Content continues after advertisement

To Cut or Not to Cut: Toe Lesion in a Cat

Jean K. Reichle, DVM, MS, DACVR, Animal Specialty & Emergency Center, West Los Angeles

Imaging

|December 2014|Peer Reviewed|Web-Exclusive

Sign in to Print/View PDF

Signalment

Spayed domestic shorthair cat of unknown age.

History

Adopted as an adult 5 years earlier. Indoor only cat. Limping on right pelvic limb for approximately two weeks.

Physical Examination

Grade IV/IV right pelvic limb lameness. Very painful, palpable soft tissue swelling of the third digit. No detectable discharge or wound along the toe.

Radiographic Findings

One dorsal–plantar view of the tarsus and foot of the right pelvic limb was obtained (Figure 1). A lateral view was not obtained because of the likelihood of low diagnostic yield (ie, superimposition of digits 2–4). The toes can be separated with gauze or string for a lateral view, but this patient was too painful to do so without analgesia/sedation.

 

Soft tissue swelling surrounded the phalanges of the right pelvic limb third digit. The entire distal phalanx of the third digit was absent, and the distal portion of the middle phalanx of the third digit was lytic.
Soft tissue swelling surrounded the phalanges of the right pelvic limb third digit. The entire distal phalanx of the third digit was absent, and the distal portion of the middle phalanx of the third digit was lytic.

Figure 1 Soft tissue swelling surrounded the phalanges of the right pelvic limb third digit. The entire distal phalanx of the third digit was absent, and the distal portion of the middle phalanx of the third digit was lytic.

Figure 1 Soft tissue swelling surrounded the phalanges of the right pelvic limb third digit. The entire distal phalanx of the third digit was absent, and the distal portion of the middle phalanx of the third digit was lytic.

Diagnosis

Aggressive bone lesion of the distal and middle phalanges of the third digit. Aggressive bone lesions can be secondary to neoplasia or infection. Absence of periosteal proliferation and the degree of lysis makes neoplasia more likely than infection. The involvement of two adjacent bones also suggests a soft tissue origin of malignancy (primary bone tumors rarely cross joints). Metastasis of pulmonary carcinoma to the digit is well documented1-3 and should be a strong differential at this point.

Should This Cat Go to Surgery?

Thoracic radiographs (Figures 2A and 2B) were obtained to check for primary or metastatic neoplasia; an approximately 8.3 cm long, 3.8 cm tall, and 3.6 cm wide soft-tissue mass was present in the dorsal aspect of the right caudal thorax (white arrows), occupying the majority of the right caudal lung lobe. The aortic arch is prominent in the ventrodorsal view (black *); this is common in geriatric felines and may be a variation of normal or possibly an indication of systemic hypertension. The finding of a mass in the lung of this cat supports a diagnosis of a primary pulmonary carcinoma originating from the right caudal lung lobe with metastasis to the third digit of the right pelvic limb. This syndrome is described in several case reports.1-3 Most cats have swelling of one or more digits with radiographic evidence of osteolysis of the affected digit(s). The tendency of feline pulmonary carcinomas to metastasize to one or more digits is not understood, and no specific treatment has been rewarding.

Clinician's Brief

Figure 2A

Clinician's Brief

Outcome

The patient received buprenorphine transmucosally q8h for pain management, but ultimately succumbed to pulmonary neoplasia with intrathoracic metastases and severe pleural effusion. The lung and digit were submitted for histopathology; papillary carcinoma of the lung and metastatic pulmonary carcinoma of the digit were confirmed.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Clinician's Brief may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.

Podcasts

Clinician's Brief:
The Podcast
Listen as host Alyssa Watson, DVM, talks with the authors of your favorite Clinician’s Brief articles. Dig deeper and explore the conversations behind the content here.
Clinician's Brief provides relevant diagnostic and treatment information for small animal practitioners. It has been ranked the #1 most essential publication by small animal veterinarians for 9 years.*

*2007-2017 PERQ and Essential Media Studies

© 2022 Educational Concepts, L.L.C. dba Brief Media ™ All Rights Reserved. Terms & Conditions | DMCA Copyright | Privacy Policy | Acceptable Use Policy