula in a dog caused by migration of a toothpick. J Am Anim Hosp Assoc 2002;38:545–547. 14. Lamb CR, White RN, McEvoy FJ. Sinography in the investigation of draining tracts in small animals: Retrospective review of 25 cases. Vet Surg 1994;23:129–134.
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15. Wallack ST. The Handbook of Veterinary Contrast Radiography. San Diego, California: San Diego Veterinary Imaging, 2003. 16. McAlister WH, Askin FB. The effect of some contrast agents in the lung: An experimental study in the rat and dog. AJR Am J Roentgenol 1983;140:245–251. 17. Orlinsky M, Knittel P, Feit T, Chan L, Mandavia D. The comparative accuracy of radiolucent foreign body detection using ultrasonography. Am J Emerg Med 2000;18:401–403. 18. Ipaktchi K, Demars A, Park J, Ciarallo C, Livermore M, Banegas R. Retained palmar foreign body presenting as a late hand infection: Proposed diagnostic algorithm to detect radiolucent objects. Patient Saf Surg 2013;7:25. 19. Boyse TD, Fessell DP, Jacobson JA, Lin J, van Holsbeeck MT, Hayes CW. US of soft-tissue foreign bodies and associated complications with surgical correlation. Radiographics 2001;21:1251–1256. 20. Iyer RS, Thapa MM. MR imaging of the paediatric foot and ankle. Pediatr Radiol 2013;43 Suppl 1: S107–119.
CVJ / VOL 55 / OCTOBER 2014
S
ubcutaneous rubber band foreign bodies have been described in humans, particularly in children and the elderly, when a rubber band is worn around a wrist or digit and is forgotten (1–3). This has been described as rubber band syndrome and has clinical features that aid in the diagnosis. One report describes a characteristic constricting scar in a person with a draining tract as a key clinical feature that should alert clinicians to the possibility of rubber band syndrome (3). Another report describes radiographic evidence of bony erosion secondary to the foreign body (2). Similar clinical and radiographic findings have been reported in a cat (4). In these previous reports, the definitive diagnosis was made after surgical exploration. To the authors’ knowledge, no reports exist describing the appearance of a constricting rubber band foreign body using computed tomography (CT). The purpose of this report is to present the clinical presentation, diagnostic imaging features, and outcome of rubber band syndrome in a dog.
Case description A 3-year-old, spayed female Chihuahua mixed breed dog was presented to the University of Georgia, Veterinary Teaching Department of Veterinary Biosciences and Diagnostic Imaging (Stelmach, Sharma) and Department of Small Animal Medicine and Surgery (Rosselli, Schmiedt), College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, Georgia 30602, USA. Address all correspondence to Dr. Dainna Stelmach; e-mail: [email protected] Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office ([email protected]) for additional copies or permission to use this material elsewhere. CVJ / VOL 55 / OCTOBER 2014
(Traduit par Isabelle Vallières)
Hospital with a 1-year history of a recurrent draining wound on the left ventral neck. At the time of adoption from a shelter, a circumferential scar identified on her neck was suspected to be from a previously embedded collar. On presentation, clear fluid was draining from a 1.5 cm 3 1.5 cm open wound on the left ventral aspect of the neck. There was mild alopecia around the scar and along the area of the right scapula. The mandibular lymph nodes were mildly enlarged. No other abnormalities were noted on physical examination. Minimum database included a complete blood cell count, a serum biochemistry profile, an impression smear of the wound, and thoracic radiographs. Blood work revealed a mild eosinophilia (1.584 3 103/mL, reference range: 0 to 1.3 3 103/mL). No other blood abnormalities were detected. Cytologic evaluation of the impression smear revealed increased eosinophils, neutrophils, and a moderate amount of spherical bacteria (cocci). Three-view thoracic radiographs showed a well-defined, 0.7 cm 3 0.3 cm, ovoid lucency, surrounded by mild sclerosis in the mid-aspect of the right scapular spine (Figure 1). The lateral margin of the scapular spine was mildly undulant. The intra-thoracic structures were normal. Computed tomography was performed for surgical planning and to identify a potential cause for the chronic draining wound. Images were acquired using a dual slice, CT scanner (GE Healthcare, Fairfield, Connecticut, USA) in 2 mm, continuous helical slices. Images were acquired in soft tissue and bone algorithms using a kVp of 120, mAs 200 and 0.7 s rotation time. Post-contrast images were acquired after intravenous Omnipaque (Iohexol 350 mg I/mL; GE Healthcare) administered at a dose of 800 mg iodine/kg body weight via a catheter in the left cephalic vein. Dorsal and sagittal plane reformations were made through standard available CT software (HiSpeed Nx/I, series 11.00; GE Healthcare). Curved multiplanar reconstruction, 3-dimensional maximum intensity 961
R A P P O R T D E CA S
Figure 2. Pre-contrast computed tomography maximum intensity projection. The circumferential linear foreign body can be seen eroding through the spine of the right scapula (white arrow).
