This step is dependent on appropriate neurologic localization. Abdominal ultrasound is another useful method to identify and characterize masses in the abdomen as well as look for free fluid or blood. Echocardiography (ultrasound of the heart) may be recommended as some dogs may have tumor spread to the heart. Surgery is the primary method of treatment for dogs with splenic masses. The body condition score was 4 out of 9, and a large, left-lateralized, mid-abdominal mass was noted on abdominal palpation. This neoplasm can resemble the rare canine lymphangiosarcoma, which is a frequently Differential diagnoses for the intraabdominal mass included a granuloma, hematoma, or neoplasia, possibly originating from the mesentery or a regional lymph node. Since neoplasia was the top differential diagnosis for a mass in the elbow of a middle-aged Flat Coated Retriever, thoracic radiographs were ordered. Unless an abdominal mass is quite large, it may be easily missed on abdominal radiographs. mass effect on the femoral nerve with resultant neuropathy has been described 6; However, presentation is often non-specific with a lack of cutaneous bruising or other localizing signs that can mean a delay in presentation and diagnosis. Abdominal masses can be the result of a number of factors, including an injury, cyst, benign tumor, cancer, or other disease. Patients with nontraumatic hemoabdomen are usually elderly dogs. [ 41] Other possible lesions include the much more common gastric adenocarcinoma and other rare submucosal malignant tumors such as lymphoma and carcinoid. In dogs, a swollen or distended abdomen may be a sign of a significant medical condition or disease, or it may be due to something less worrying, such as a resolvable bacterial infection or parasites. Upper abdominal/ epigastric mass. At that time, the owner reported a “pea-sized” mass on the lateral aspect of the paw. Soft tissue surgeon Ivan Doran took the dog to surgery. Developing a comprehensive list of differential diagnosis is a key step in the diagnostic approach of patients with neurologic problems. Some tumors grow large enough to block the passage of food through the stomach or intestine. A pedunculated or exophytic liver mass is defined as a protruding mass that is connected to the liver by a pedicle and has a center that lies beyond the contour of the liver (1, 2).The differential diagnoses for this type of mass are the same as those for other benign (e.g., hepatic cyst, focal nodular hyperplasia, hepatocellular adenoma, etc.) In pursuing a differential diagnosis, an abdominal ultrasound was performed revealing a large abdominal mass. It is important ... intra-abdominal masses, and pregnancy. Her peripheral lymph nodes were within normal limits. Not all patients with a protruberant abdomen or history of increasing abdominal girth have ascites. The average age at diagnosis is 10 years with no sex or breed predilection. The sonogram defines if the lesion includes "crucial parts" or "extra parts" to remove. Diagnosis was confirmed by (1) histopathologic examination of the adrenal gland tumor after adrenalectomy (4 dogs); or (2) positive results of ACTH stimulation test or low-dose dexamethasone suppression test (9 dogs). Displacement, obstruction or distention, inflammation or infection, perforation or rupture, and/or vascular compromise in any of these systems can result in somatic or visceral pain and the presentation of an acute abdomen. Lateral radiograph revealed a mid cranial abdominal mass with mass effect upon the intestinal tract displacing the mesentery caudally. Splenic masses are the most common canine abdominal mass seen in veterinary medicine. There are over 30 described types of canine lymphoma, and these cancers vary tremendously in their behavior. Lymphoma in dogs. The cause is genetic, but there are also suspected environmental factors involved, including in one study an increased risk with the use of the herbicide 2,4-D. As a result, it is important to consider hyperadrenocorticism as a differential diagnosis in cats and to appreciate how the presentation and management of the disease differs from dogs. The Fothergill sign is a mass in the abdominal wall that does not cross the midline and does not change with flexion of the rectus muscles. Clinical Differential Diagnosis ... AKI was likely secondary to renal artery compression from mass effect associated with abdominal metastases. Splenic masses can be cancerous but up to 50% of splenic masses are benign. Introduction. Endoscopic examination reveals an incidental finding of a subepithelial mass in the antrum of the stomach (Figure 1). Pulmonary metastasis of CHP (canine hemangiopericytoma) is rare and there is no previous report of direct invasion to