Atlas of Normal Radiographic Anatomy and Anatomic Variants in the Dog and Cat [3 ed.] 9780323796156

Table of contents :
Front Cover
Inside front cover
Front matter
Atlas of Normal Radiographic Anatomy and Anatomic Variants in the Dog and Cat THIRD EDITION
Copyright
Preface
Acknowledgments
Table of Contents
1 Basic imaging principles and physeal closure time
How to use this atlas
What is normal?
Why are computed tomography and magnetic resonance images included in this atlas?
Why are images from radiographic contrast procedures included in this atlas?
Radiographic terminology
Viewing images
Standard projections
Oblique projections
Dorsoplantar view
Lateral view
Oblique views
Physeal closure
Reference
Skeletal maturation data compiled from the following sources
2 The skull
Overview
Dentition
Nasal cavity and sinuses
Temporomandibular joints and tympanic bullae
The mandibles and larynx
References
3 The spine
Cervical spine
Thoracic spine
Lumbar spine
Sacral spine
Caudal spine
References
4 The thoracic limb
The scapula and brachium
The elbow joint
Antebrachium
Carpus
Metacarpus and phalanges
References
5 The pelvic limb
Pelvis
Femur and stifle
Tibia and fibula
Pes
References
6 The thorax
Left lateral view
Right lateral view
Dorsoventral view
Ventrodorsal view
Thoracic wall
Mediastinum
Trachea and bronchi
Esophagus
Heart
Lung
Diaphragm
References
7 The abdomen
Liver
Spleen
Pancreas
Kidneys and ureters
Deep circumflex iliac vessels
Urinary bladder
Prostate gland
Urethra/penis
Stomach
Small intestine
Large intestine
Miscellaneous
References
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
R
S
T
U
V
W
X
Y
Z
Color Plates

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Normal Radiographic Anatomy AND Anatomic Variants IN THE Dog AND Cat ATLAS OF

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Normal Radiographic Anatomy and Anatomic Variants in the Dog and Cat ATLAS OF

THIRD EDITION DONALD E. THRALL,

dvm, phd, dacvr

(Radiology, Radiation Oncology) Emeritus Professor Department of Molecular Biomedical Sciences College of Veterinary Medicine North Carolina State University Raleigh, North Carolina Quality Control, Radiologist VDIC—IDEXX Telemedicine Consultants IDEXX Laboratories, Inc. Clackamas, Oregon

IAN D. ROBERTSON,

bvsc, dacvr

Emeritus Clinical Professor Department of Molecular Biomedical Sciences College of Veterinary Medicine North Carolina State University Raleigh, North Carolina Radiologist Dragonfy Imaging PLLC Cary, North Carolina

Elsevier 3251 Riverport Lane St. Louis, Missouri 63043

ATLAS OF NORMAL RADIOGRAPHIC ANATOMY AND ANATOMIC VARIANTS IN THE DOG AND CAT, THIRD EDITION Copyright © 2023 by Elsevier Inc. All rights reserved.

ISBN: 978-0-323-79615-6

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations, such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verifcation of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors, or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2011 and 2016.

Content Strategist: Jennifer Catando Content Development Specialist: Shilpa Kumar Publishing Services Manager: Deepthi Unni Project Manager: Thoufq Mohammed Design Direction: Brian Salisbury Printed in India. Last digit is the print number:  9  8  7  6  5  4  3  2  1