Figure 1. Ventrodorsal thoracic radiograph. There is a welldefined ovoid lucent defect in the mid aspect of the right scapula (white arrow).
projections and 3-dimensional volume rendering images were created post-processing in OsiriX (version 5.0.2, 64-bit; Pixmeo, Geneva, Switzerland). Computed tomography findings included a circumferential, linear foreign body embedded in the musculature of the caudal cervical region and penetrating through the spinous process of the right scapula (Figure 2). The foreign body was markedly hyper-attenuating, making it easily identifiable on pre-contrast images (Figure 3). On post-contrast images, there was moderate contrast enhancement adjacent to the foreign body along its entire length. The foreign body was continuous with a fluid to soft tissue attenuating fistulous tract extending to the skin surface, consistent with the reported draining tract. Additional, multifocal, smaller pockets of non-enhancing fluid to soft tissue attenuating material were noted along the length of the foreign body tract (Figure 4). The right superficial cervical lymph node was mildly enlarged. The imaging findings were consistent with an embedded concentric linear foreign body surrounded by an abscessated fistulous tract, focal pressure necrosis of the right scapula, and reactive hyperplasia of the regional lymph node. Based on the CT images, exploratory surgery was performed to remove the foreign body. With the patient in dorsal recumbency, an incision was made parallel with the scar and draining tract on the caudoventral neck. The draining tract was traced caudolaterally towards the right thoracic limb. A separate approach was made caudodor962
sal to the right scapula. With digital palpation of the area, a thin fibrous tract could be traced to the ventral aspect of the draining tract. The area between the 2 surgical approaches was explored until the foreign body, which was a large, red rubber band, was identified. The rubber band was transected and easily pulled from the tract. A tissue sample of the tract was obtained for microbial culture and sensitivity. The surgical wound was copiously lavaged. A Jackson-Pratt drain was placed within the wound, exiting lateral to the scar. Both incisions were closed in a 2-layer fashion. The dog was sent home with the broad-spectrum antibiotic, cephalexin (Kefavet; Orion, Espoo, Finland), 250 mg, PO, q12h, and buprenorphine (Buprenex; Reckitt & Colman, Berkshire, England), 0.09 mg, PO, q8h, for pain relief. The culture revealed heavy growth of Staphylococcus intermedius group, which was susceptible to the chosen antibiotic. The patient healed without complications and there have not been any recurrent draining tracts in 5 months since the surgery.
Discussion Pre-surgical diagnosis of foreign bodies using routine radiography can be difficult due to small size, potential for being obscured by adjacent structures, and, in non-mineral or metallic foreign bodies, their relative lack of contrast compared to adjacent soft tissues. The utility of diagnostic imaging for diagnosing foreign bodies has been described in veterinary medicine (5–12). Non-metallic foreign bodies, such as wooden splinters or sticks may be common, but are generally not visible on radiographs. In descriptions of rubber band syndrome in veterinary and human patients, radiographic evidence of osteolysis in association with a concentric scar may suggest the presence of a constricting foreign body (2–4). In our patient, radiographically evident osteolysis of the scapular spine was secondary to pressure necrosis associated with the rubber band foreign body. Sinography or fistulography, the injection of iodinated contrast material into a draining tract or sinus, has proven useful in diagnosing some cases of foreign body migration in small and large animal patients (13,14). If pulmonary communication is CVJ / VOL 55 / OCTOBER 2014
CA S E R E P O R T
Figure 3. Pre-contrast computed tomography maximum intensity projection. There is an ovoid lucent defect in the spine of the right scapula (black arrow). A hyperattenuating circumferential linear foreign body surrounds the deep cervical musculature (white arrow).
Figure 4. Post-contrast computed tomography curved multiplanar reconstruction. There is a concentric, contrastenhancing tract that follows the foreign body. Multiple fluidattenuating pockets are present along the length of the tract (black arrow) and in the area of the chronic draining tract of the ventral neck (white arrow).
