Disease diagnosis in horses involves the identification and characterization of illnesses through various diagnostic methods and tools. This process is essential for effective veterinary care and management of equine health. Techniques used in diagnosing diseases in horses include clinical examinations, laboratory tests, imaging modalities such as ultrasonography and radiography, and molecular diagnostics. Blood tests are frequently utilized to assess parameters such as complete blood count and biochemical profiles, which can indicate underlying health issues. Additionally, advancements in genetic testing and biomarker identification have enhanced the ability to detect specific diseases early. This page aggregates peer-reviewed research studies and scholarly articles that explore diagnostic methodologies, their applications, and their impact on equine health management.
Russell T, Wainscott M.Twenty-seven horses were treated for epiglottic entrapment by using an oral, hand-assisted bistoury knife technique, under general anaesthesia; 26 of them returned successfully to racing, but one developed a permanently displaced soft palate. After the surgery 13 of the horses had an increased handicap rating and 13 had a decreased rating.
Sampson SN, Schneider RK, Tucker RL, Gavin PR, Zubrod CJ, Ho CP.Injury to the oblique and straight distal sesamoidean ligaments is becoming recognized as a more common cause of lameness in horses than was previously thought. The purpose of this study was to review the magnetic resonance (MR) imaging findings of 27 horses affected with desmitis of the oblique and/or straight distal sesamoidean ligament and determine long-term prognosis for horses with this diagnosis. Imaging was performed with horses in right lateral recumbency in a high-field 1 T magnet. All horses had lameness localized to the digit or metacarpophalangeal/metatarsophalangeal joint region ...
Dyson S, McNie K, Weekes J, Murray R.We tested the hypotheses that mature horses without lameness have a repeatable radiopharmaceutical uptake pattern in the stifle, which is bilaterally symmetric; immature horses have a different radiopharmaceutical uptake pattern; and forelimb lameness alters the radiopharmaceutical uptake pattern in the stifle. The objectives of the study were to describe the normal radiopharmaceutical uptake patterns using region of interest (ROI) analysis; to compare uptake patterns between left and right stifles of the same horse and between mature and immature horses; to compare radiopharmaceutical uptake ...
Morgan EE, Miller WH, Wagner B.Skin hypersensitivities (allergies) in horses are often diagnosed using clinical signs only. Intradermal testing or serological assays are diagnostic options to confirm the allergic nature of the disease and to identify the allergen(s). Our objective was to develop an allergen-specific enzyme-linked immunosorbent assay (ELISA) using a monoclonal antibody specific for horse IgE and to examine its potential for allergen detection in serum in comparison to intradermal testing. Intradermal testing with 61 allergen extracts was performed on 10 horses affected with skin hypersensitivity. Their sera ...
Sharp EL, Farrell HE, Borchers K, Holmes EC, Davis-Poynter NJ.Equid herpesvirus 2 (EHV-2), in common with other members of the subfamily Gammaherpesvirinae, encodes homologues of cellular seven-transmembrane receptors (7TMR), namely open reading frames (ORFs) E1, 74 and E6, which each show some similarity to cellular chemokine receptors. Whereas ORF74 and E6 are members of gammaherpesvirus-conserved 7TMR gene families, E1 is currently unique to EHV-2. To investigate their genetic variability, EHV-2 7TMRs from a panel of equine gammaherpesvirus isolates were sequenced. A region of gB was sequenced to provide comparative sequence data. Phylogenetic analysi...
Vlaminck LE, Steenhault M, Maes D, Huys L, Gasthuys F.This study investigated the placement of an intra-alveolar prosthesis of bone substitute on gingival/periodontal health in 5 ponies following repulsion of cheek teeth 108 and 208. In each pony, one randomly chosen alveolus was allowed to heal by second intention while the other was filled with a non-resorbable, biocompatible bone substitute. At 6, 12 and 24-months after surgery, both maxillary arches were evaluated for wear abnormalities and for gingival health using a periodontal scoring system. Recorded changes included development of overgrowths on mandibular cheek teeth, widening of maxill...
