Extensive aggressive bone destruction in the region of the frontal sinus. The contralateral frontal sinus is filled with soft tissue attenuating material. Note the permeative lysis of the cribriform plate creating an open connection with the cranial fossa.
SonoPath Goes CT on a hemangiosarcoma nasal tumor in the August, 2015 Case Of the Month. We are crossing the waters into computed tomography this month as we work with Epica Medical International (http://www.epicamed.com/) with interpretation of many of the Vimago CT image sets coming from specialty and generalist clinics alike that use our full teleradiology service http://www.sonopath.com/spa. This month Dr. Nele Ondreka, Head of Clinical Radiology at the University of Giessen, Germany and rock star SonoPath teleradiologist http://www.sonopath.com/about/specialists interprets the Vimago CT from a dog with a nasal tumor to evaluate the degree of invasion. Case managed by Dr. Boatsman of Neel Veterinary hospital owned by Dr. Tina Neel in Oklahoma City, Oklahoma. *Note our case archive now includes lots of CT and radiology cases for our members to learn from or discuss in the forum http://www.sonopath.com/signup.
History
The patient was presented for significant swelling on the face and difficulty breathing. The patient recently had surgery to remove a tumor from the medial canthus of the left eye. The pathology report revealed a low-grade hemangiosarcoma. The surgical borders were not clear. There is now a round, slightly raised, firm mass on the bridge of the nose right between the eyes.
Image Interpretation
A significant asymmetric soft tissue swelling with a mass effect was seen on the dorsum of the nose and frontal bones. Both nasal cavities and the nasal fundus were almost entirely occupied by a soft tissue attenuating mass. The right frontal sinus was filled with soft tissue attenuating material. There was extensive bilateral asymmetric destruction of the maxillary, nasal and frontal bones. Severe turbinate and nasal septal lysis was seen as well as focal left-sided destruction of the frontal calvarial bone and cribriform plate creating an open connection to the cranial fossa and brain. On the left side the mass lesion penetrated the floor of the bony orbit and extended into the retrobulbar region associated with a mild unilateral exophthalmos. Furthermore, there was permeative lysis of the alveolar crest of the left maxillary bone and tooth root destruction of the cheek teeth.
DX
The computed tomographic findings are compatible with a malignant soft tissue neoplasm with extensive and highly aggressive bone destruction and principally match the prediagnosed hemangiosarcoma. There was bilateral involvement of the nose and frontal sinuses, the cranial fossa and left orbita.
Outcome
The prognosis is poor. Radiation therapy and/or chemotherapy might be considered as palliative measures. A complete staging including sampling of the regional lymph nodes, chest radiographs, abdominal and cardiac ultrasound would be required for a treatment plan. Due to a steady decline in health the patient was euthanized 2 weeks after this CT scan.
Videos
Nasal tumor rendering.
Asymmetrical facial soft tissue mass with extensive aggressive destruction of the frontal and nasal bones and orbita. The contralateral frontal sinus is filled with soft tissue attenuating material. Note the permeative lysis of the cribriform plate creating an open connection with the cranial fossa.