suspected, sinography/fistulography may be contraindicated due to the risk of severe pulmonary edema (15). This risk may be minimized, however, with the use of non-ionic, iodinated contrast agents (16). Reports on humans have indicated that ultrasound is an accurate imaging modality for detecting and diagnosing radiolucent foreign bodies (17). Ultrasonographically, foreign bodies have been described as linear, hyperechoic structures with variable distal acoustic shadowing and/or reverberation artifact (18,19). However, ultrasound may be limited at increased depths as well as in cases where overlying gas-filled, osseous, or dense anatomical structures impede or attenuate the ultrasound beam. A recent study compared the accuracy of ultrasonography, CT, and magnetic resonance imaging (MRI) for the diagnosis of a wooden foreign body in the canine manus. In this study, there were limitations when using ultrasound, especially in the area of the metacarpal pad. The distal acoustic shadow associated with the pad tended to obscure the underlying foreign body. In that study, CT was the most accurate diagnostic imaging modality in detecting wooden foreign bodies in the canine manus (11). Magnetic resonance imaging is generally less useful for identifying the actual foreign body than it is for detecting the resultant surrounding soft tissue inflammation. Reports in human medicine have determined MRI characteristics of foreign bodies. On MRI, non-metallic foreign bodies have been identified as linear areas of decreased signal intensity on T1- and T2-weighted images. There may be ill-defined, increased signal intensity in the surrounding soft tissues on T2-weighted and T2-STIR sequences associated with inflammation. Depending on severity, this inflammation may completely obscure the foreign body (20). Because of the limitations of other imaging modalities, as well as the speed of acquisition and general affordability of
CT, pre- and post- contrast, CT was the imaging modality of choice in our patient. In this case, the foreign body was easily detectable as a hyper-attenuating, thin, circular structure, prior to contrast administration. With intravenous contrast administration, areas of increased perfusion or vascularity, such as inflammation, are more easily delineated from normal tissue. In this case, post-contrast images delineated the entire tract that corresponded to the superficial, circumferential scar, and demonstrated communication with the external draining wound. Three-dimensional reconstructions of the area were useful for surgical planning. To the authors’ knowledge, this is the first report of the CT characteristics of a rubber band foreign body and rubber band syndrome in a dog. CVJ
CVJ / VOL 55 / OCTOBER 2014
References 1. Kumar P, Kumar B, Singh K. A constriction ring of the thigh secondary to a rubber band. Plast Reconstr Surg 1995;95:209–210. 2. Saour S, Mohanna PN, James M. An elastic band foreign body circumferentially around the proximal phalanx, detected 2 years post injury. J Plast Reconstr Aesthet Surg 2010;63:e199–200. 3. Aggarwal AN, Kini SG, Arora A, Singh AP, Gupta S, Gulati D. Rubber band syndrome — High accuracy of clinical diagnosis. J Pediatr Orthop 2010;30:e1–4. 4. Brisson BA, Theoret MC. Osteolysis of the radius and ulna induced by a circumferential foreign body in a cat. J Am Vet Med Assoc 2008; 233:1117–1120. 5. Mahajan SK, Anand A, Sangwan V, Mohindroo J, Singh K. Surgical retrieval of a metallic foreign body from the spleen of a dog. Can Vet J 2012;53:399–401. 6. Goldsworthy SJ, Burton C, Guilherme S. Parotid duct foreign body in a dog diagnosed with CT. J Am Anim Hosp Assoc 2013;49:250–254. 7. Shanaman MM, Schwarz T, Gal A, O’Brien RT. Comparison between survey radiography, b-mode ultrasonography, contrast-enhanced ultrasonography and contrast-enhanced multi-detector computed tomography findings in dogs with acute abdominal signs. Vet Radiol Ultrasound 2013;54:591–604. 8. Johnson-Neitman JL, Bahr RJ, Broaddus KD. Fistula formation secondary to a nylon cable band in a dog. Vet Radiol Ultrasound 2006;47:355–357.
963
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9. Lefebvre J, Kuehn NF, Wortinger A. Computed tomography as an aid in the diagnosis of chronic nasal disease in dogs. J Small Anim Pract 2005; 46:280–285. 10. Llabres-Diaz FJ, Brissot H, Ibarrola P. Imaging diagnosis — Celiac artery pseudoaneurysm associated with a migrating grass awn. Vet Radiol Ultrasound 2010;51:508–511. 11. Ober CP, Jones JC, Larson MM, Lanz OI, Werre SR. Comparison of ultrasound, computed tomography, and magnetic resonance imaging in detection of acute wooden foreign bodies in the canine manus. Vet Radiol Ultrasound 2008;49:411–418. 12. Schultz RM, Zwingenberger A. Radiographic, computed tomographic, and ultrasonographic findings with migrating intrathoracic grass awns in dogs and cats. Vet Radiol Ultrasound 2008;49:249–255. 13. Jackson AH, Degner DA. Cutaneopulmonary fistula in a dog caused by migration of a toothpick. J Am Anim Hosp Assoc 2002;38:545–547. 14. Lamb CR, White RN, McEvoy FJ. Sinography in the investigation of draining tracts in small animals: Retrospective review of 25 cases. Vet Surg 1994;23:129–134.
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15. Wallack ST. The Handbook of Veterinary Contrast Radiography. San Diego, California: San Diego Veterinary Imaging, 2003. 16. McAlister WH, Askin FB. The effect of some contrast agents in the lung: An experimental study in the rat and dog. AJR Am J Roentgenol 1983;140:245–251. 17. Orlinsky M, Knittel P, Feit T, Chan L, Mandavia D. The comparative accuracy of radiolucent foreign body detection using ultrasonography. Am J Emerg Med 2000;18:401–403. 18. Ipaktchi K, Demars A, Park J, Ciarallo C, Livermore M, Banegas R. Retained palmar foreign body presenting as a late hand infection: Proposed diagnostic algorithm to detect radiolucent objects. Patient Saf Surg 2013;7:25. 19. Boyse TD, Fessell DP, Jacobson JA, Lin J, van Holsbeeck MT, Hayes CW. US of soft-tissue foreign bodies and associated complications with surgical correlation. Radiographics 2001;21:1251–1256. 20. Iyer RS, Thapa MM. MR imaging of the paediatric foot and ankle. Pediatr Radiol 2013;43 Suppl 1: S107–119.
CVJ / VOL 55 / OCTOBER 2014
