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Topic:Diagnostic Imaging

Diagnostic imaging in horses encompasses a range of techniques used to visualize the internal structures of the equine body for the purpose of diagnosis and treatment planning. These techniques include radiography, ultrasonography, magnetic resonance imaging (MRI), computed tomography (CT), and nuclear scintigraphy. Each modality offers unique advantages in assessing different tissues and conditions, such as bone fractures, soft tissue injuries, and joint abnormalities. Radiography is commonly employed for evaluating bone structures, while ultrasonography is frequently used for soft tissue assessment. MRI and CT provide detailed cross-sectional images, facilitating the examination of complex anatomical regions. Nuclear scintigraphy can detect areas of increased bone activity, often used in lameness evaluations. This page compiles peer-reviewed research studies and scholarly articles that explore the applications, advancements, and comparative effectiveness of diagnostic imaging modalities in equine veterinary practice.
A comparison of arthroscopy to ultrasonography for identification of pathology of the equine stifle.
Equine veterinary journal    February 25, 2016   Volume 49, Issue 3 314-321 doi: 10.1111/evj.12541
Adrian AM, Barrett MF, Werpy NM, Kawcak CE, Chapman PL, Goodrich LR.To evaluate and compare the diagnostic capability of arthroscopy and ultrasonography for the detection of pathological change in equine stifle joints. Although descriptions of the arthroscopic and ultrasonographic boundaries of the normal femorotibial joint exist, there are few examples in the literature comparing the pathological changes observed with each imaging modality. Objective: To evaluate and compare arthroscopic and ultrasonographic examinations for characterising pathological change in the stifle joint. To describe how the results of arthroscopic and ultrasonographic examinations ma...
Evaluation of a Permanent Synthetic Osteochondral Implant in the Equine Medial Femoral Condyle.
Veterinary surgery : VS    February 22, 2016   Volume 45, Issue 3 364-373 doi: 10.1111/vsu.12453
Husby KA, Reed SK, Wilson DA, Kuroki K, Middleton JR, Hoepp NC, Charles EM, Cook JL.To evaluate bone ingrowth, integration, and tolerance of a synthetic osteochondral implant in the medial femoral condyle (MFC) of normal horses. Methods: Experimental study. Methods: Adult horses (n = 6). Methods: Horses were anesthetized and bilateral femorotibial arthrotomies were performed for placement of 1 implant consisting of polycarbonate urethane with a titanium base in 1 MFC. The contralateral MFC served as a sham-operated control without reaming of cartilage or subchondral bone. Lameness evaluations and radiographs were performed pre-operatively with subsequent monthly lameness exam...
Echocardiographic measurements of right heart size and function in healthy horses.
Equine veterinary journal    February 15, 2016   Volume 49, Issue 1 58-64 doi: 10.1111/evj.12554
Decloedt A, De Clercq D, Ven Sofie S, Van Der Vekens N, Sys S, Broux B, van Loon G.Right ventricular (RV) function is scarcely described in horses. Objective: To establish reliable echocardiographic measurements of right heart size and function in horses. Methods: Descriptive study in healthy horses. Methods: Ten healthy untrained adult trotter horses underwent repeated echocardiography performed by 2 sonographers from right and left parasternal standard and nonstandard views. Nonstandard views included a right parasternal view focused on the right atrium, left parasternal long-axis pulmonary artery view, left parasternal long-axis view focused on the right ventricle includi...
Proximal suspensory desmopathy in hindlimbs: A correlative clinical, ultrasonographic, gross post mortem and histological study.
Equine veterinary journal    February 4, 2016   Volume 49, Issue 1 65-72 doi: 10.1111/evj.12563
Dyson S, Murray R, Pinilla MJ.It has been suggested that ultrasonography is unreliable for the detection of hindlimb proximal suspensory desmopathy (PSD) based on comparisons between ultrasonographic and magnetic resonance images. Objective: To compare ultrasonography with gross and histopathological post mortem examination in horses with PSD diagnosed based on ultrasonography and control horses. Methods: Retrospective descriptive study. Methods: Part 1: 19 horses with hindlimb PSD and 10 control horses were humanely destroyed. Twenty control limbs and 37 lame limbs were examined grossly and 40 suspensory ligaments (SLs) w...