the abdominal cavity as observed in the present case. This risk was not confirmed in another study. Patients with mesenteric neoplasms usually present with nonspecific symptoms of abdominal pain, weight loss, a palpable abdominal mass, or diarrhea. Peritoneal irritation and occult bloody stools may be present. The overlying mucosa is normal in appearance. Differential diagnoses for the abdominal wall mass included benign or malignant … A volume-contracted heart was also visible. - Abdominal wall swelling eg lipoma or hematoma - epigastric hernia (@ linea alba) - divarication of rectus abdominus - incisional hernia - intra-abdominal mass, such as - Gastric tumour - Pancreatic tumour - Pancreatic pseudocyst - Colonic tumour no movement with resp - … Abdominal fluid buildup main symptom is a visibly distended stomach in your dog. Male dogs rarely develop such a tumor. Differential diagnoses for the abdominal wall mass included benign or malignant … Fibroadenomatous hyperplasia is an important differential diagnosis for mammary gland neoplasia in cats. Patients with nontraumatic hemoabdomen are usually elderly dogs. 7,25 Hemorrhagic abdominal effusion may also be present. The neurological signs attributed to pituitary masses in dogs are wide ranging and include changes in behaviour, inappetance, apparent blindness, The differential diagnosis of these tumors includes taking into account other conditions that give rise to similar symptoms. Cytological examination of the peritoneal fluid revealed anaplastic epithelioid cells. Fibroadenomatous hyperplasia is a progestogen-dependent ductal hyperplasia. Take a look at this radiograph. Cysts. Abdominal distension and pain, peritoneal effusion and weight loss are common. Using a canine analogy, if you only tested for hyperadrenocorticism in dogs with calcinosis cutis, then you would miss around 90% of cases. In dogs with abdominal distension, abnormal biochemistry results may indicate which organ is affected and what the problem might be. Some examples are: Differential Diagnosis. There are numerous conditions that could result in this as discussed later on in this post. Hyperplasia or dysplasia. Splenic hematomas and hemangiomas as well as other benign disease can have a similar clinical presentation and must be differentiated from hemangiosarcoma. Vomiting tends to occur more with tumors in the small intestine, while diarrhea or constipation can occur with tumors of the large intestine. Physicians should make sure that patients are experiencing problems caused by Liposarcoma and not other conditions like: Other types of Sarcomas, like Leiomyosarcoma and Fibrosarcoma Macroscopic fat is readily identified with both computed tomography (CT) … While not common in terms of the frequency with which they are seen in small animal practice, primary intestinal neoplasia is an important differential diagnosis for a dog or cat with vomiting, especially chronic vomiting, chronic diarrhea, anorexia and weight loss, particularly animals that are middle-aged and older. Pain in the right lower quadrant may mimic appendicitis. Hemoabdomen in dogs can be fatal. This suggests a rectus sheath hematoma and is useful to determine if the abdominal mass is within the abdominal wall or intraabdominal cavity. Symptoms of Ascites in Dogs. From 577 quotes ranging from $3,000 - $10,000 The report on any diagnostic Matsumoto S, Aikawa H, Miyake H, Mori H, Maeda T, et al. Image 1. A CT scan was performed next, and a mass enveloping the left elbow was confirmed. Tumors are abnormal growths of cells. This causes fluid to shift into the peritoneal cavity, leading to severe dehydration and electrolyte imbalance. They collectively represent approximately 7-14% of all cancers diagnosed in dogs. Unclassified tumors. Tumors arising from mammary tissue are commonly observed in older, intact female dogs and cats. Changes seen on survey films may include dilated, gas-filled loops of small bowel, an abdominal mass, radiodense foreign body, or ascitic fluid. Bloodwork was unremarkable. To the best of the authors’ knowledge, this is the second documented case of a primary ureteral hemangiosarcoma. Pancreatic. Peritoneal. Since both the differential diagnoses are considered slowly-progressive, and the dog was showing clinical signs relating to the mass, a decision to surgically-excise the abdominal mass was made in the interest of improving the dog’s comfort. pelvic, abdominal or lumbar trauma (e.g. The main differential diagnoses would include dietary indiscretion, parasitism orgastroenteritis of unknown origin. A mammary tumor is usually suspected on detection of a mass during physical examination in the caudal abdominal and cranial thoracic mammary glands (in dogs and cats, respectively). Cranial