Preface Becoming an expert in radiographic interpretation requires a signifcant time investment. Board certifcation typically requires an internship followed by a 3- to 4-year residency and successful completion of a rigorous multistage examination. However, specialist radiologists make up only a small fraction of veterinarians who interpret radiographs each day. Most radiographic studies are interpreted by practicing veterinarians whose training in image interpretation has been limited to a relatively few hours of didactic veterinary school instruction and supervised clinical training. All of these people, both specialists, practitioners, and students, must have a solid appreciation for normal radiographic anatomy, anatomic variants, and things that mimic disease, also known as “fakeouts.” There is an incredible amount of normal variation within animal species. While the generic cat is relatively standard morphologically, dogs come in all shapes and sizes, with innumerable inherent variations that can be misinterpreted as disease unless recognized as normal. Added to this morphologic variation are errors in radiographic positioning that increase the level of confusion. During training, specialists have this information drilled into them during many hours of mentored learning. Nonspecialists, on the other hand, may gain some appreciation of this variability during their education, but this becomes diluted by the sheer volume of information needed to be a competent veterinary practitioner. Therefore there is a real need for a reference source dealing with normal appearance and variation for both practicing veterinarians and students. Trained specialists may also question whether the appearance of a certain structure is normal or not. These needs led to the development of this atlas. In this book, we point out the identity of essentially every clinically signifcant anatomic part of a dog or cat that can be seen radiographically, and we include more than one example. Also, simply labeling structures in radiographs of a generic dog or cat falls short of the mission of providing a clinically relevant atlas. Therefore we also provide clear text relevant to the description of normal anatomy. This provides a basis for the reader to understand why a structure appears as it does in radiographs. Digesting the text may require a bit of effort from the reader in comparison to a picture atlas, but this small investment of time has the potential for a big payoff in terms of interpretive ability. Where applicable, technical factors are included to the extent that their infuence on the image needs to be understood. Beginning with the frst edition of the atlas and continuing through this third edition, only exceptional examples of digital radiographs were selected. Diffcult concepts have been explained by inclusion of a small number of two- and three-dimensional computed tomography images as well as magnetic resonance images and a small number of drawings. This approach was expanded in the second edition, and this expansion has continued into this third edition. The text has been modifed as needed, and more examples of all types of illustrations noted above have been provided. New to this edition is an expansion of coverage of neonatal and juvenile subjects. Also, the normal appearance of some of the more common special contrast procedures performed in general practice has been included. We believe that these modifcations have increased the utility of the atlas.

v

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Acknowledgments I wish to thank my wife and colleague, Debbie, for her continued professional advice and personal support through life’s journey. To Heather and Matt, our wonderful children, you have sacrifced so much family time to the veterinary profession, of which this book is just one small project. This I do acknowledge, and I am humbled by your unconditional patience and support. You are my heroes, and I am so very proud of you both. Ian Robertson I enjoyed writing this atlas with my good friend Ian Robertson. During my career, he has been an inspiration and a friend and has made me a better radiologist. I also have to acknowledge my children, Hilary and Tristan, of whom I am so proud. My work detracted from activities that I could have shared with them. I appreciate their support of me and my professional efforts throughout my career. Don Thrall Most of the images in this book were obtained from the patient database at the College of Veterinary Medicine at North Carolina State University. We also acknowledge inclusion of a small number of images provided courtesy of IDEXX Telemedicine.

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Contents 1 Basic Imaging Principles and Physeal Closure Time, 1

2 The Skull, 21

3 The Spine, 50

4 The Thoracic Limb, 91

5 The Pelvic Limb, 133

6 The Thorax, 176

7 The Abdomen, 235 Index, 295 ix

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Normal Radiographic Anatomy AND Anatomic Variants IN THE Dog AND Cat ATLAS OF

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1

CHAPTER

Basic Imaging Principles and Physeal Closure Time

2

Atlas of Normal Radiographic Anatomy and Anatomic Variants in the Dog and Cat

HOW TO USE THIS ATLAS The purpose of a radiographic atlas is to assist in determining whether a radiographic fnding is normal or abnormal. This can be challenging, but it is the frst step in accurate interpretation of an image. No atlas will be able to provide an answer to the “What is that, and is it normal?” question in every case, but this atlas can help. The best way to use this atlas is to spend some time with it and get to know it. Labeled images are provided, and every atlas needs these. But, contrary to a pure picture atlas, there is much important information in the text. Being familiar with the brief and focused text, and noting the principles that have been augmented with illustrative examples, can help defne a basis for image interpretation that extends beyond structure identifcation alone.

WHAT IS NORMAL? Many dogs and cats have clinically insignifcant congenital or developmental changes that are apparent radiographically. Although these changes are not truly normal, inclusion of some of these changes in this atlas is justifed because they are often confused with disease. This book covers much of the morphologic diversity currently present in dogs and cats that has come to be accepted as clinically insignifcant.

WHY ARE COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGES INCLUDED IN THIS ATLAS? This is a radiographic atlas; therefore, most images are radiographs. This book is not an atlas of normal computed tomography (CT) or magnetic resonance (MR) imaging, but some CT and MR images are included to reinforce or explain the appearance of selected structures in radiographs. A radiograph is a 2-dimensional image of a 3-dimensional (3D) object. As a result, structures cannot always be accurately localized spatially in radiographs, even with multiple views. CT images are tomographic, creating multiple image slices of the patient. Slicing the patient solves the problem of spatial localization and can assist with understanding radiographic anatomy more thoroughly. Additionally, transverse plane CT images can be reformatted into sagittal and/or dorsal plane images for clarifcation or to improve structure visualization. Transverse CT images can even be reformatted into 3D volumetric images for depicting more complex structures. Therefore, a selection of CT images has been included. A few MR images are also included. In addition to being tomographic, MR images have extreme contrast resolution that can be useful in explaining the radiographic appearance of certain structures.

