Duval Justin D, Epstein Steven E, Gibson Erin A, Culp William T N
J Am Vet Med Assoc. 2020 Mar 15;256(6):696-700. doi: 10.2460/javma.256.6.696.
An 11-month-old mixed-breed dog was evaluated because of a 2-day history of acute-onset, intermittent vocalization and collapse several days after ingesting metallic wire foreign material.
Physical examination findings were initially unremarkable. After a brief period of hospitalization, the patient acutely developed non-weight-bearing lameness with signs of severe pain localized to the left thoracic limb and inability or refusal to rise. Results of cervical, thoracic, and abdominal radiography revealed a linear metallic foreign body at the thoracic inlet and a single metallic foreign body in the cranial aspect of the abdomen. Neuropathic pain at the level of the left brachial plexus was suspected. Results of a subsequent CT scan were consistent with a metallic foreign body in the left axilla with associated abscess formation and neuritis and an additional metallic foreign body within the omental fat near the pyloroduodenal junction.
Intraoperative fluoroscopy was used to facilitate localization and surgical removal of the axillary foreign body. The intra-abdominal foreign body was removed laparoscopically. Complete resolution of clinical signs was observed before discharge from the hospital the following day. On telephone follow-up 8 months after surgery, the owners reported the patient had no signs of lameness or complications.
Migrating metallic foreign bodies may be identified as incidental findings with the potential to cause harm in the future or may be a cause for severe clinical signs. Migrating foreign bodies should be considered as a differential diagnosis for patients reported to have acute collapse or lameness and consistent clinical history.
一只11个月大的混种犬因摄入金属丝异物几天后出现急性发作、间歇性发声和虚脱2天而接受评估。
最初体格检查结果无异常。经过短暂住院,患者急性出现非负重性跛行,严重疼痛体征局限于左前肢,无法或拒绝站立。颈椎、胸椎和腹部X线检查结果显示在胸廓入口处有一条线性金属异物,在腹部头侧有一个单一金属异物。怀疑左侧臂丛神经水平存在神经性疼痛。随后的CT扫描结果显示左腋窝有一个金属异物,伴有脓肿形成和神经炎,在幽门十二指肠交界处附近的网膜脂肪内还有一个额外的金属异物。
术中使用荧光透视法辅助定位并手术取出腋窝异物。通过腹腔镜手术取出腹腔内异物。在第二天出院前观察到临床症状完全缓解。术后8个月电话随访时,主人报告该患者没有跛行或并发症迹象。
游走性金属异物可能作为偶然发现被识别,有可能在未来造成伤害,也可能是严重临床症状的原因。对于报告有急性虚脱或跛行且有一致临床病史的患者,游走性异物应被视为鉴别诊断之一。