Imaging diagnosis: Disseminated hemangiosarcoma in a Welsh pony

A 16-year-old pony gelding presented with epistaxis and a head tilt. Referral skull radiographs suggested an ethmoid hematoma. Concurrent neurologic abnormalities prompted contrast-enhanced CT of the head and cranial neck, revealing numerous hyperattenuating masses throughout the brain and paranasal sinuses, along with a large osteolytic mass in the second cervical vertebra. The vertebral mass extended into the vertebral canal, causing focal extradural compressive myelopathy. These findings were inconsistent with ethmoid hematoma and metastatic hemangiosarcoma or malignant melanoma were prioritized as potential causes for the clinical signs. Postmortem examination confirmed the sinonasal, intracranial, and vertebral masses as hemangiosarcoma, and additionally revealed innumerable thoracoabdominal metastatic lesions and hemorrhagic foci. A final diagnosis of disseminated hemangiosarcoma was made. In this study, CT proved invaluable for evaluating the severity and characterizing regional disease and neural involvement, directly affecting case management decisions.