Ultrasound Imaging of the Musculoskeletal System.
The Veterinary clinics of North America. Small animal practice    February 2, 2016   Volume 46, Issue 3 355-v doi: 10.1016/j.cvsm.2015.12.001
Cook CR.Musculoskeletal ultrasound is a rapidly growing field within veterinary medicine. Ultrasound for musculoskeletal disorders has been commonly used in equine and human medicine and is becoming more commonly performed in small animal patients due to the increase in the recognition of soft tissue injuries. Ultrasound is widely available, cost-effective, but technically difficult to learn. Advantages of musculoskeletal ultrasound are the opposite limb is commonly used for comparison to evaluate symmetry of the tendinous structures and the ease of repeat examinations to assess healing. The article d...
COMPUTED TOMOGRAPHIC APPEARANCE OF MELANOMAS IN THE EQUINE HEAD: 13 CASES. Dixon J, Smith K, Perkins J, Sherlock C, Mair T, Weller R.Melanomas are one of the most common neoplasms in the horse and are frequently found in the head region. There is a genetic predisposition in horses with a gray hair coat. Computed tomography (CT) is frequently used in referral practice to evaluate the equine head but there are few reports describing the CT appearance of melanomas in this location. The aim of this retrospective, case series study was to describe characteristics in a group of horses with confirmed disease. Case records from two referral hospitals were reviewed, and 13 horses were identified that had undergone CT of the head, wi...
Differences in the vascular tree of the femoral trochlear growth cartilage at osteochondrosis-susceptible sites in foals revealed by SWI 3T MRI.
Journal of orthopaedic research : official publication of the Orthopaedic Research Society    January 21, 2016   Volume 34, Issue 9 1539-1546 doi: 10.1002/jor.23149
Martel G, Kiss S, Gilbert G, Anne-Archard N, Richard H, Moser T, Laverty S.Focal ischemic chondronecrosis of epiphyseal growth cartilage (EGC) during endochondral ossification is believed to be a key early event on the pathway to osteochondrosis (OC) in both animals and humans. The lateral ridge of the equine trochlea is a site where severe osteochondritis dissecans lesions frequently arise and is a model for the study of naturally occurring disease. Non-invasive imaging to investigate EGC vascularity may help elucidate why focal ischemia occurs. 3T MRI susceptibility-weighted imaging (SWI) of femoral trochlea of OC predisposed (n = 10) and control (n = 6) da...
Comparison of image quality and in vivo appearance of the normal equine nasal cavities and paranasal sinuses in computed tomography and high field (3.0 T) magnetic resonance imaging.
BMC veterinary research    January 19, 2016   Volume 12 13 doi: 10.1186/s12917-016-0643-6
Kaminsky J, Bienert-Zeit A, Hellige M, Rohn K, Ohnesorge B.Computed tomography (CT) is a well-established imaging technique in the diagnostics of equine sinunasal disease. High-field magnetic resonance imaging (MRI) is becoming more readily available in equine veterinary medicine. MRI is appreciated for its superior ability to depict soft tissues with high contrast. To compare the established technique of CT in the depiction of the equine nasal cavities, paranasal sinuses and adjoining anatomical structures to 3 Tesla MRI the nasal cavities and paranasal sinuses of 13 horses were examined using CT and 3 Tesla MRI. Results: Comparison of CT and MRI ima...
Assessing aortic regurgitation severity from 2D, M-mode and pulsed wave Doppler echocardiographic measurements in horses.
Veterinary journal (London, England : 1997)    January 18, 2016   Volume 210 34-38 doi: 10.1016/j.tvjl.2016.01.011
Ven S, Decloedt A, Van Der Vekens N, De Clercq D, van Loon G.Aortic regurgitation (AR) in horses can lead to left ventricular (LV) eccentric hypertrophy, ventricular arrhythmia and heart failure. Objective quantification of the severity of regurgitation is difficult. The aim of this study was to evaluate dimensional measurements, systolic time intervals and blood flow velocities, acquired by standard 2D, M-mode and pulsed wave Doppler echocardiography, for quantification of AR. Echocardiography was performed in 32 healthy horses and 35 horses with AR that were subdivided in three groups (mild, moderate or severe AR). From the recorded images LV, left at...
