Atlas of Clinical Imaging and Anatomy of the Equine Head presents a clear and complete view of the complex anatomy of the equine head using cross-sectional imaging. * Provides a comprehensive comparative atlas to structures of the equine head * Pairs gross anatomy with radiographs, CT, and MRI images * Presents an image-based reference for understanding anatomy and pathology * Covers radiography, computed tomography, and magnetic resonance imaging
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Introduction: General Presentation of Atlas
CHAPTER 1: Overview of CT and MRI of the Equine Head
Indications for performing CT versus MRI
CHAPTER 2: Clinical and Surgical Anatomy of the Equine Head: Transverse Sections
CHAPTER 3: Clinical and Surgical Anatomy of the Equine Head: Sagittal Sections
Brain sagittal close-up
CHAPTER 4: Clinical and Surgical Anatomy of the Equine Head: Dorsal Sections
Anatomical and imaging terms
End User License Agreement
Figure 1 A lateral (a) and dorsoventral radiograph (b) of the head from an older adult equine cadaver that was used in the making of this book. Two radiographs are spliced together to create each image of the whole head. These radiographs demonstrate the excellent contrast between the air‐filled nasal passages, paranasal sinuses and guttural pouches, and the mineral opaque bones and teeth. The soft tissues are difficult to differentiate unless they are surrounded by gas or bone.
Figure 2 CT scan of an adult horse that presented with a facial deformity from an unknown trauma and signs of sinusitis. The patient was imaged in dorsal recumbency for the CT scan. (a,b) Transverse images at the level of the fracture in a bone filter and window (a) and a soft tissue filter and window (b), demonstrating thickened and irregular margins of the frontal, nasal, and lacrimal bones. Fluid is also noted in the conchofrontal sinus and caudally displaced ventral conchal sinus. The lining of the sinuses is thickened, consistent with sinusitis. (c,d) “Three‐dimensional” reconstructions of the CT dataset with a dorsal view (c) and left dorsolateral view (d) of the skull. These images help to get an overall look at the bones of the skull and to determine that this deformity was likely caused by a concussive trauma to a sharp linear object, such as the corner of a beam or post. The displacement of the ventral conchal sinus and concha caused by the trauma caused narrowing of the conchomaxillary opening that impeded drainage, resulting in the sinusitis.
Figure 3 Transverse (a) and sagittal (b) reconstructions of a CT scan of an adult horse that presented with a history of seizures. The WW is 83 and WL is 27. Within each lateral ventricle is an ovoid, faintly mineral‐dense structure arising from the choroid plexus. There is also fluid distension of the lateral ventricles, consistent with an obstruction to CSF outflow. These mineralized structures are consistent with cholesterinic granulomas causing an obstructive hydrocephalus.
Figure 4 MRI images of a young horse. (a–c) Transverse MR images of the rostral third of the cerebrum at the level of the lateral ventricles. (a) T2‐weighted sequence. (b) FLAIR sequence. (c) T1‐weighted sequence plus contrast administration (gadolinium) and fat saturation. Note the fluid suppression of the CSF on the FLAIR sequence (b) in the lateral ventricles when compared to (a). (d) Sagittal plane, T2‐weighted sequence of the brain on midline. In (c), there is contrast enhancement of the choroid plexus in the lateral ventricles, and the blood vessels ventral to the brain.
Figure 5 (a) An adult horse is raised onto the MRI table with hobbles placed around the feet and a ceiling hoist. The table is then rolled into the MRI suite, the wheels locked, and the patient moved forward into the magnet by sliding it across the padded table (b,c). (b) View from the MRI control room of the horse in the magnet. (c) Side view from the entry door of the horse in the magnet.
Figure 6 An adult horse has been hoisted onto the large animal CT table and positioned in dorsal recumbency. (a) Back view of the horse. (b) Back and side view of the horse. (c) Side view of the horse. (d) Front view of the scanner with the horse intubated and connected to the anesthetic equipment.
Table of Contents
To my wonderful wife and family – who make everything I do possible, fun and worthwhile – Jan, Buddy, Katie, Jana, Eli.
To my amazing, strong, and beautiful wife, Emily. A lover of all creatures great and small.
Alex zur Linden
To my late husband, Dub, and my children Brett and Cathy – your support has been instrumental in anything I have accomplished.
Larry Kimberlin, DVM, FAVD, CVPP
Alex zur Linden, DVM, DACVR
Lynn Ruoff, DVM
This edition first published 2017 © 2017 by John Wiley & Sons, Inc.
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Library of Congress Cataloging‐in‐Publication Data
Names: Kimberlin, Larry, 1956– author. | Zur Linden, Alex, 1979– author. | Ruoff, Lynn, 1951– author.Title: Atlas of clinical imaging and anatomy of the equine head / Larry Kimberlin, Alex zur Linden, Lynn Ruoff.Description: Ames, Iowa : John Wiley & Sons, Inc., 2017. | Includes bibliographical references and index.Identifiers: LCCN 2016023788 (print) | LCCN 2016030763 (ebook) | ISBN 9781118988978 (cloth) | ISBN 9781118988985 (pdf) | ISBN 9781118988992 (epub)Subjects: LCSH: Horses–Anatomy–Atlases. | Head–Anatomy–Atlases. | Head–Imaging–Atlases. | MESH: Horses–anatomy & histology | Head–anatomy & histology | Diagnostic Imaging–veterinary | Anatomy, Veterinary | AtlasesClassification: LCC SF765 .K56 2017 (print) | LCC SF765 (ebook) | NLM SF 765 | DDC 636.1/0891–dc23LC record available at https://lccn.loc.gov/2016023788
A catalogue record for this book is available from the British Library.
