Urinary Bladder tumor in a Horse

A 12 year old gelding presented to PHD veterinary services for the complaint of "dribbling" urine and intermittent bouts of urinating blood (hematuria). The horse had been treated with a combination of antibiotics and steroids which had resulted in resolution of blood in the urine however he continued to dribble urine. On presentation the physical exam was normal other than evidence of chronic urinary incontinence based on the accumulation of dried urine over the dorsum of both hind limb pasterns. A rectal exam was performed and a softball-size mass was palpated within the urinary bladder.

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Cystoscopic exam noted several small soft tissue masses leading into the urinary bladder with evidence of active, mild hemorrhage (Figure 1). Once the urinary bladder was entered with the scope, a mass was noted lying underneath the urine that was present in the urinary bladder (Figure 2). The urine was evacuated through the scope revealing a large, soft tissue mass that was firmly attached to the ventral or bottom aspect of the urinary bladder (Figure 3 and 4).

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Urinary bladder neoplasia or cancer is rare in horses. The most common common type reported in horses is squamous cell carcinoma and it commonly associated with hematuria. Other types of cancer include transitional cell carcinoma, lymphosarcoma, leimyosarcoma and fibrous polyps. Management of urinary bladder neoplasia in horses involves surgical resection and possible intra-lesional chemotherapy; however the prognosis is poor for long term survival. This horse will be managed with systemic anti-inflammatory medications to reduce local inflammation within the urinary bladder and the proximal urethra.

Superficial Flexor Tendonitis in a Horse

A 12 year old mare presented for sudden onset forelimb lameness and swelling of the tendons in the right front limb. On palpation, the swollen tendons were significantly sensitive to palpation yet it was not possible to determine if it was the superficial flexor tendon (SDF) or the deep digital flexor (DDF) tendon. The mare was a grade 3/5 lame in the right front when trotted in a straight line on firm ground. Ultrasound exam of the soft tissue structures revealed a core-like lesion within the outside corner of the SDF tendon. In Figures 1-3, the core-like lesion appears as a black area (red circle) within the body of the SDF tendon (blue circle).  In Figure 2, the image to the right is a cross-sectional view of the tendon and the lesion is a small black circle within the body of the SDF tendon. In the image to the left in Figure 2, the tendon is in a longitudinal view and the lesion appears as a black streak through the body of the SDF tendon.This view is important because it highlights the over-all length of the lesion which in this case was 4-5cm long. The cross-sectional area measured in Figure 3 determined that the core-like lesion was approximately 20% of the entire cross-sectional area of the SDF tendon.

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The mare was treated with ultrasound guided injection of Platelet rich plasma (PRP), stall rest, daily ice therapy and we will follow-up with 3 doses of extra-corporeal shock wave treatment. We anticipate a full return to work after the appropriate period of rehabilitation.