WHY ARE IMAGES FROM RADIOGRAPHIC CONTRAST PROCEDURES INCLUDED IN THIS ATLAS? As with CT and MR images, this atlas is not a reference for the normal appearance of contrast procedures that are performed in dogs and cats. However, sometimes the presence of contrast medium can facilitate the explanation of the way a structure appears in a survey radiograph. Also, some normal aspects of certain contrast procedures are so often misinterpreted as abnormal, so there is justifcation for including them as well.

RADIOGRAPHIC TERMINOLOGY This book uses the standard method for naming radiographic projections approved by the American College of Veterinary Radiology.1 In general, this is based on anatomic directional terms, as defned by the Nomina Anatomica Veterinaria, combined with the point-of-entrance to point-of-exit of the primary x-ray beam. In other words, a radiograph is named by knowing the point-ofentrance and point-of-exit of the primary x-ray beam. For example, a spinal radiograph made with a dog in dorsal recumbency would be a ventrodorsal view because the xray beam strikes the ventral aspect of the dog and exits dorsally. The accepted anatomic directional terms must be known to name radiogrphs correctly. (Figure 1-1). There are also some special circumstances that need to be taken into account. For example: n The terms anterior and posterior should not be used when describing a radiographic projection. n In the head, the term rostral should be substituted for cranial. n In the forelimb distal to the antebrachiocarpal joint, the terms dorsal and palmar should be substituted for cranial and caudal, respectively. n In the hindlimb distal to the tarsocrural joint, the terms dorsal and plantar should be substituted for cranial and caudal, respectively. n For CT or MR images, the terms dorsal and transverse should be substituted for coronal and axial, respectively. One common shortcut to the standard terminology applies to the naming of lateral radiographs. For example, the correct name of a lateral thoracic radiograph made with the subject lying on the left side and the x-ray beam entering the right side is a right-left lateral. However, it is commonplace to take a shortcut and name lateral views according to the side the subject is lying on. Thus, a right-left lateral is typically abbreviated to left lateral because the subject is lying on the left side. Similarly, a left-right lateral is abbreviated right lateral. This shortcut is almost always applied to lateral views of the skull, spine, thorax, abdomen, and pelvis, providing a vertically directed x-ray beam is used.

Chapter 1 

n 

Basic Imaging Principles and Physeal Closure Time

3

Dorsal

ral

Caudal

Cranial

Dist

Vent

al-p roxi mal

Dist

al-p roxi mal

Dorsal

Occipitoatlantal junction Rostral Caudal Cranial

Caudal

Ventral

Figure 1-2.  Correct orientation of a lateral view of any body part. A lateral view of the thorax is shown here.

Cranial

Tarsocrural joint

Antebrachiocarpal joint Dorsal

Palmar

Dorsal

Plantar

Figure 1-1.  Diagram of a dog depicting the major directional anatomic terms, accepted by Nomina Anatomica Veterinaria.

VIEWING IMAGES When radiographs were viewed as flm images, a method for consistently hanging flm on a viewbox was developed. Viewing radiographs in the same orientation for every subject reduces variation, and the brain becomes more familiar with the way a certain body part should appear. The basic aspects of that radiograph-hanging system are as follows: n Lateral images of any body part should be oriented with the cranial or rostral aspect of the body heading to the examiner’s left (Figure 1-2). n Ventrodorsal or dorsoventral images of the head, neck, or trunk should be oriented with the cranial or rostral aspect of the subject heading up and the left side of the subject positioned on the examiner’s right (Figure 1-3). n As already noted, lateromedial or mediolateral images of extremities should be oriented with the proximal aspect of the limb at the top and the cranial or dorsal aspect of the limb heading to the examiner’s left (Figure 1-4). This orientation is correct regardless of whether the left or right limb has been imaged. n Caudocranial (palmarodorsal or plantarodorsal) or craniocaudal (dorsopalmar or dorsoplantar) images of extremities should be oriented with the proximal aspect at

Right

Left

Caudal

Figure 1-3.  Correct orientation of a ventrodorsal view of the head, spine, thorax, abdomen, or pelvis. A ventrodorsal view of the thorax is shown here. This same orientation would be used if the image were a dorsoventral view.

the top and the distal aspect at the bottom. These can all be considered sagittal-plane radiographs. There is no convention directing whether the medial or lateral side of the extremity should be on the examiner’s left (Figure 1-5). This orientation is correct regardless of whether the left or right limb has been imaged.