Koneberg DG, Edinger J.The purpose of this in vitro study was to evaluate the value of three-dimensional (3D) ultrasonography for the diagnosis of equine meniscal and trochlear ridge lesions under in vitro conditions. Lesions were created in the isolated meniscus and femoral trochlea of 25 cadaver stifle joints. Cylindric, conic, and cuboid lesions were created on the trochlear ridge. Five different meniscal tear configurations were created. A total of 107 lesions of the trochlear ridge and 103 lesions of the meniscus were created. 3D ultrasonography was performed in a waterbath, using a 7.5 MHz 3D scanner. Trochlea...
Elsheikha HM, Mansfield LS.Sarcocystis neurona is an important protozoal pathogen because it causes the serious neurological disease equine protozoal myeloencephalitis (EPM). The capacity of this organism to cause a wide spectrum of neurological signs in horses and the broad geographic distribution of observed cases in the Americas drive the need for sensitive, reliable and rapid typing methods to characterize strains. Various molecular methods have been developed and used to diagnose EPM due to S. neurona, to identify S. neurona isolates and to determine the heterogeneity and evolutionary relatedness within this specie...
Nielsen MK, Peterson DS, Monrad J, Thamsborg SM, Olsen SN, Kaplan RM.Strongylus vulgaris is an important strongyle nematode with high pathogenic potential infecting horses world-wide. Several decades of intensive anthelmintic use has virtually eliminated clinical disease caused by S. vulgaris, but has also caused high levels of anthelmintic resistance in equine small strongyle (cyathostomin) nematodes. Recommendations aimed at limiting the development of anthelmintic resistance by reducing treatment intensity raises a simultaneous demand for reliable and accurate diagnostic tools for detecting important parasitic pathogens. Presently, the only means available t...
Boscan P, Steffey EP.To assess the changes in colloid osmotic pressure (COP) in horses undergoing surgery for colic. Methods: Prospective clinical evaluation. Methods: Twenty-nine adult horses presented for emergency laparotomy. Methods: Horses were premedicated with intravenous (IV) xylazine and anesthesia was induced with ketamine, diazepam and guaifenesin and was maintained with isoflurane as required. Lactated Ringer's solution (LRS) was given to all horses during anesthesia. Blood was collected in heparin before, and every 30 minutes during, anesthesia to measure COP, total protein concentration (TP), osmolal...
Johnston K, Holcombe SJ, Hauptman JG.To determine the relationship between plasma lactate concentration and colonic viability and survival in horses with >or=360 degrees volvulus of the ascending colon. Methods: Retrospective study. Methods: Horses (n=73) with >or=360 degrees volvulus of the ascending colon. Methods: Medical records (January 2000-November 2005) of all horses examined for colic at Michigan State University Veterinary Teaching Hospital were reviewed. Horses were included only if plasma lactate concentration was measured preoperatively and a diagnosis of >or=360 degrees volvulus of the ascending colon was c...
Johns IC, Del Piero F, Wilkins PA.An 11-year-old Thoroughbred broodmare was evaluated for suspected hepatic dysfunction. Clinical signs of hepatic encephalopathy were evident at admission. Hepatic ultrasonographic evaluation revealed an increase in hepatic size, rounded borders and normal echogenicity. There was no evidence of cholelithiasis or bile duct distention. Increased activity of hepatic enzymes, increased bile acid and bilirubin concentration and an increased ammonia concentration were supportive of a diagnosis of hepatic disease and hepatic encephalopathy. Histopathological evaluation of a liver biopsy specimen was c...
Labeda DP, Donahue JM, Sells SF, Kroppenstedt RM.A novel actinomycete, designated strain LDDC 2876-05(T), was isolated from an equine placenta during the course of routine diagnostic tests for nocardioform placentitis. In a preliminary study, the strain was observed to be phylogenetically distinct from the genera Crossiella and Amycolatopsis and probably a member of the genus Lentzea. A polyphasic study of strain LDDC 2876-05(T) confirmed its identification as a member of Lentzea on the basis of its chemotaxonomic and morphological similarity to all of the known species of the genus. Moreover, the strain could be distinguished from other spe...
Fietz S, Bondzio A, Moschos A, Hertsch B, Einspanier R.The aim of this study was to develop a specific myeloperoxidase (MPO) activity assay in the synovial fluid of horses and investigate whether MPO activity is increased in different forms of joint diseases. Synovial fluid samples were taken from affected joints from horses with osteoarthritis, chronic non-septic arthritis and septic arthritis, and from healthy control horses. MPO activity was measured using a specific modified o-dianisidine-assay containing 4-aminobenzoic acid hydrazide as a potent and specific inhibitor of the MPO. This assay is characterized by high reproducibility. The result...