Abdomen Mass. There is a mass located between the fundus of the stomach and the left kidney. However, in obese dogs it is difficult to detect an enlarged liver on physical examination. The varied differential diagnosis of such pathology was discussed in the Ebers Papyrus (ca. Exploratory confirmed a soft-ball sized mass attached to the pylorus. A cancer diagnosis for your dog is heartbreaking and often overwhelming. The differential diagnosis for gastric stromal tumors includes benign lesions such as true leiomyoma, schwannoma, lipoma, ectopic pancreas, and sarcomas. Lateral radiograph revealed a mid cranial abdominal mass with mass effect upon the intestinal tract displacing the mesentery caudally. Palpation and X-rays revealed a large mass in the cranial abdomen. Because GISTs are often fragile, they can sometimes rupture, which can lead to a hole ( perforation ) in the wall of the GI tract. Pheochromocytoma, although rare, should be a differential diagnosis whenever such a mass is identified. Dogs with hemoperitoneum had a higher frequency of splenic neoplasia. An accumulation of new tissue (a tumor), fluid, a bowel obstruction, bacterial infection, fungal infection, parasitic infection, expansion of an organ, or entrapment of an organ can all cause abdominal masses.. Because the causes, treatments, and complications vary so widely, it is very important to have any abdominal … Microscopic examination of the recurrent mass, intra-abdominal mass and pulmonary nodule revealed histopathological features similar to those observed in the primary mass (Figure 1C).In IHC analysis, neoplastic cells showed strong positivity to vimentin staining and blood vessels inside whorls of neoplastic cells showed positive staining for factor VIII (Figure 1D). Dysgerminomas in dogs are reported rarely, but have a distinctive, recognizable, cytologic appearance and should be included in the differential diagnosis of an intra-abdominal mass in a … Image 1. Differential diagnoses for cranial mediastinal masses include thymoma, lymphosarcoma, ectopic thyroid or parathyroid tissue, chemodectoma, metastic neoplasia, granuloma and thymic branchial cyst [20]. abdominal pain and abdominal mass clinically present together. These tumors can be divided into four different groups: Malignant cancers. Differential Dyspnea-Tachypnea - Small Animal Medicine Veterinary Teaching Hospital Airlangga University Small Animal Practice Differential Diagnose • Dyspnea, defined as difficult or labored breathing, can be observed in dogs or cats as forced or difficult breathing, particularly when the dog or cat is at rest. Liposarcoma Differential Diagnosis. In our canine patient, a caecal mass‐like structure was visualised on abdominal ultrasound. Breaking point A volume-contracted heart was also visible. Primary ureteral neoplasia in dogs is extremely rare. Physical exam revealed a mid abdominal thickening potentially of intestinal origin. Bloodwork was unremarkable. Necropsy findings revealed an irregular-shaped mass attached to the pancreas and stomach with numerous nodules covering the intestinal and urinary bladder serosa. (1990) CT and sonographic diagnosis of retained surgical sponge. The mass was located over the lateral aspect of the metatarsophalangeal joint. Case Description—An 8-year-old 12.2-kg (26.9-lb) spayed female American Cocker Spaniel was referred for evaluation of abdominal discomfort and a suspected intra-abdominal lipoma with possible invasion into the thorax.. Clinical Findings—Physical examination revealed a tense abdomen, and the margins of a large abdominal mass could be appreciated.. Abdominal imaging revealed a mass of … The radiology report Each radiological study is a diagnostic test. Skin tumors are diagnosed more frequently than other tumors in animals in part because they are the most easily seen tumors and in part because the skin is constantly exposed to many tumor-causing factors in the environment. Define the lesion with a needle and remove it with a scalpel. The mass was first noted approximately 2.5 months before sampling. Pancreatic Exocrine Tumors Average Cost. Fine-needle aspirate of an intra-abdominal mass in a young dog. Dog’s with hemoabdomen have a buildup of blood within the lining of the abdominal wall and the abdominal organs (stomach, intestines, pancreas, liver and the gallbladder). The differential diagnosis includes hemangiosarcoma and lymphangiosarcoma; however, current nomenclature favors angiosarcoma to avoid the controversy of blood or lymphatic vessel origin. The neurological signs attributed to pituitary masses in dogs are wide ranging and include changes in behaviour, inappetance, apparent blindness, So a pancreatic mass would be your top differential. An