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Atlas of Normal Radiographic Anatomy and Anatomic Variants in the Dog and Cat

Although these principles were developed to defne how a flm should be hung on a viewbox, they have carried over to digital imaging and are used to orient digital images correctly on a monitor or in print. The ability to adjust the orientation of the digital image on the monitor using the viewing software allows adherence to these principles regardless of the orientation of the original image. It is also important to realize that the position of the patient when the radiograph was made has no bearing on how the image should be oriented for viewing. This concept is commonly misunderstood. For example, it is a common misconception to think that ventrodorsal versus dorsoventral radiographs of the thorax would be oriented differently. This is not true.

Proximal

Proximal

C r a n i a l

C a u d a l

P l a n t a r

D o r s a l

STANDARD PROJECTIONS Distal

A

Distal

B

Figure 1-4.  Correct orientation of lateral views of two extremities. A lateral view of a humerus (A) and a lateral view of a tarsus/pes (B) are shown here. Note the difference in directional terms depending on whether the part being imaged is above or below the tarsocrural or antebrachiocarpal joint.

Proximal

Proximal

Most standard radiographic examinations comprise at least two projections made at 90 degrees to each other. These are termed orthogonal views. Table 1-1 lists the most common orthogonal views for the major body parts. These views are named according to the point-of-entrance to point-of-exit of the primary x-ray beam. Making the same standard orthogonal views of every body part is very important. Looking at the same radiographic projections and orientations repeatedly makes it easier to recognize abnormal from normal. On the other hand, when an object or body region is radiographed using an unconventional point-of-entrance to point-of-exit of the x-ray beam, the image becomes less recognizable and more diffcult to interpret (Figure 1-6).

Table 1-1  Common Orthogonal Views for Major

L a t e r a l

M e d i a l

M e d i a l

L a t e r a l

Body Parts

Body Part

View

Orthogonal View

Skull

Left-right lateral or right-left lateral Left-right lateral or right-left lateral Left-right lateral or right-left lateral Left-right lateral or right-left lateral Left-right lateral or right-left lateral Lateral-medial or medial-lateral

Ventrodorsal or dorsoventral Ventrodorsal*

Craniocaudal or caudocranial

Lateral-medial or medial-lateral Lateral-medial or medial-lateral

Dorsopalmar or palmarodorsal Dorsoplantar or plantarodorsal

Spine Thorax Abdomen Pelvis Distal

Distal

A

B

Figure 1-5.  Correct orientation of a sagittal-plane radiograph of an extremity. A caudocranial view of a humerus is shown here. There is no convention regarding whether the lateral side of the limb is placed on the examiner’s right (A) or left (B). However, it is probably more common to orient medial and lateral relative to the patient. As such, a left limb would be oriented as in Figure 1-5A, and a right limb would be oriented as in Figure 1-5B.

Brachium, antebrachium, thigh, crus Carpus/manus Tarsus/pes

Ventrodorsal or dorsoventral Ventrodorsal* Ventrodorsal*

*Dorsoventral views of the spine, abdomen, or pelvis are rarely acquired.

Chapter 1 

A

B

n 

Basic Imaging Principles and Physeal Closure Time

5

used along with the two standard orthogonal projections to improve lesion detection. The objective of using multiple views is to project as many surfaces or edges as possible. The best solution for accurate imaging of a complex structure is to use a tomographic imaging modality. As noted earlier, tomographic imaging modalities display images in slices, thus completely avoiding the problem of superimposition. Ultrasound, CT, and MR images are all tomographic. If tomographic imaging is not possible, the use of oblique radiographic projections can also reduce the complexity created by the superimposition of structures. For oblique radiography, projections in addition to standard orthogonal projections are acquired. In other words, the entrance location of the primary x-ray beam is somewhere other than the locations used for standard orthogonal projections. Typically, this location is approximately midway between the entrance points for the conventional views, but other locations can also be used depending on the need. Understanding the point-ofentrance to point-of-exit radiographic naming method is crucial to understanding oblique radiographic images. The following explanation of oblique radiography is based on the canine tarsus.* These principles also apply to other regions. If these principles are applied to the forelimb, plantar is replaced with palmar.

Dorsoplantar View The dorsoplantar view is a standard radiographic view of the tarsus and pes (Table 1-2). In a dorsoplantar view of a tarsus/pes, the x-ray beam strikes the dorsal surface, and the image plate is plantar (Figure 1-7). In this view, the medial and lateral aspects are projected in an unobstructed manner (see Figures 1-7 and 1-8). This does not mean that only the medial and lateral edges can be evaluated because the infrastructure can still be assessed, but the lateral and medial edges are where a periosteal reaction or cortical erosion will be able to be identifed.

