In cooperation with

What Is Your Diagnosis? RI

CAN COLL

EG
AM

E
GY
OF V

LO
ET
E

IO
RI D
NA RY RA

Figure 1—Lateral (A) and ventrodorsal (B) radiographic views of the tho-
rax of a 15-year-old 38.5-kg (84.7-lb) neutered male mixed-breed dog
evaluated because of previously diagnosed maxillary osteosarcoma.

History
A 15-year-old 38.5-kg (84.7-lb) neutered male mixed-breed dog was evaluated because of previously diagnosed
maxillary osteosarcoma. Physical examination revealed a left maxillary, ulcerated intraoral mass and moderate den-
tal disease. The only abnormality detected on presurgical hematologic evaluation was mild leukocytosis. Computed
tomography revealed a lytic mass that was infiltrating the left maxilla but not the nasal cavity or the orbit. Thoracic
radiographs were obtained (Figure 1).

Determine whether additional imaging studies are required, or make your diagnosis from Figure 1—then turn
the page →

This report was submitted by Jessica L. Duncan, DVM, and Amy Sato, DVM; from the Department of Clinical Sciences, Cummings School of
Veterinary Medicine, Tufts University, North Grafton, MA 01536. Dr. Duncan’s present address is Cape Cod Veterinary Specialists, 11 Bourne
Bridge Approach St, Buzzards Bay, MA 02532.
Dr. Duncan was a fourth-year veterinary student at the time of case submission.
No extrainstitutional funding was used.
Address correspondence to Dr. Duncan (jessieldvet@comcast.net).

JAVMA, Vol 246, No. 3, February 1, 2015 Vet Med Today: What Is Your Diagnosis? 291
 Figure 2—Same lateral (A) and ventrodorsal (B) radiographic imag-
es as in Figure 1 and a magnified view of the left lateral radiograph
(C). The extrathoracic structures, cardiac silhouette, and pulmonary
vasculature are normal in appearance. Multifocal, well-defined, 1-
to 3.5-mm-diameter mineral opacities are present throughout the
lung parenchyma (arrowheads).

CT evaluation. Also, on the recheck radiography, the

Radiographic Findings and Interpretation
The extrathoracic structures, cardiac silhouette,
and pulmonary vasculature are normal in appearance.
Multifocal, well-defined, 1- to 3.5-mm-diameter min-
eral opacities are present throughout the lung paren-
chyma (Figure 2). The size and opacity of these struc-
tures are most compatible with incidental pulmonary
osteomas.
Treatment and Outcome
The left maxillary osteosarcoma was surgically
resected with narrow but complete margins. The dog
recovered from anesthesia and surgery without compli-
cations. The owners elected not to pursue further treat-
ment, but recheck examination, thoracic radiography,
and CT of the head were performed 4 months after sur-
gery. No evidence of tumor recurrence was found on
pulmonary mineral opacities were unchanged from the
previous evaluation.
The dog was brought to the emergency service, 2
days after the recheck appointment, following acute
collapse. The dog was weak, lethargic, tachycardic, and
hypotensive. An echocardiogram revealed a moder-
ate amount of pericardial effusion, a mass on the right
atrium, and a possible mass on the ventricular wall. Be-
cause of the dog’s age and history of osteosarcoma, the
owners elected to have the dog euthanatized. A nec-
ropsy was not performed.
Comments
Pulmonary osteomas (ie, osseous metaplasia,
heterotopic bone, microlithiasis, or pneumoliths) are
commonly seen in clinically normal older dogs and
are benign. Predisposed breeds include Collies, Box-
ers, and Shetland Sheepdogs, but all dogs are sus-
ceptible.1 Pulmonary osteomas present grossly as dif-
fuse, mineralized nodules < 3 mm in diameter in the
parenchyma of the lungs.1 They form when the type
I pneumocytes produce osteoid, which accumulates
and calcifies with age, forming small, random nod-
ules in the lungs of some dogs.2 It is not known why
some older dogs develop pulmonary osteomas and
others do not.
Pulmonary osteomas can be mistaken for pulmo-
nary metastases on radiographs. To avoid this error, 2
radiographic criteria should be considered: opacity and

292 Vet Med Today: What Is Your Diagnosis? JAVMA, Vol 246, No. 3, February 1, 2015