Zhang J, Miszczak F, Pronost S, Fortier C, Balasuriya UB, Zientara S, Fortier G, Timoney PJ.Genetic variation and phylogenetic relationships among 22 French isolates of equine arteritis virus (EAV) obtained over four breeding seasons (2001-2004) were determined by sequencing open reading frames (ORFs) 2a-7. The ORFs 2a-7 of 22 isolates differed from the prototype virulent Bucyrus strain of EAV by between 14 (99.5% identity) and 328 (88.7% identity) nucleotides, and differed from each other by between 0 (100% identity) and 346 (88.1% identity) nucleotides, confirming genetic diversity among EAV strains circulating in France. Phylogenetic analysis based on the partial ORF5 sequences (n...
Egenvall A, Bonnett B, Wattle O, Emanuelson U.Our objective was to determine the amount, type and cost of veterinary care during a 5-year follow-up period, in Swedish warmblooded riding horses with and without locomotor problems as recorded in 1997. The study population comprised horses with complete insurance both for veterinary care and life during 1997. The horses were followed from the beginning of January 1998 to the end of December 2002. The exposed cohort was composed of 1558 horses that had experienced >or=1 veterinary-care event because of locomotor problems in 1997 (LP-cohort). The exposure-negative (LN) cohort was composed of 1...
Osborne RL, Coggins MK, Walla M, Dawson JH.The heme-containing respiratory protein, myoglobin (Mb), best known for oxygen storage, can exhibit peroxidase-like activity under conditions of oxidative stress. Under such circumstances, the initially formed ferric state can react with H2O2 (or other peroxides) to generate a long-lived ferryl [Fe(IV)=O] Compound II (Cpd II) heme intermediate that is capable of oxidizing a variety of biomolecules. In this study, the ability of Mb Cpd II to catalyze the oxidation of carcinogenic halophenols is demonstrated. Specifically, 2,4,6-trichlorophenol (TCP) is converted to 2,6-dichloro-1,4-benzoquinone...
Lowden S, Gray S, Dawson K.The horse biting louse (Werneckiella equi) is a common global equine ectoparasite. To our knowledge, benzoyl(phenyl)urea insecticides (triflumuron, diflubenzuron) commonly used as sheep lousicides, have not been evaluated for efficacy against W. equi. The aim of this study was to determine louse control efficacy, general wellness and dermal safety following triflumuron application as a backline pour-on to horses. Two efficacy trials using 25 adult naturally infested lousy horses, and a dermal safety trial using 10 adult louse-free horses were conducted over a 14-month period. Lousy animals wer...
Pauwels FF, Hawkins JF, MacHarg MA, Rothenbuhler RD, Baird DK, Moulton JS.3 Horses were examined and treated because of sudden onset of signs of abdominal pain. Results: All horses had a retrosternal (Morgagni) hernia involving the right side of the diaphragm. In each horse, the large colon was incarcerated in a right muscular defect in the diaphragm with a large hernial sac. Results: Definitive surgical repair of the hernia was not performed during the initial celiotomy. The hernia was repaired with mesh herniorrhaphy, but without resection of the hernia sac in 2 horses. For 1 horse, conservative management was applied. In the 2 horses treated with surgical correct...
Young BD, Samii VF, Mattoon JS, Weisbrode SE, Bertone AL.To evaluate and correlate patterns of subchondral bone density and articular cartilage degeneration (derived by use of gross, histologic, and computed tomographic [CT] examinations) in equine third metacarpal condyles with and without osteoarthritis. Methods: 8 metacarpophalangeal (MCP) joints (n = 4 horses) without osteoarthritis and 6 osteoarthritis-affected MCP joints (4). Methods: Horses were euthanized. The third metacarpal condyles of the joints were examined grossly and via CT (3 slice images/condyle). For 6 condylar zones, mean bone density and pattern of density distribution were dete...
Beech J, Boston R, Lindborg S, Russell GE.To compare the effect of thyrotropin-releasing hormone (TRH) administration on endogenous ACTH concentrations in healthy horses and those with pituitary pars inter-media hyperplasia and compare the test with the dexamethasone suppression test (DST). Methods: Prospective case series. Methods: 15 horses with clinical signs of pituitary pars intermedia dysfunction (PPID), 4 horses with equivocal signs of PPID, and 29 horses without signs of PPID. Methods: ACTH concentrations prior to and after administration of TRH were measured 61 times in 48 horses. Results of the DST (cortisol response) were c...