Lateral View C Figure 1-6.  Dorsoventral (A), lateral (B), and rostrocaudal (C) radiographs of a box turtle. In A and B, which are orthogonal to each other, it is clear that the subject is a turtle. Eggs are visible in the coelom. In C, which is also an orthogonal view with respect to both A and B, it is not obvious that the subject is a turtle because this orientation is uncommon and unfamiliar. The eggs are also not visible in C.

OBLIQUE PROJECTIONS For anatomically complex regions, such as the manus and pes, two orthogonal radiographic views are often not adequate because of the extensive superimposition, and important lesions can be missed. Other projections can be

A lateral view is the orthogonal view to the dorsoplantar view and is made when the x-ray beam strikes the lateral or medial surface of a limb with the cassette or imaging plate on the opposite side (Figure 1-9). Although these views are called lateral views, lateral-medial or mediallateral is more correct depending on which side of the limb is struck by the primary x-ray beam. In a medial-lateral view of a tarsus/pes, for example, the x-ray beam strikes the medial surface, and the image plate is on the lateral side (see Figure 1-10). In this view, the dorsal and palmar edges are projected in an unobstructed manner (see Figures 1-9 and 1-10). This does not *The colorized surface renderings in Figures 1-8, 1-10, 1-12, and 1-14 were expertly prepared by Sarena Sunico, DVM, DACVR

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Atlas of Normal Radiographic Anatomy and Anatomic Variants in the Dog and Cat

Dorsal

Table 1-2  Correct Names for Radiographic

Dorsopalmar

Dorsoplantar

Craniocaudal

Orientation Primary x-ray beam strikes front surface of forelimb at antebrachiocarpal joint or distal. Cassette or imaging plate is perpendicular to primary x-ray beam. Primary x-ray beam strikes front surface of hindlimb at tarsocrural joint or distal. Cassette or imaging plate is perpendicular to primary x-ray beam. Primary x-ray beam strikes front surface of forelimb or hindlimb proximal to antebrachiocarpal joint or tarsocrural joint. Cassette or imaging plate is perpendicular to primary x-ray beam.

T C

Medial

Correct Name of View

Lateral

Projections of a Limb Where the X-Ray Beam Strikes the Front Surface of the Limb and the Cassette or Imaging Plate Is Directly behind the Limb

Plantar

Figure 1-7.  The object being radiographed depicts outlines of the talus (T) and calcaneus (C) obtained from a transverse CT image of a canine tarsus. The x-ray beam strikes the tarsus from the front. The correct name of this radiographic projection is a dorsal-plantar projection, and the only edges that will be projected without obstruction are the medial edge of the talus and the lateral edge of the calcaneus; dotted arrows indicate these edges. These are the only edges that can be evaluated for abnormalities such as periosteal reaction or cortical lysis. Other edges will be superimposed on another structure.

Figure 1-8.  The left panel is a dorsoplantar radiograph of a canine tarsus. The middle panel is a three-dimensional rendering of a normal right canine tarsus from the perspective of the x-ray beam when making a dorsoplantar radiograph. The right panel is identical to the middle panel, except each bone has been colorized (see Color Plate 1). Colorizing makes it easier to comprehend the extent of overlap. Note in the radiograph that the only edges that can be evaluated are the medial and lateral edges.

Chapter 1 

mean that only the lateral and medial edges can be evaluated because the infrastructure can still be assessed, but the dorsal and plantar edges are the only places where a surface change, such as a periosteal reaction or cortical erosion, will be able to be identifed.

T C

Medial

Lateral

Dorsal

Plantar

Figure 1-9.  The object being radiographed depicts outlines of the talus (T) and calcaneus (C) obtained from a transverse CT image of a canine tarsus. The x-ray beam strikes the tarsus from the medial side. The correct name of this projection is a mediallateral projection or abbreviated to lateral projection. In a lateral projection, the only edges that will be projected without obstruction from other edges are the dorsal edge of the talus (T) and the plantar edge of the calcaneus (C); dotted arrows indicate these edges. These are the only edges that can be evaluated for abnormalities such as periosteal reaction or cortical lysis. Other edges will be superimposed on another structure.