Computed Tomographic Appearance of the Temporomandibular Joint in 1018 Asymptomatic Horses: A Multi-Institution Study. Carmalt JL, Kneissl S, Rawlinson JE, Zwick T, Zekas L, Ohlerth S, Bienert-Zeit A.Published descriptions of nonseptic arthritis of the equine temporomandibular joint (TMJ) are rare and large studies investigating variations in the TMJ for asymptomatic horses are lacking. The objectives of this cross-sectional, retrospective, multi-institutional study were to describe anatomical variations in the TMJ detected using computed tomography (CT) in an equid population asymptomatic for TMJ disease and determine whether these variations were associated with patient signalment, reason for CT examination, or CT slice width. Medical records at eight hospitals were searched for horses t...
Feasibility and Safety of Contrast-Enhanced Ultrasound in the Distal Limb of Six Horses. Seiler GS, Campbell N, Nixon B, Tsuruta JK, Dayton PA, Jennings S, Redding WR, Lustgarten M.Vascular alterations play important roles in many orthopedic diseases such as osteoarthritis, tendonitis, and synovitis in both human and equine athletes. Understanding these alterations could enhance diagnosis, prognosis, and treatment. Contrast-enhanced ultrasound (CEUS) could be a valuable method for evaluation of blood flow and perfusion of these processes in the equine distal limb, however no reports were found describing feasibility or safety of the technique. The goal of this prospective, experimental study was to describe the feasibility and safety of distal limb CEUS in a sample of si...
Longitudinal Cell Tracking and Simultaneous Monitoring of Tissue Regeneration after Cell Treatment of Natural Tendon Disease by Low-Field Magnetic Resonance Imaging.
Stem cells international    January 10, 2016   Volume 2016 1207190 doi: 10.1155/2016/1207190
Berner D, Brehm W, Gerlach K, Gittel C, Offhaus J, Paebst F, Scharner D, Burk J.Treatment of tendon disease with multipotent mesenchymal stromal cells (MSC) is a promising option to improve tissue regeneration. To elucidate the mechanisms by which MSC support regeneration, longitudinal tracking of MSC labelled with superparamagnetic iron oxide (SPIO) by magnetic resonance imaging (MRI) could provide important insight. Nine equine patients suffering from tendon disease were treated with SPIO-labelled or nonlabelled allogeneic umbilical cord-derived MSC by local injection. Labelling of MSC was confirmed by microscopy and MRI. All animals were subjected to clinical, ultrason...
High-throughput analysis of horse sperms’ 3D swimming patterns using computational on-chip imaging.
Animal reproduction science    January 7, 2016   Volume 169 45-55 doi: 10.1016/j.anireprosci.2015.12.012
Su TW, Choi I, Feng J, Huang K, Ozcan A.Using a high-throughput optical tracking technique that is based on partially-coherent digital in-line holography, here we report a detailed analysis of the statistical behavior of horse sperms' three-dimensional (3D) swimming dynamics. This dual-color and dual-angle lensfree imaging platform enables us to track individual 3D trajectories of ∼1000 horse sperms at sub-micron level within a sample volume of ∼9μL at a frame rate of 143 frames per second (FPS) and collect thousands of sperm trajectories within a few hours for statistical analysis of their 3D dynamics. Using this high-throughp...
Intra-arterial versus intra venous contrast-enhanced computed tomography of the equine head.
BMC veterinary research    January 7, 2016   Volume 12 6 doi: 10.1186/s12917-016-0632-9
Crijns CP, Baeumlin Y, De Rycke L, Broeckx BJ, Vlaminck L, Bergman EH, van Bree H, Gielen I.The anatomical complexity of the horse's head limits the abilities of radiography. Computed tomography (CT) in combination with contrast enhanced CT is used more often for diagnosing various head pathology in horses. The objective of this study was to compare intravenous and intra-arterial contrast-enhancement techniques and describe normal and abnormal contrast enhancement in the horse's head. Results: All 24 horses included in the study recovered without complication from the procedures. Compared to the pre-contrast studies, post-contrast studies showed significant contrast enhancement in th...
Equine endometrial vascular pattern changes during the estrous cycle examined by Narrow Band Imaging hysteroscopy.