Westermann CM, Dorland L, Wijnberg ID, van der Kolk JH.This review gives an overview of the presently known human and equine metabolic myopathies with emphasis on the diagnostic approach. Metabolic myopathies are muscle disorders caused by a biochemical defect of the skeletal muscle energy system, which results in inefficient muscle performance. Myopathies can arise in different levels of the metabolic system. In this review the metabolic myopathies are categorized in disorders of the carbohydrate metabolism, lipid metabolism, mitochondrial myopathies (other than those described in lipid metabolism), disorders of purine metabolism, primary disorde...
Boswinkel M, Sloet van Oldruitenborgh-Oosterbaan MM.The importance of Anoplocephala perfoliata in horses with colic was studied in 139 horses referred for colic and 139 control horses with no signs of colic for at least three years. The serodiagnostic method of Proudman and Trees, which measures the level of A. perfoliata antibody, was used to detect A. perfoliata infection. Thirty-two horses were examined at necropsy, to determine whether the presence of A. perfoliata in the ileocaecal region was associated with the A. perfoliata antibody level. The mean A. perfoliata antibody level was significantly higher in horses with colic than in horses ...
Matiasek K, Cronau M, Schmahl W, Gerhards H.A 25-year-old Haflinger gelding was evaluated for chronic-progressive unilateral exophthalmos. Ultrasonographic investigation and magnetic resonance (MR) imaging revealed a retrobulbar space-occupying mass to be the cause of eyeball displacement. Ultrasonographic features were not sufficient to specify the type and extension of the lesion. Magnetic resonance scans, however, clearly displayed an infiltrative intracranial growth pattern but sparing of orbital soft tissues. Based on MR appearance, tentative diagnosis of an orbital soft tissue neoplasia was made and subsequently confirmed by histo...
Milinovich GJ, Trott DJ, Burrell PC, Croser EL, Al Jassim RA, Morton JM, van Eps AW, Pollitt CC.Carbohydrate-induced laminitis in horses is characterized by marked changes in the composition of the hindgut microbiota, from a predominantly Gram-negative population to one dominated by Gram-positive bacteria. The objective of this study was to monitor changes in the relative abundance of selected hindgut bacteria that have previously been implicated in the pathophysiology of equine laminitis using fluorescence in situ hybridization (FISH). Caecal cannulae were surgically implanted in five Standardbred horses and laminitis induced by oral administration of a bolus dose of oligofructose. Caec...
Pusterla N, Mapes S, Gebhart C.The cell-mediated immune response to Lawsonia intracellularis, the agent of equine proliferative enteropathy (EPE), was investigated in vaccinated and naturally infected foals. Interferon (IFN)-γ gene expression was determined in peripheral blood mononuclear cells collected from vaccinated (n=6) and control foals (n=6) every 30 days for 180 days following first vaccine administration, and from clinically affected foals (n=16) within 7-10 days of diagnosing EPE. Seroconversion (immunoperoxidase monolayer assay titer ≥60) occurred in 5/6 vaccinated foals between 60 and 90 days following the f...
Dybkjær E, Steffensen KF, Honoré ML, Dinesen MA, Christophersen MT, Pihl TH.Up-to-date and hospital-specific knowledge of prognoses for horses with various forms of colic is essential for helping to guide owners' decisions on costly treatments, and for assessing the continuous development of standards of care in the hospital. This study aimed to determine the short-term survival rates of horses admitted with colic to the University Hospital for Large Animals (UHLA), University of Copenhagen, Denmark, from 2010 to 2018, and to compare these to a previous local study as well as recent, comparable international studies. Short-term survival rates were calculated for horse...
Kuhar U, Malovrh T.The equine infectious anaemia virus (EIAV), which belongs to the Retroviridae family, infects equids almost worldwide. Every year, sporadic EIAV cases are detected in Slovenia. Objective: To characterise the Slovenian EIAV strains in the p15 gag gene region phylogenetically in order to compare the Slovenian EIAV strains with EIAV strains from abroad, especially with the recently published European strains. Methods: Cross-sectional study using material derived from post mortem examination. Methods: In total, 29 EIAV serologically positive horses from 18 different farms were examined in this stu...