n 

Basic Imaging Principles and Physeal Closure Time

7

Oblique Views In oblique views of the tarsus/pes, the entrance location of the primary x-ray beam is intentionally shifted to some point between dorsal and lateral or between dorsal and medial. Typically, this position is approximately midway between dorsal and lateral or midway between dorsal and medial, but other angles can be used depending on the circumstances (Table 1-3). The oblique view where the entrance point is shifted 45 degrees between dorsal and medial is termed a dorsal 45-degree medial-plantarolateral oblique (D45°M-PtLO, often abbreviated to DM-PtLO) view (see Table 1-3). The x-ray beam strikes the dorsal surface midway between dorsal and medial with the image plate perpendicular to the primary x-ray beam (Figure 1-11). In this geometric arrangement, the dorsolateral and plantaromedial edges are visualized in an unobstructed manner (see Figures 1-11 and 1-12). The oblique view where the entrance point is shifted 45 degrees between dorsal and lateral is termed a dorsal 45-degree lateral-plantaromedial oblique (D45°L-PtMO, often abbreviated to DL-PtMO) view (see Table 1-3). The x-ray beam strikes the dorsal surface midway between dorsal and lateral with the image plate perpendicular to the primary beam (Figure 1-13). In this geometric arrangement, the dorsomedial and plantarolateral edges are visualized in an unobstructed manner (see Figures 1-13 and 1-14). It is important to reemphasize that the terminology used in this example of a pes applies to a pelvic limb; if

Figure 1-10.  The left panel is a medial-lateral radiograph of a canine tarsus. The middle panel is a three-dimensional rendering of a normal right canine tarsus as seen from the perspective of the x-ray beam when making a medial-lateral radiograph. The right panel is identical to the middle panel, but where each bone has been colorized (see Color Plate 2). Colorizing makes it easier to comprehend the extent of overlap. Note in the radiograph that the only edges that can be evaluated are the dorsal and plantar edges. The proximal edge of the calcaneus is also visible in this projection because it is not superimposed on any other structure.

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Atlas of Normal Radiographic Anatomy and Anatomic Variants in the Dog and Cat

Table 1-3  Correct Names for Oblique Radiographic Projections of a Limb Where the X-Ray Beam

Strikes the Front Surface of the Limb Midway Between the Front and Side and the Cassette or Imaging Plate Is Behind the Limb and Perpendicular to the Primary X-Ray Beam

Correct name of View

Orientation

Dorsal 45-degree lateral-palmaromedial

Primary x-ray beam strikes front surface of forelimb midway between dorsal and lateral aspects, at antebrachiocarpal joint or distal. Cassette or imaging plate is perpendicular to primary x-ray beam. Results in projection of dorsomedial and palmarolateral aspects of region of interest. Primary x-ray beam strikes front surface of hindlimb midway between dorsal and lateral aspects, at tarsocrural joint or distal. Cassette or imaging plate is perpendicular to primary x-ray beam. Results in projection of dorsomedial and plantarolateral aspects of region of interest. (See Figures 1-13 and 1-14.) Primary x-ray beam strikes front surface of forelimb midway between dorsal and medial aspects, at antebrachiocarpal joint or distal. Cassette or imaging plate is perpendicular to primary x-ray beam. Results in projection of dorsolateral and palmaromedial aspects of region of interest. Primary x-ray beam strikes front surface of hindlimb midway between dorsal and medial aspects, at tarsocrural joint or distal. Cassette or imaging plate is perpendicular to primary x-ray beam. Results in projection of dorsolateral and plantaromedial aspects of region of interest. (See Figures 1-11 and 1-12.) Primary x-ray beam strikes front surface of forelimb or hindlimb midway between cranial and lateral aspects, proximal to antebrachiocarpal or tarsocrural joint. Cassette or imaging plate is perpendicular to primary x-ray beam. Results in projection of craniomedial and caudolateral aspects of region of interest. Primary x-ray beam strikes front surface of forelimb or hindlimb midway between cranial and medial aspects, proximal to antebrachiocarpal or tarsocrural joint. Cassette or imaging plate is perpendicular to primary x-ray beam. Results in projection of craniolateral and caudomedial aspects of region of interest.

Dorsal 45-degree lateral-plantaromedial

Dorsal 45-degree medial-palmarolateral

Dorsal 45-degree medial-plantarolateral

Cranial 45-degree lateral-caudomedial

Cranial 45-degree medial-caudolateral

T C

Medial

a thoracic limb were being radiographed, plantar would be replaced by palmar. Not all oblique views involve the use of a primary xray beam angle between dorsal and lateral or dorsal and medial. For example, there are special oblique views of the bicipital groove of the humerus (cranioproximalcraniodistal fexed view of shoulder) and the proximal surface of the talus (dorsoplantar fexed tarsus) that are designed to make certain portions of these bones more conspicuous. Having a good understanding of how radiographs are named reduces confusion when assessing these more unconventional views and in understanding exactly why the images appear the way they do. These less frequently used oblique views are explained in more detail in the sections in which they are illustrated. By using oblique radiographic views, more edges of a complex joint can be evaluated for periosteal reaction and cortical lysis, and small fragments can be localized accurately. It is important to understand the anatomy of oblique views to draw accurate conclusions regarding the location of any abnormality and to acquire the correct oblique view when interrogating specifc anatomic regions.