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The equine head is a clinically important part of the equine patient. It provides residence to the most important structure of any patient – the brain. The brain is the control center for all activities of its host. The head also contains the primary structural components of four of the five senses (sight, hearing, taste, smell, and touch).
Major components of all the major body systems are present here as well:
the brain and cranial nerves
the entry point of food for the digestive system
the entry point of air for the respiratory system
the activating and stimulating precursors of the endocrine system
the vascular system is well represented, as well as the integumentary system.
As such, the head has long been clinically and surgically important for the equine practitioner. Radiography has been the gold standard for diagnosing and treating pathologic conditions related to the head. Two‐dimensional plain film radiographs have been instrumental in the clinician’s armamentarium, but technologic advances in cross‐sectional imaging have now become the gold standard for diagnosis and treatment planning of trauma, neurologic, dental, and sinus/airway disease. Improvements in technology and decreased costs have made cross‐sectional imaging more accessible to the practitioner. It is the authors’ opinion that in the near future, cross‐sectional imaging will become standard of care for diagnosis of many equine diseases.
It was with this thought in mind that the idea for this atlas was born. Until now, there has been no comprehensive comparative atlas for structures of the head. The three‐plane cross‐sectional composition of the cadaver pictures allows the student and clinician to view structures of the head that may not be readily visible by dissection alone. The multiplanar preparation allows direct comparison of the structures with the corresponding imaging modalities of CT and MRI scanning.
The authors have attempted to identify the clinically important structures of the head to use as a reference for understanding anatomy and pathology, and as a surgical reference. The anatomy has been labeled with the help of anatomical atlases and peer‐reviewed scientific journals. Each structure is identified in the cadaver and each imaging modality (if visible) for comparison. A legend is included for each image that identifies the location and direction of the slice. An index key for each structure is present on each image with further designation of the body system.
1. Bones of the head
2. Oral and dental structures
3. Nasal and sinus structures
4. Larynx, pharynx, and guttural pouches
5. Ophthalmic structures
6. Auricular structures
7. Brain and nervous system
8. Vascular anatomy
10. Glandular structures – lymph and salivary
It is the authors’ sincere hope that this atlas will aid students and clinicians as a study and clinical guide to better understand the anatomy of the equine head, as part of our mission to help our patients and their owners by treatment of pathologic processes encountered in daily practice.
Larry Kimberlin DVM, FAVD, CVPPAlex zur Linden DVM, DACVRLynn Ruoff DVM
The diagnosis of conditions affecting the equine head is challenging for the veterinary practitioner due to its large size, complex anatomy, and the multitude of different tissues present and thus the large number of potential disease processes. Disease processes of the teeth include caries, periodontal disease, tooth root abscess, tooth fracture, dentigerous cysts, and malocclusion to name a few . The tongue can be affected by trauma, infection, or neoplasia. The nasal passages and paranasal sinuses are important parts of the equine head that can be the site of sinusitis, ethmoid hematomas, cysts, or neoplasia. The diverticulum of the auditory tube (guttural pouch) can develop fungal granulomas, empyema, blood clots, or tympany. Laryngeal hemiplegia, dorsal displacement of the soft palate, epiglottic entrapment, rostral displacement of the palatopharyngeal arches, arytenoid chondritis, and pharyngeal narrowing can affect the pharyngeal region . Other tissues in the head such as the lymph nodes and salivary glands can be affected by infectious or non‐infectious inflammation, or neoplasia. The brain can be affected by trauma, bleeding, infarction, neoplasms, cholesterinic granulomas, ventriculomegaly (hydrocephalus), and infection (meningitis or meningoencephalitis). Trauma to the head can result in fractures of the calvarium, mandible, temporomandibular joint, basisphenoid bone, and nuchal crest of the occipital bone. Although uncommon in horses, neoplasia that can be found in the head includes melanoma, adenocarcinoma or rhabdomyosarcoma of the tongue, lacrimal gland adenocarcinoma and ophthalmic tumors associated with the eye, and multicentric lymphoma affecting the lymph nodes in the head . The hyoid bones can be affected by fractures or temporohyoid osteoarthropathy. The eyes and ears are also prone to a variety of pathological conditions. Many of these conditions can be diagnosed on physical examination; however, many require further diagnostics.
Diagnostic imaging of the equine head is most commonly done via radiography (Figure 1) or endoscopy. Routine radiographic examination can include orthogonal projections of the area of interest, oblique projections of the dental arcades or temporomandibular joints and intraoral projections for the rostral mandible/maxilla. Due to the size of the adult head and the limited size of the X‐ray cassette or imaging plate, multiple radiographs are needed to image the entire head, although this is not routinely performed in clinical practice. Radiographs offer superior spatial resolution compared to more advanced imaging options; however, due to the superimposition of anatomy, lesion localization can be quite challenging using radiography. The anatomy of the head is complex and radiographs do not provide adequate contrast of the soft tissues of the head. Radiographic anatomy has been thoroughly described elsewhere and is outside the scope of this book.
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