The use of computed tomography to diagnose bilateral forelimb tendon pathology in a horse with unilateral lameness
Authors: Hunter B. G., Huber M. J., Nemanic S.
Journal: Equine Veterinary Education
Summary
# Editorial Summary This case report describes a horse presenting with unilateral forefoot lameness in which computed tomography (CT) identified bilateral deep digital flexor tendon (DDFT) lesions—notably, the contralateral (non-lame) limb also showed pathology despite clinical soundness. Venous contrast-enhanced CT proved particularly valuable in this instance, revealing concurrent distal sesamoidean impar ligament desmitis in the lame forelimb that may have contributed to the clinical presentation. The bilateral nature of the DDFT changes is clinically significant, as it suggests the apparently sound limb may be at heightened risk of future lameness and warrants preventative management strategies. For practitioners involved in diagnosis and management, this case reinforces that CT—especially when combined with contrast enhancement—offers superior soft tissue visualisation within the hoof capsule compared to conventional imaging modalities, allowing detection of subtle pathology that might otherwise be missed. The findings underscore the importance of imaging contralateral limbs in horses with unilateral lameness, as subclinical lesions may influence rehabilitation prognosis and inform realistic expectations for return to work.
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Practical Takeaways
- •Unilateral lameness may mask bilateral pathology—use advanced imaging like contrast-enhanced CT when clinical signs don't fully explain imaging findings
- •Contrast-enhanced CT is superior to standard CT for visualizing soft tissue lesions in the distal limb and within the hoof capsule
- •Consider bilateral imaging even in unilateral lameness cases to identify subclinical contralateral lesions that may become problematic
Key Findings
- •CT imaging identified bilateral DDFT lesions in a horse presenting with unilateral lameness
- •Venous contrast-enhanced CT revealed distal sesamoidean impar desmitis in the lame forelimb
- •Contrast enhancement improved lesion conspicuity and diagnostic sensitivity for soft tissue structures within the hoof capsule