abdominal mass may be palpated on initial examination in approximately 20% to 40% of dogs with lymphoma 22,27 and 20% to 50% of dogs with nonlymphomatous solid intestinal tumors. The final diagnosis relies on microscopic examination the mass after surgical removal. lymphoma, teratoma) Our top differential diagnosis for the caecal mass‐like structure was a GIST, which in humans have been documented to cause hypoglycaemia due to production of insulin‐like growth factors (Davda & Seddon 2007 ) and could have explained the suspected hypoglycemic episodes noted before … mass in the left cranial abdomen. When a large, single mass is located in the liver, called a massive tumor, a hepatocellular carcinoma is the diagnosis in at least half of dogs. Abstract An 11‐year‐old female Yorkshire terrier was presented to the University of Minnesota Veterinary Medical Center for evaluation of a palpable intra‐abdominal mass and alopecia. Percussion of the flanks can be used to rapidly determine if the patient has ascites. Abdominal Ultrasonography We consider the causes of palpable or otherwise detectable mass lesions in the various regions of the abdomen. Differential diagnoses for the intraabdominal mass included a granuloma, hematoma, or neoplasia, possibly originating from the mesentery or a regional lymph node. Peritonitis may be due to infectious causes such as the stomach flu or non-infectious causes such as a hernia. Other important findings include identifying fluid or gas filled bowel loops, a plicated or thickened intestinal segment, or a mass (tumor, intussusception or foreign body). 1500 bc).1 Egyptian medical scholars retroperitoneal lymphadenopathy (e.g. Abdominal masses can be caused by a wide variety of conditions and diseases. Clinical signs usually seen with intestinal tumors include weight loss, decreased appetite, vomiting, diarrhea, and blood within the vomit or feces. 13,23 Physical examination may be unremarkable except for weight loss or may include a palpable abdominal mass, pale mucous membranes, and pain on abdominal palpation. Cysts. A differential diagnosis for acute kidney injury based on a case with suspected renal artery stenosis as the etiology for progressive, oliguric AKI. Differential diagnosis for chronic vomiting, inappetence, and weight loss are gastritis, fungal or inflammatory granulomas, foreign body, gastric ulceration, motility disorders, malignant and benign tumors, and … radiographic findings, the top differential diagnosis was pancreatitis with extrahepatic biliary obstruction. Hepatobiliary. The mass was excised, and histopathology revealed a leiomyoma. Clinical signs of canine pancreatitis can be acute in onset as in acute or acute-on-chronic pancreatitis. A mid abdominal thickening was palpable. The left kidney is displaced caudal to its normal position. Hemoabdomen in dogs can be fatal. The mass grew slowly over the next several weeks and measured 2.3 x 1.4 cm at the time of sampling. Intra-abdominal mass aspirate from a spayed dog with abdominal pain. Based on these findings, a differential diagnosis of haematoma, haemangioma, haemangiosarcoma or … Clinically-affected dogs are usually young entire females up to 6 years of age with symptoms referable to an ovarian mass. However, other cases present with clinical signs consistent with acute abdomen but too vague to identify a specific diagnosis … Concurrent granulosa cell tumor (which are the most common canine ovarian tumor) and teratoma have also been reported in the dog. The differential diagnostic list includes primary diseases of the gastrointestinal, hepatobiliary and urogenital tract, intraabdominal tumors, splenic torsion and hypoadrenocorticism. Her peripheral lymph nodes were within normal limits. The mass is located in the left cranial quadrant of the abdomen, in the area of the proximal extremity of the spleen. What Is Your Diagnosis? Benign masses can be hemangiomas, hematomas, fibromas or leiomyomas, which are all fancy medical names for different non cancerous masses that can be found on the spleen. Most intestinal tumors are in the large intestine (colon and rectum); although, some particular tumors (lymphoma) occur more commonly in the small intestines. Up to 2/3 of dogs with splenic masses have a malignant tumor (2/3 of these are hemangiosarcoma). Tumors affecting the skin or the tissue just under the skin are the most commonly seen tumors in dogs. Veterinary Teaching Hospital Airlangga University Small Animal Practice Differential Diagnose 2. Dog’s with hemoabdomen have a buildup of blood within the lining of the abdominal wall and the abdominal organs (stomach, intestines, pancreas, liver and the gallbladder). Canine lymphomas are a diverse group of cancers, and are among the most