Vimago HDVI Dental Oliver

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A six-month-old mix breed canine patient weighing 61 lbs (27.9 kg) presented for swelling associated with the eruption of the #405 adult tooth. The DVM performed an FNA that was unremarkable. Differential Dx includes dentigerous cyst, infection, or some kind of cancerous process. The DVM used his Vimago HDVI CT to perform a scan of the skull to gather more information.

CT findings and reports are provided by Peregrine Radiology.

Here is a link to the full radiology report.

Clinical Findings History & Clinical Signs Acute swelling associated with unerupted #405, Fine needle aspirate was unremarkable. No overt evidence of infectious/inflammatory process. differential diagnosis Dentigerous cyst r/o infectious, cancerous process

Current Medications

• Gabapentin 300 mg q 8-12 hr.

• Clavamox 375 mg q 12 hr.

• Prednisone 20 mg q 24 hr.

Drugs or Sedation Used

• Hydromorphone/dexdomitor/propofol

How are Images Submitted?

• DICOM

Date Of Most Recent Images

• 2020-12-18

CT Report Findings

Survey and post-i.v. contrast CT of the skull

Nasal Cavity: No fluid or mass seen. No turbinate lysis or deviation or lysis of the septum

Oral cavity: Poorly marginated soft tissue swelling with fat stranding in the region of the 405

Dentition: periodontal lysis is seen surrounding the root of 405. No missing teeth seen. Poorly marginated lysis of the mandible in the root region of 404 and 404.

Orbital structures appear normal.

Frontal sinuses: Right side and left side air filled. No frontal bone lysis seen

Ventral nasal meatus: air filled

Nasopharynx: air filled

Nasal vault: No maxilla, nasal bone or hard palate lysis seen

Cribriform plate: no lysis seen

Brain: No evidence of aberrant meningeal contrast enhancement or deviation of the falx. Pituitary gland normal size (5.7 mm tall)

Tympanic Bullae: air filled and no bulla wall lysis or thickening seen. hyperostotic tympanic bone spicules (HTBS)

External ear canals: air filled and no wall thickening Temporomandibular joints (TMJ's) appear normal

Mandibular LN's: symmetrical normal shape and size (7.6 mm wide)

Medial retropharyngeal LN's: symmetrical normal shape and size (10.3 mm wide)

Thyroid glands: symmetrical normal shape and size (3.6 mm wide)

Conclusion

Rostral right mandibular region selling and mandibular lysis: possible osteomyelitis; periapical infection, septic focus, lucent foreign body

Recommendations

• Antibiotic therapy and recheck in 7-10 days

• fungal titers as geographically relevant

• Oral examination for lesions of teeth 404, 405