Animal reproduction science    January 6, 2016   Volume 166 80-89 doi: 10.1016/j.anireprosci.2016.01.006
Otzen H, Sieme H, Oldenhof H, Kassens A, Ertmer F, Rode K, Müller K, Klose K, Rohn K, Schoon HA, Meinecke B.The aim of this study was to evaluate the uterine blood supply and endometrial vessel architecture, during the equine estrous cycle. Narrow Band Imaging (NBI) hysteroscopy was used for evaluating changes in the endometrial vasculature during the estrous cycle [six mares, d 0 (representing the day of ovulation), d 6 and 11 in four locations]. In addition, endometrial biopsy samples were used for immunodetection of markers for angiogenesis (Vascular Endothelial Growth Factor A, its receptor 2, as well as angiopoietin-2 and its receptor-tyrosine-kinase Tie2) during the estrous cycle (three mares,...
Quantitative comparison of bone mineral density characteristics of the distal epiphysis of third metacarpal bones from Thoroughbred racehorses with or without condylar fracture.
American journal of veterinary research    December 29, 2015   Volume 77, Issue 1 32-38 doi: 10.2460/ajvr.77.1.32
Bogers SH, Rogers CW, Bolwell C, Roe W, Gee E, McIlwraith CW.To compare regional proportions and spatial distributions of volumetric bone mineral density (BMDv) of the palmar aspect of the distal epiphysis of the third metacarpal bone (McIII) in limbs with or without a condylar fracture from Thoroughbred racehorses. Methods: McIIIs from cadavers of Thoroughbred racehorses with (n = 6 bones) and without (8) a condylar fracture. Methods: BMDv and spatial distributions of BMDv in peripheral quantitative CT images of the distal epiphysis of McIIIs were quantitatively assessed with spatial analysis software. Relative proportions of voxels within 9 threshold ...
In Vivo Imaging and Tracking of Technetium-99m Labeled Bone Marrow Mesenchymal Stem Cells in Equine Tendinopathy.
Journal of visualized experiments : JoVE    December 9, 2015   Issue 106 e52748 doi: 10.3791/52748
Dudhia J, Becerra P, Valdés MA, Neves F, Hartman NG, Smith RK.Recent advances in the application of bone marrow mesenchymal stem cells (BMMSC) for the treatment of tendon and ligament injuries in the horse suggest improved outcome measures in both experimental and clinical studies. Although the BMMSC are implanted into the tendon lesion in large numbers (usually 10 - 20 million cells), only a relatively small number survive (<10%) although these can persist for up to 5 months after implantation. This appears to be a common observation in other species where BMMSC have been implanted into other tissues and it is important to understand when this loss o...
Internal Fixation of Cervical Fractures in Three Horses.
Veterinary surgery : VS    December 7, 2015   Volume 45, Issue 1 104-109 doi: 10.1111/vsu.12425
Rossignol F, Brandenberger O, Mespoulhes-Rivière C.To describe the surgical treatment outcome of cervical fractures in 3 horses. Methods: Case report. Methods: Three client-owned horses with cervical vertebral fractures. Methods: Three horses were refered for neck stiffness, pain, and ataxia after a cervical trauma because of a fall. Radiographic examination showed an oblique displaced fracture of the caudal aspect of the body of the second cervical vertebra (C2) in horse 1, an oblique displaced fracture of the caudal aspect of C4 involving the disc between C4 and C5 in horse 2, and a displaced transverse fracture of the body of the axis (C2) ...
Prevalence and characteristics of osteochondrosis in 309 Spanish Purebred horses.
Veterinary journal (London, England : 1997)    December 3, 2015   Volume 207 112-117 doi: 10.1016/j.tvjl.2015.09.024
Boado A, López-Sanromán FJ.Articular osteochondrosis (OC) is commonly reported in horses but there are no reports of its prevalence in the Spanish Purebred (SP). The objective of this study was to assess the prevalence and characteristics of OC of the tarsocrural, dorsal metacarpo-metatarsophalangeal and femoropatellar joints in the SP in a retrospective study. The data were obtained from the radiographs of 309 SP horses and the prevalence and characteristics of lesions were calculated. Osteochondral lesions at predilected sites were diagnosed in 48.8% of the horses. It was more common to find the presence of fragments ...
Ultrasonographic Examination of the Equine Neonate: Thorax and Abdomen.