common cancers diagnosed in dogs. Incidental masses in the area of the adrenal glands are being discovered with greater frequency because of the increased use of abdominal ultrasound and other imaging techniques. Intestinal Tumors in Dogs and Cats Clinical Oncology Service Ryan Veterinary Hospital of the University of Pennsylvania Intestinal cancer is fairly uncommon in dogs and cats. pelvic fractures) blood dyscrasia Dysgerminomas in dogs are reported rarely, but have a distinctive, recognizable, cytologic appearance and should be included in the differential diagnosis of an intra-abdominal mass in a reproductively intact female dog. 11,30,32 Pain and fever were reported in 20% of dogs with lymphoma in one report. No evidence of intrathoracic metastasis was observed. Therefore, the diagnostic process for evaluating abdominal pain and abdominal masses is largely the same and has been preserved since ancient times. (DeJesus, Hoyt) Address correspondence to Dr. DeJesus ( Antonia.A.DeJesus@gmail.com ). On examination your veterinarian will find an enlarged liver or a palpable mass in the abdominal area. The mass is usually observed behind the rib cage and may even be visible with naked eye. The following conditions may give a false positive appearance of ascites: The obese patient with a lax anterior abdominal wall may have a protuberant umbilicus (everted umbilicus sign) abdominal masses were detected. Conclusion: The results corroborate previous findings that hemangiosarcoma is the most frequent neoplasm of the canine spleen. I have since learned that this is a rather common idiopathic condition in older dogs, but the neurologist that examined her determined that she wasn’t “classically vestibular”. disease, polyps, intussusception, intramural masses (neoplasia, granulomatous enteritis, phycomycosis, satrictures, hematoma), and extramural compression (adhesions, strangulation, volvulus). Key words: perivascular wall tumors, metastasis, lung, abdominal cavity, dog. Gastric dilatation–volvulus (GDV) is the most likely diagnosis. The absence of flank dullness excludes ascites with 90% Pathology Etiology. Abdominal radiographs are frequently obtained as a screening tool to detect abdominal masses and can also be used to stage malignancies. Differential Diagnosis: Liver & Ascites False Appearance. Peritonitis is often associated with acute abdominal pain due to the sudden inflammation of the abdominal tissues, or peritoneum, hence the name for the condition. BluePearl Veterinary Partners, 410 W 55th St, New York, NY, 10019. denied abdominal pain or weight loss. The non-malignant masses consisted of nodular hyperplasia (n=60), splenic hematoma (n=41), and splenitis (n=6). Functional obstruction is caused by such disorders as adynamic ileus (e.g., surgical operations, peritonitis, sepsis, metabolic abnormalities). Lung tumors have moderate to high potential for … Variation in species, breed and conformation, body condition, gastrointestinal contents, and radiographic projection Abdominal ultrasonography revealed a round, anechoic lesion with heterogeneous septations of approximately 2.5 cm in diameter in the dorsal aspect of the head of the spleen. The dog was obtained by a local animal shelter 48 hours before presentation, and previous medical history was unknown. Approximately 50% of all mammary tumors are malignant (cancerous) and of those, 50% have spread at the time of diagnosis. The body condition score was 4 out of 9, and a large, left-lateralized, mid-abdominal mass was noted on abdominal palpation. Cats tend to develop more benign tumors than dogs. Putwain S, Archer J (2009) What is your diagnosis? The goal of the imaging procedure is to rule in disease, rule out disease, or discover new information. A 13-year-old, intact female Fox terrier was presented for evaluation of possible pyometra or abdominal mass. Nihon Igaku Hoshasen Gakkai Zasshi 50: 1350-1358. Differential Diagnosis Ascites refers to the pathologic accumulation of fluid within the peritoneal cavity. Intrathoracic tumors rarely occur in the cranial medi-astinum in dogs [20]. However, in approximately half of the cases benign lesions were histologically diagnosed. Three months after surgery, the progesterone concentration had returned to normal and the alopecia had nearly resolved. The clinician has already examined the animal and has a list of differential diagnoses in mind. Abdominal masses can be the result of a number of factors, including an injury, cyst, benign tumor, cancer, or other disease. Abdominal … The primary and metastatic gastrointestinal synovial sarcoma is rare with a wide differential diagnosis. This is called an obstruction , and it can cause severe abdominal pain and vomiting. We present a case of metastatic synovial sarcoma with unusual immunophenotype causing diagnostic challenges. Lymphoma typically is a diffuse disease of the spleen, but it can sometimes form focal masses that may distort the splenic contour or cavitate if the masses are large (Figure 10). 