Lateral

Dorsal

Plantar

Figure 1-11.  The object being radiographed depicts outlines of the talus (T) and calcaneus (C) obtained from a transverse CT image of a canine tarsus. The x-ray beam strikes the tarsus midway between the dorsal and medial surfaces. The correct name of this projection is a dorsal 45-degree medial-plantarolateral view. In this view, the dorsolateral edge of the talus (T) will be projected in an unobstructed fashion. The plantar edge of the calcaneus (C) will also be seen because it extends so far proximally; this is better comprehended in Figure 1-12. These are the only edges that can be evaluated for abnormalities such as periosteal reaction or cortical lysis. Other edges will be superimposed on another structure.

Chapter 1 

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Dorsolateral surface

Plantaromedial surface

Figure 1-12.  The left panel is a dorsal 45-degree medial-plantarolateral radiograph of a canine tarsus. The middle panel is a three-dimensional rendering of a normal right canine tarsus as seen from the perspective of the x-ray beam when making a dorsal 45-degree medialplantarolateral radiograph. The right panel is identical to the middle panel, but where each bone has been colorized (see Color Plate 3). Colorizing makes it easier to comprehend the extent of overlap. Note in the radiograph that the only edges that can be evaluated are the dorsolateral and plantaromedial edges. Even though the proximal aspect of the calcaneus is plantarolateral, it can still be seen in this view because it extends suffciently proximal that it will not be superimposed on the tibia.

Dorsal

T C

Medial

Lateral

PHYSEAL CLOSURE

Plantar

Figure 1-13.  The object being radiographed depicts outlines of the talus (T) and calcaneus (C) obtained from a transverse CT image of a canine tarsus. The x-ray beam strikes the tarsus approximately midway between the dorsal and lateral surfaces. The correct name of this view is a dorsal 45-degree lateral-plantaromedial view. In this view, the plantarolateral edge of the calcaneus (C) and the dorsomedial edge of the talus (T) will be projected tangentially. Dotted arrows indicate these edges. These are the only edges that can be evaluated for abnormalities such as periosteal reaction or cortical lysis. Other edges will be superimposed on another structure and cannot be assessed.

Juvenile orthopedic disorders are common, particularly in dogs. Many arise from disruption to normal physeal development. Breed, genetics, nutrition, intercurrent disease, activity, and trauma can all affect skeletal development adversely. Some understanding of the radiographic appearance of normal physeal maturation and the age at which this occurs is a prerequisite to the identifcation and management of such disorders. Table 1-4 provides an overview of when the various ossifcation centers appear, and Table 1-5 shows when physes are typically radiographically closed. It should be noted that there is considerable variation in physeal closure, and these tables are designed to act only as guides. The tables refect a compilation of data from multiple sources. Table 1-6 documents the approximate ages at which the fusion of skull bones occurs in both canines and felines. Figures 1-15 through 1-20 diagrammatically show the long canine bone and joint morphology from 1 month to 8.5 months. Figures 1-21 through 1-28 diagrammatically show the long feline bone and joint morphology from 3.5 weeks to 16.5 months.

Atlas of Normal Radiographic Anatomy and Anatomic Variants in the Dog and Cat

Plantarolateral surface

Dorsomedial surface

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Figure 1-14.  The left panel is a dorsal 45-degree lateral-plantaromedial radiograph of a canine tarsus. The middle panel is a three-dimensional rendering of a normal right canine tarsus as seen from the perspective of the x-ray beam when making a dorsal 45-degree lateralplantaromedial radiograph. The right panel is identical to the middle panel, but where each bone has been colorized (see Color Plate 4). Colorizing makes it easier to comprehend the extent of overlap. It is important to note that the dorsal surface of the radiograph is oriented to the viewer’s left; this is standard policy. The dorsal surfaces of the three-dimensional models are oriented to the viewer’s right because the models are anatomically correct, and this is the orientation that the radiographer would see. Note in the radiograph that the only edges of the tarsal bones where the surface can be evaluated are the dorsomedial and plantarolateral edges.