The Veterinary clinics of North America. Equine practice    November 28, 2015   Volume 31, Issue 3 515-543 doi: 10.1016/j.cveq.2015.09.004
Sprayberry KA.Diagnostic imaging can substantially augment physical examination findings in neonatal foals. Used in combination with radiography or as a stand-alone imaging modality, ultrasound evaluation of the thoracic and abdominal body cavities can be a high-yield diagnostic undertaking. Many of the conditions that afflict neonatal foals are highly amenable to sonographic interrogation, including pneumonia and other changes in the lungs associated with sepsis, systemic inflammatory response syndrome, multiple organ dysfunction, and prematurity; colic arising from medical and surgical causes; and urinary...
Diagnostic Imaging of the Lower Respiratory Tract in Neonatal Foals: Radiography and Computed Tomography.
The Veterinary clinics of North America. Equine practice    November 28, 2015   Volume 31, Issue 3 497-514 doi: 10.1016/j.cveq.2015.08.003
Lascola KM, Joslyn S.Diagnostic imaging plays an essential role in the diagnosis and monitoring of lower respiratory disease in neonatal foals. Radiography is most widely available to equine practitioners and is the primary modality that has been used for the characterization of respiratory disease in foals. Computed tomography imaging, although still limited in availability to the general practitioner, offers advantages over radiography and has been used diagnostically in neonatal foals with respiratory disease. Recognition of appropriate imaging protocols and patient-associated artifacts is critical for accurate...
Magnetic resonance imaging assisted management in five cases of suspected quittor.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    November 9, 2015   Volume 29, Issue 1 75-82 doi: 10.3415/VCOT-15-02-0039
Meehan LJ, Taylor SE, Labens R, Cillán-García E.Assessment of the usefulness of magnetic resonance imaging (MRI) in treatment planning in suspected cases of quittor in the horse. Methods: Five horses with chronic discharging tracts at the level of the foot underwent MRI for treatment planning. Results: The MRI examination revealed variable involvement of soft tissue and osseous structures of the foot in addition to abnormalities of the ungular cartilages in all cases. In two cases, follow-up MRI examination was performed. Four of five horses had a successful outcome, with three of these undergoing only one surgical procedure and one being m...
An anatomical study of the dorsal and ventral nasal conchal bullae in normal horses: Computed tomographic anatomical and morphometric findings.
Equine veterinary journal    November 6, 2015   Volume 48, Issue 6 749-755 doi: 10.1111/evj.12516
Liuti T, Reardon R, Smith S, Dixon PM.Infection of the dorsal nasal conchal bulla and ventral nasal conchal bulla has recently been shown to cause clinical disease in horses, but the anatomy of these 2 structures is poorly documented. Objective: To describe the anatomical features, dimensions and relationships to adjacent structures of the dorsal conchal bulla and ventra conchal bulla in normal horses using computed tomography (CT). Methods: Descriptive imaging study using cadavers. Methods: Computed tomographic images acquired from 60 equine cadaver heads that were shown to be free of sinonasal disease were categorised into 3 age...
Accuracy and precision of oscillometric blood pressure in standing conscious horses.
Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)    October 21, 2015   Volume 26, Issue 1 85-92 doi: 10.1111/vec.12411
Olsen E, Pedersen TL, Robinson R, Haubro Andersen P.Arterial blood pressure (BP) is a relevant clinical parameter that can be measured in standing conscious horses to assess tissue perfusion or pain. However, there are no validated oscillometric noninvasive blood pressure (NIBP) devices for use in horses. Methods: Seven healthy horses from a teaching and research herd. Objective: To evaluate the accuracy and precision of systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP) in conscious horses obtained with an oscillometric NIBP device when compared to invasively measured arterial BP. Methods: An ...
ULTRASONOGRAPHIC FINDINGS IN 13 HORSES WITH LYMPHOMA. Janvier V, Evrard L, Cerri S, Gougnard A, Busoni V.Ultrasonography and radiography are commonly used for staging of lymphoma in horses, however there is little published information on imaging characteristics for horses with confirmed disease. The purpose of this retrospective, case series study was to describe ultrasonographic and radiographic findings for a group of horses with a confirmed diagnosis of lymphoma. A total of 13 horses were sampled. Lymphadenopathy (8/13), peritoneal effusion (6/13), splenic (6/13), and hepatic (5/13) lesions were the most frequently identified. The predominant splenic and hepatic ultrasonographic lesions were ...