7 In dogs, the abdominal lymph nodes (eg, medial iliac, hepatic, and mesenteric) are often markedly enlarged. Scrotal masses must be differentiated from other diseases that cause scrotal swelling,scrotal pain,such as testicular tortion , epididimitis, testicular tumors, inguinal herniation and many other diseases. 1. Veterinary Teaching Hospital Airlangga University Small Animal Practice Differential Diagnose 2. • Dyspnea, defined as difficult or labored breathing, can be observed in dogs or cats as forced or difficult breathing, particularly when the dog or cat is at rest. • Tachypnea, defined as increased of respiratory rate or excessive rapid breathing. Enlargement of the abdomen is the most commonly observed symptom. Demonstration of fat within a lesion at noninvasive imaging is an important clue for narrowing the differential diagnosis. Mucosal biopsies are performed to obtain tissue for a diagnosis. A 12-year-old spayed female goldendoodle was presented with a history of polyuria and weight loss. Differential Dyspnea-Tachypnea - Small Animal Medicine 1. Due to the possibility of organ failure or breathing difficulty, however, any swelling in the abdominal area warrants an immediate veterinary visit. However, inflammatory hepatopathy, such as a gallbladder mucocele with possible bile peritonitis or hepatic neoplasia with hemorrhagic or neoplastic effusion, were also considered differential diagnoses. Ascites results from leakage of fluid from blood vessels, internal organs, abdominal masses and lymphatics into the abdomen. It usually expresses cytokeratins EMA, BCL2 with an occasional CD99, and S100 positivity but not desmin. The dog presented a severe abdominal distension. See also abdominal distension, kidney mass, splenomegaly, hepatomegaly, hepatosplenomegaly, rectal mass and scrotal mass. The patient was emaciated, vomiting and anorexic. The dog was obtained by a local animal shelter 48 hours before presentation, and previous medical history was unknown. diagnosis of hemangiopericytoma was made by histopathological and immunohistochemical examination. Vet Clin Pathol 38: 253-256. Many individualized, large, round to fusiform cells that often contain vacuoles and display moderate anisocytosis and anisokaryosis are present. Tumors that spread to the liver from another organ or region of the body are more common than those that originate within the liver itself. "Well that's not supposed to be there"…. palpable mass. Metastatic cancer to the lungs is much more common than primary lung cancer. Abdominal sonography identified unilateral adrenal mass in 7 dogs and bilateral enlargement in 6 dogs. Lung tumors are relatively rare in dogs, accounting for only 1% of all cancers diagnosed. Clinical presentation. abdominal masses were detected. https://www.medvetforpets.com/diagnose-this-dog-with-abdominal-mass Small Animal Medical Differential Diagnosis, 2nd Edition is a practical, concise guide to the differential diagnosis, etiology, laboratory abnormalities, and classification of clinical signs and medical disorders in dogs and cats. Clinically, patients with typhlitis present with a mixture of localized and systemic symptoms including a fever, chills, nausea, vomiting, diarrhea, abdominal pain, tenderness and a distended abdomen. (See “Differential Diagnosis of Hypoglycemia” at VeterinaryPracticeNews.com/DDHypo.) Lymphoma is one of the most common malignant tumors to occur in dogs. Benign tumors. The patient was emaciated, vomiting and anorexic. https://wearethecure.org/.../canine-cancer-library/intestinal-tumors CT plays a critical role in achieving an accurate diagnosis of these neoplasms to guide patient management. Note the mitotic figure (arrow). Foreign bodies, intussusception, calculi, enlarged organs and abdominal masses may be palpated in the cooperative patient. Cats and dogs presenting with a short history of diarrhoea and/or vomiting, without any concerninghistorical features, and with normal physical examination and bloodwork, can initially be managedsymptomatically. The differential diagnosis of extrahepatic abdominopelvic masses is wide. Diagnosis of SIBO requires quantitative aerobic and anaerobic culture of duodenal juice. Physical exam revealed a mid abdominal thickening potentially of intestinal origin. Causes. For example, a dog with an abnormal gait in all four limbs could have a lesion in the cerebellum, brain stem, or cervical spinal cord. 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