20140516065134 - Untitled1 | Spleen | Abdomen

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  Hemoabdomen + Hemangiosarcoma  635 2 0 0 VETERINARIAN SPECIALTY CASE STUDY Accumulation of blood in spleens (Hemoabdomen) sometimes grow masses either benign tumors (hemangiomas) or malignant tumors (hemangiosarcomas). A seven-year-old FS Shepherd Mix presents a possible mass effect in the mid-abdomen and loss of serosal detail in the cranial abdomen. After further examination by ASGVets patient was diagnosed with Hemoabdomen and Hemangiosarcoma. 1. Referral: Nani is a seven-year-old FS Shepherd Mix that was referred to Animal Specialty Group (ASG) from her regular veterinarian for a probable hemoperitoneum. She had srcinally presented to her rDVM with a 1-2 week history of melena and a recent episode of hematuria after srcinally having a routine check-up 3 weeks prior, at which she was found to be fine. The owner had his pet evaluated due to the other pets in the family recently having severe problems: one cat was recently euthanized with carcinomatosis and another dog had surgery at ASG for a hemoperitoneum and diagnosed with a splenic hematoma. Radiographs of the abdomen were performed by the regular veterinarian, which showed a possible mass effect in the mid-abdomen and loss of serosal detail in the cranial abdomen. Chest radiographs were also performed there which showed a bronchointerstitial pattern consistent withaging fibrosis but there was no evidence of metastatic disease present.  2. Examination: On physical examination at ASG, Nani was tachycardic and tachypneic with bounding femoral pulses and with weak pulses distally. She had pale pink mucous membranes and abdominal palpation revealed a palpable fluid wave present. Nani was otherwise QAR, and the rest of the physical examination was within normal limits. 3. Diagnostics: A blood pressure was performed upon arrival at the hospital which revealed a Doppler of 88 mmHg. Initial blood gas analysis had identified a metabolic acidosis with a significant hyperlactatemia. A flash ultrasound of the abdomen was performed which identified a moderate amount of free fluid in theabdomen. An abdominocentesis was performed confirming the presence of frank blood that did not clot after allowing the fluid to sit. The flash ultrasound had also identified the presence of a cavitated mid-abdominal mass. A diagnosis of a hemoperitoneum was made with a suspected splenic mass. It was then recommended to have Nani taken for an emergency exploratory laparotomy. 4. Procedure: The patient was taken to surgery where 750 mls of blood was removed from the abdomen. The spleen had multiple omental adhesions and 3 separate masses which were noted to have fresh clots and active hemorrhage present. There were 1-2 mm red masses present on the omentum and a 1.5 cm raised mass present on the medial aspect of the right lateral liver lobe which was not bleeding. After removing the fluid from the abdomen a routine splenectomy was performed using a vessel sealant device and a liver biopsy was performed using 2-0 PDS with a guillotine technique. Intraoperatively the patient received 2 synthetic colloid boluses for hypotension and was started on 1 unit of pRBCs after the spleen had been removed. 5. Discussion: Nontraumatic hemoperitoneum is a life threatening condition that can be associated with a potentially poor long-term prognosis depending on the cause. One study involving 71 cases reported the prevalence of malignant splenic neoplasia in cases of hemoperitoneum and a splenic mass as 76.1%  whereas benign splenic lesions were seen in 23.9% of the cases. (1) Another study looking at nontraumatic hemoperitoneum involving 60 cases involving all causes reported a prevalence of hemangiosarcoma in 63.3%, other neoplasia in 5%, and benign lesions in 31.6%. (2) FNA of splenic aspirates have largely been unrewarding for the diagnosis of hemangiosarcoma because they typically have too much blood contamination, and aspirates of the spleen can result in an iatrogenic hemoperitoneum. Unfortunately, at this time there is not a good diagnostic test that can be performed prior to surgery that can differentiate between benign and malignant disease. Hemangiosarcoma in dogs is a disease process associated with a poor long-term prognosis, high metastatic potential and large financial burden. Median survival times with splenic hemangiosarcoma may range from 1-3 months with surgery alone and 6-8 months with surgery and chemotherapy. Hemangiosarcoma has also been associated with microangiopathic hemolytic anemia and disseminated intravascular coagulation. 6. Recovery: No further blood transfusions were needed after raising the PCV from 21% to 30%. The day after surgery Nani developed a conscious proprioceptive deficit in the left pelvic limb that was not present prior to surgery and was believed to be due to a vascular event while pulses remained WNL to that limb. Throughout the recovery period she was started on a lidocaine CRI for ventricular tachyarrhythmias. The patient became nauseous on the lidocaine CRI and the ventricular tachycardia was refractory to the lidocaine and she was switched to oral Sotalol while tapering off of the lidocaine CRI, and the ventricular tachyarrhythmias resolved. The biopsy of the spleen was reported as splenic hemangiosarcoma with no evidence of metastasis on the liver biopsy taken. She was discharged from the hospital after 4 days in the hospital with oral tramadol for pain, Sotalol for the arrhythmias, amoxicillin for a concurrent urinary tract infection and famotidine for nausea. After sutures were removed Nani followed up with the oncology department and chemotherapy. She was treated with Adriamycin/carboplatin based protocol but, unfortunately, several months later Nani was euthanized for a progressive worsening in her quality of life.- See more at: http://www.asgvets.com/hemoabdomen-hemangiosarcoma/#sthash.flRSRjp5.dpuf 
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