Radiographic, computed tomographic and surgical anatomy of the equine sphenopalatine sinus in normal and diseased horses.
Equine veterinary journal    October 9, 2015   Volume 48, Issue 5 578-584 doi: 10.1111/evj.12492
Tucker R, Windley ZE, Abernethy AD, Witte TH, Fiske-Jackson AR, Turner S, Smith LJ, Perkins JD.Knowledge of imaging anatomy, surgical anatomy and disorders affecting the sphenopalatine sinus are currently lacking. Objective: To describe the computed tomographic (CT) and surgical anatomy of the sphenopalatine sinus and diagnosis, treatment and outcome in clinical cases with sphenopalatine sinus disease. Methods: Cadaver observational study and retrospective case series. Methods: The sphenopalatine sinuses of 10 normal cadaver heads were examined with digital radiography, CT and sinoscopic examination prior to anatomical sectioning. Sphenopalatine sinus anatomy was described and compared ...
Seizures in horses: diagnosis and classification.
Veterinary medicine (Auckland, N.Z.)    October 5, 2015   Volume 6 301-308 doi: 10.2147/VMRR.S62078
Lacombe VA.Seizures are a diverse and very common set of chronic neurologic disorders in humans and dogs but are less common in horses. Seizures refer to a specific clinical event (described as sudden and severe) regardless of the etiology, which includes both intracranial and extracranial causes. Therefore, after briefly reviewing some definitions, this article aims to describe the use of a standardized classification, which could facilitate a logical approach for the clinician to establish a diagnosis, as well as to use a consistent mode of communication. For instance, seizures can be classified by typ...
Mature teratoma arising from an undescended testis in a horse: comparison between ultrasonographic and morphological features.
Folia morphologica    October 2, 2015   Volume 75, Issue 2 211-215 doi: 10.5603/FM.a2015.0088
Pasolini MP, Della Valle G, Pagano TB, Miele F, Paciello O, Fatone G, Greco M.Scant information is available on the ultrasonographic appearance of different testicular tumours in the stallion. Preoperative ultrasound imaging and gross and microscopic features of a testicular teratoma in a horse is described. An asymptomatic 4 years old cryptorchid Arabian horse was admitted for orchiectomy. Combined transabdominal and inguinal ultrasound examination revealed a large complex ovoid mass, containing both solid and cystic elements with internal echoes, located dorsally to the superficial inguinal ring. Two main hypoechoic cavities divided by a linear hyperechoic septum were...
Clinical Research Abstracts of the British Equine Veterinary Association Congress 2015.
Equine veterinary journal    September 17, 2015   Volume 47 Suppl 48 16 doi: 10.1111/evj.12486_36
Hardeman LC, van der Meij BR, Back W, van der Kolk JH, Wijnberg ID.In cases of laminitis, an increased muscle force or contracture of the deep digital flexor muscle (DDFM) is suggested, but evidence-based research is lacking. Objective: To test if the DDFM of laminitic equines shows an increased muscle force detectable by needle-EMG including Interference Pattern Analysis (IPA). Methods: Cross-sectional study. Methods: Three groups consisted of Group 0 (control): 6 Royal Dutch Sport horses, 3 Shetland ponies and one Welsh pony (healthy, sound adults, mean ± s.d. weight 411 ± 217 kg). Group 1: 3 Royal Dutch Sport horses, one Friesian, one Haflinger...
Clinical Research Abstracts of the British Equine Veterinary Association Congress 2015.
Equine veterinary journal    September 17, 2015   Volume 47 Suppl 48 13-14 doi: 10.1111/evj.12486_30
Satchell G, McGrath M, Dixon J, Pfau T, Weller R.Infrared imaging is becoming popular as an aid to traditional diagnostic tools, its repeatability under practically relevant conditions is still discussed. Objective: We hypothesise that time of day, ambient temperature and relative humidity affect thermography readings, and that there is no difference between values from left and right side. Methods: Repeated thermography in a convenience sample. Methods: Fifteen sound horses were thermographically imaged at 3 time points in the same day (08.00, 12.00 and 16.00 h). Images were taken of the following regions: neck, carpus, distolateral thora...
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