Rawlings CA, Byars TD, Van Noy MK, Bisgard GE.Activated coagulation test (ACT) was performed in 37 adult ponies and 31 adult horses. The mean ACT time of all ponies and horses was 2 minutes 38 seconds, with a standard deviation (SD) of 29 seconds. The ACT was compared with the Lee-White clotting test in heparinized ponies. The correlation of ACT with the Lee-White test was 0.95. Anticoagulation heparinized ponies during prolonged cardiopulmonary bypass was successfully monitored with the ACT. The ACT is simple and reproducible, has a definite end point, and would seem to be an ideal screening test for hemorrhagic diathesis in equine anima...
Aleman M, Madigan JE, Williams DC, Holliday TA.Reports of the use of brainstem auditory evoked response (BAER) as a diagnostic modality in foals have been limited. Objective: To describe BAER findings and associated causes of hearing loss in foals. Methods: Study group 18 foals (15 neonatal, 3 nonneonatal), control group (5 neonatal foals). Methods: Retrospective. BAER records from the Clinical Neurophysiology Laboratory were reviewed from the years of 1982 to 2013. Peak latencies, amplitudes, and interpeak intervals were measured when visible. Clinical data were extracted from the medical records. Foals were grouped under disease categori...
Wilkołek P, Szczepanik M, Sitkowski W, Adamek Ł, Pluta M, Taszkun I, Gołyński M.New techniques in equine veterinary allergy testing include multiple allergen simultaneous tests (MASTs) that cover insect bite hypersensitivity (IBH), respiratory and atopic allergic diseases. The in vivo intradermal test (IDT) method is one of the most widely used techniques in veterinary practice, but recently, in vitro methods have been introduced as possible alternatives. This study was designed to assess the correlation between IDTs and MASTs based on IgE determination in serum. The study was performed on Malopolski breed horses with IBH (n = 26). IDTs were performed, and allergen-spe...
Dubin A, Potempa J, Kurdowska A, Pajdak W, Koj A.Alpha-1-proteinase inhibitors isolated from plasmas of horse, ox, pig, rabbit and man were used for determination of some kinetic parameters of interaction with three horse leucocyte proteinases and bovine pancreatic trypsin and chymotrypsin. Effective molar ratio of enzyme-to-inhibitor, inactivation rate constant and inhibition constant were measured. In horse, ox, pig and rabbit two principal electrophoretic forms of alpha 1-PI could be distinguished. Both forms effectively inhibited trypsin but usually only one form reacted promptly and stoichiometrically with chymotrypsin and leucocyte ela...
De Keyser K, Berth M, Christensen N, Willaert S, Janssens S, Ducatelle R, Goddeeris BM, De Cock HE, Buys N.Diagnosis of chronic progressive lymphoedema (CPL) in draught horses, including the Belgian Draught Horse, is mainly based on clinical evaluation of typical lower limb lesions. A deficient perilymphatic elastic support, caused by a pathological elastin degradation in skin and subcutis, has been suggested as a contributing factor for CPL. Elastin degradation products induce the generation of anti-elastin Ab (AEAb), detectable in horse serum by ELISA. For a clinically healthy group of draught horses, a significantly lower average AEAb-level than 3 clinically affected groups (mild, moderate and s...
Headley SA, Kummala E, Saarinen H, Tupamäki A, Tulamo RM.An 11-yr-old Dressage mare had abnormal gait, and an abscess of the left hoof was suspected but not observed. Radiographic and computerized tomographic evaluations showed a large cystic lesion near the apex of the pedal bone, and a smaller, similar lesion at the lateral wing. Sagittal sections through the affected member revealed two intraosseous cysts at the third phalanx. Histologic and histochemical results characterized the lesions as intraosseous epidermoid cysts of the third phalanx.
Roberts MC, Pinsent PJ.Three horses suffering from malabsorption were shown to have alimentary lymphosarcoma predominantly affecting the small intestine and the associated lymph nodes. The diffuse cellular infiltration in two of the case produced marked changes in the villous architecture reducing the available mucosal surface area, and, with lowered or barely detectable disaccharidase activities, contributed to the impairment of digestive-absorptive processes. One of the horses maintained a voracious appetite and was not diarrhoeic, but failed to gain weight, indicating differences in the production and utilisation...
