Plan of Action


Radiographs of the Left Stifle: 2 Views: With cranial Cruciate ligament rupture 
we expect normal bone structure, minimal soft tissue   
  swelling.  Due to acute nature of injury, we do not expect 
  radiographic changes such as osteophytes, or 
  thickening of the joint capsule.   
  For neoplasia we expect to see increased soft tissue  
  opacity around stifle joint, bony lysis, bony proliferation, 
  soft tissue swelling, possible fracture of distal femur, and  
  elevation of the periosteum.
  The pathologic changes seen with osteoarthritis can be   
  described by an irregular distribution of cartilage loss  
  especially in areas of increased load, subchondral cysts, 
  subchondral bone sclerosis, osteophytes on the margins of 
  the joint.



Ultrasound:			 To evaluate structure and patency of ligaments and   
tendons.  We expect all tendons and ligament to be normal    
except the cranial cruciate ligament.  
Possibly the meniscal ligaments and the caudal cruciate  
could be damaged.  This test should prove one way or the  
other.  

Joint Fluid Evaluation:          Signs of sepsis and infection as well as immune mediated      
                                                 disorders

Arthroscopy: 		Visualization of CCL and meniscal ligament to evaluate   
                                                damage

CBC Profile:                           We would expect to see an inflammatory leukogram and 
                                                 possibly a superimposed stress leukogram.
 
MRI: 				 Same as arthroscopy

Thoracic radiographs:	In the case of neoplasia, may see metastasis- typically 
discrete round, soft tissue density nodules.

Bone Biopsy:	For neoplasia, necessary for definite diagnosis.  Expect to 
see neoplastic cells from soft tissue and bony components.

Lymph node aspirate:	To check for metastasis from neoplasia.
The initial tests we believe are the most important for diagnosing this case include 
radiographs (thoracic and left stifle), CBC and Chemistry panel, and joint fluid analysis. 
Based on the results of these tests, we would continue with diagnostic testing depending 
on the clientÕs financial resources.