Table 1-4  Approximate Ages at Which Ossifcation Centers Appear (Canine and Feline) Site

Canine

Feline

SCAPULA Body Supraglenoid tubercle

Birth 6-7 weeks

Birth 7-9 weeks

HUMERUS Proximal epiphysis (head and tubercles) Diaphysis Condyle Medial epicondyle

1-2 weeks Birth 2-3 weeks 6-8 weeks

1-2 weeks Birth 2-4 weeks 6-8 weeks

RADIUS Proximal epiphysis Diaphysis Distal epiphysis

3-5 weeks Birth 2-4 weeks

2-4 weeks Birth 2-4 weeks

ULNA Olecranon tubercle Diaphysis Anconeal process Distal epiphysis

6-8 weeks Birth 6-8 weeks 5-6 weeks

4-5 weeks Birth 3-4 weeks

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Table 1-4  Approximate Ages at Which Ossifcation Centers Appear (Canine and Feline)—cont’d Site

Canine

Feline

3-6 weeks 2 weeks

3-8 weeks 3-8 weeks

2 weeks 6-7 weeks 4 months

3-8 weeks 3-8 weeks

Birth 5-7 weeks 3-4 weeks 2 months 4 months

Birth

Birth 5-7 weeks 4-6 weeks

Birth 3-4 weeks 3-4 weeks

Birth 4-6 weeks Birth

Birth 4 weeks Birth

PELVIS Ilium/ischium/pubis Acetabular bone Iliac crest Ischial tuberosity Ischial arch

Birth 2-3 months 4-5 months 3-4 months 6 months

Birth

FEMUR Greater trochanter Lesser trochanter Head Diaphysis Distal epiphysis

7-9 weeks 7-9 weeks 1-2 weeks Birth 3-4 weeks

5-6 weeks 6-7 weeks 2 weeks Birth 1-2 weeks

STIFLE SESAMOID BONES Patella Fabellae Popliteal sesamoid

6-9 weeks 3 months 3-4 months

8-9 weeks 10 weeks

TIBIA Tibial tuberosity Proximal epiphysis Diaphysis Distal epiphysis Medial malleolus

7-8 weeks 2-4 weeks Birth 2-4 weeks 3 months

6-7 weeks 2 weeks Birth 2 weeks

CARPUS Radial carpal (3 centers) Other carpal bones Accessory carpal Diaphysis Apophysis Sesamoid bone in abductor pollicis longus METACARPUS/METATARSUS Diaphysis of 1-5 Proximal epiphysis of MC1 Distal epiphysis of MC2-5 Palmar sesamoid bones Dorsal sesamoid bones PHALANGES (FORE AND HIND) P1 Diaphysis of digits 1-5 Proximal epiphysis digit 1 Distal epiphysis digits 2-5 P2 Diaphysis of digits 2-5 Proximal epiphysis of digits 2-5 P3 (one ossifcation center)

3 weeks 2-2.5 months

Continued

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Atlas of Normal Radiographic Anatomy and Anatomic Variants in the Dog and Cat

Table 1-4  Approximate Ages at Which Ossifcation Centers Appear (Canine and Feline)—cont’d Site

Canine

Feline

FIBULA Proximal epiphysis Diaphysis Distal epiphysis

8-10 weeks Birth 4-7 weeks

6-7 weeks Birth 3-4 weeks

Birth

Birth

6 weeks Birth 3 weeks 4 weeks 3 weeks 2 weeks

4 weeks Birth 4-7 weeks 4-7 weeks 4-7 weeks 4-7 weeks

TARSUS Talus Calcaneus Tuber calcanei Diaphysis Central tarsal bone First and second tarsal bones Third tarsal bone Fourth tarsal bone SPINE Atlas, three centers of ossifcation Neural arch (bilateral) Intercentrum Axis, seven centers of ossifcation Centrum of proatlas Centrum 1 Intercentrum 2 Centrum 2 Neural arch (bilateral) Caudal epiphysis Cervical, thoracic, lumbar, sacral vertebrae Paired neural arches and centrum Cranial and caudal epiphysesa

Birth Birth 6 weeks Birth 3 weeks Birth Birth 2 weeks Birth 2 weeks

Epiphyses are often absent in the last 1 to 2 caudal vertebrae.

a

Table 1-5  Approximate Age When Physeal/Ossifcation Center Closure Occurs (Canine and Feline) Bone

Physis

Canine

Feline

Scapula Humerus

Supraglenoid tubercle Proximal Medial epicondyle Condyle to shaft Condyle (lateral and medial parts) Proximal Distal Anconeal process Olecranon tuberosity Distal Radial (radiointermediate)

4-7 months 12-18 months 6-8 months 6-8 months 6-10 weeks 7-10 months 10-12 months