Pascoe RR.The epidemiology of dermatomycocis due to Trichophyton equinum var autotrophicum was studied in a number of thoroughbred stables in south-east Queensland. The significant factors in the epidemiology were defined. The infection was readily transmitted, particularly by infected saddle-girths, on which the fungus could survive for 12 months. Mild abrasion from the saddle during work favoured the development of lesions and prolonged the recovery period. A pronounced age and seasonal incidence of the disease was demonstrated as young horses under the age of 3 years were most susceptible, and the ma...
Monahan CM, Chapman MR, Taylor HW, French DD, Klei TR.Eighteen mixed-breed, naturally infected ponies ranging in age from 1 to 16 yr and four cyathostome-naïve ponies reared and maintained under parasite-free conditions ranging in age from 1 to 4 yr were used in this study. Naturally-infected ponies were treated with 1 dose of ivermectin (IVM) at 200 micrograms kg-1, followed by a 5-day regimen of oxibendazole (OBZ) at 20 mg kg-1 to remove existing cyathostome burdens; cyathostome-naïve control ponies were treated with IVM alone. The naturally infected ponies were matched on age and gender, then randomly assigned to one of three treatment group...
Galera PD, Brooks DE.Keratomycosis in the horse exists in several unique clinical forms. This paper discusses the diagnosis and clinical management of keratomycosis in the horse associated with tear film instability, epithelial keratopathy, subepithelial infiltrates, superficial and deep ulcers, plaques, melting ulcers, descemetoceles, iris prolapse, and stromal abscesses. Prompt diagnosis and aggressive treatment of equine keratomycosis can make a major difference in the maintenance of a cosmetic and visual eye.
Sedrish SA, Moore RM, Valdes-Vasquez MA, Haynes PF, Vicek T.Pythiosis, caused by Pythium insidiosum, is a common cutaneous granulomatous disease in horses. Surgical removal is the most common treatment; however, high rates of recurrence have been reported. Results of examination of 2 horses with pythiosis granulomas in which a neodymium:yttrium-aluminum-garnet laser was used to photoablate the bed after removal are reported. The mass had not recurred in either horse 1 year after surgery. Photoablation results in collateral thermal necrosis and may kill organisms that have infiltrated surrounding tissues, thus reducing the risk of recurrence.
Slatter DH, Hawkins CD.Serum samples were collected from 479 clinically normal horses from 11 different locations in Queensland. Using a microscopic agglutination test, 157 serums (33%) reacted to one or more serovars of Leptospira interrogans at a minimum serum dilution of 1/30. The prevalences of reactors among all horses to the serovars tested were pomona 30.5% icterohaemorrhagiae 23.9%, tarassovi 18.8%, hardjo 12.2%, canicola 8.6%, grippotyphosa 3.6%, and australis 2%. There was a significantly higher prevalence of reactors in tropical areas than in sub-tropical areas, but no difference in prevalence between coa...
Fuentes-Romero B, Muñoz-Prieto A, Cerón JJ, Martín-Cuervo M, Iglesias-García M, Aguilera-Tejero E, Díez-Castro E.Obesity and its associated complications, such as metabolic syndrome, are an increasing problem in both humans and horses in the developed world. The expression patterns of resistin differ considerably between species. In rodents, resistin is expressed by adipocytes and is related to obesity and ID. In humans, resistin is predominantly produced by inflammatory cells, and resistin concentrations do not reflect the degree of obesity, although they may predict cardiovascular outcomes. The aim of this study was to investigate the usefulness of resistin and its relationship with ID and selected ind...
Swanson TD.The purpose of this article is to describe the clinical features present in the patient affected with acute laminitis. The variations in the stance and characteristic lameness of the acute disease are described in relation to the disease severity and limb involvement. The elements of establishing a diagnosis including clinical history, physical and radiologic evaluation, and differential diagnosis are discussed. Difficulties and criteria used in establishing a prognosis of the acute phase patient are defined.
Garrett KS.Diagnostic imaging is often an important part of the diagnostic approach to neurologic disease. Advanced imaging techniques such as myelography, computed tomography (CT), and magnetic resonance imaging (MRI) provide more information than radiography and ultrasonography but are more limited in their availability. The clinician should be cognizant of the findings of the clinical examination when interpreting diagnostic imaging findings.