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Compendium October 2010 (Vol 32, No 10)

Clinical Snapshot — Soft Tissue Swelling in an Arabian Gelding

by Thomas O’Brien, MVB, Christoph Koch, DrMedVet, Michael A. Livesey, BVM&S, MS, DACVS

    A 14-year-old Arabian gelding was referred to our hospital for examination of a slowly expanding soft tissue swelling proximal to the point of the right hock. The swelling reportedly had an acute onset approximately 2 months previously. At that time, it was suspected to have resulted from trauma, although no injury or skin blemishes were observed. No lameness was associated with the swelling. Three days before presentation, a bloody discharge was observed draining from the lateral aspect of the swelling.

    On presentation, the physical examination results were unremarkable except for the localized soft tissue swelling, which was centered approximately 6 cm proximal to the point of the right hock. The mass was firm, softball sized, nonpainful, and intimately associated with the adjacent soft tissue structures, appearing to occupy the space immediately cranial to the common calcaneal tendon, from the medial to lateral aspect of the limb. There was a small draining tract on the lateral aspect of the swelling, from which fluid had drained and dried, resulting in matting of the hair distal to the swelling. The horse was not lame at the walk and did not resent flexion of the hock, which resulted in a viscous, serosanguineous discharge that flowed freely from the draining tract. A sample of draining fluid was collected and submitted for cytologic examination, revealing neutrophils and eosinophils in numbers greater than those associated with blood contamination, hyperplastic synovial epithelial cells, and moderate numbers of mast cells on a proteinaceous background (FIGURE A). These results were interpreted as a mixed inflammatory response of synovial origin. Ultrasonography of the swelling revealed a large hyperechoic mass with small heterogeneous, hypoechoic areas on the medial aspect.

    1. Based on the clinical presentation and fluid cytology, what is your differential diagnosis?

    2. What further diagnostic procedures would help make a definitive diagnosis?

    3. How would you manage this case?

    4. What information regarding the lesion could you give the owner?

    To see the answers, download the pdf .

    NEXT: Clinical Snapshot — Tenesmus and Obstipation in a Cat

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