Rex, a 10 year old neutered male black Labrador Retreiver dog, came to Atlantic Street Veterinary Hospital and Pet Emergency Center because the owners had noticed that his belly seemed distended (enlarged) and he had been lethargic (having a decreased energy level).
The owners had noticed that the night before, about 3 hours after eating his dinner, Rex seemed lethargic and his belly seemed big. They had previously felt he was acting fairly normal with a good energy level, normal appetite and no obvious signs of a problem. He had vomited once the morning that he came to our clinic. When questioned further about Rex’s belly the owner thought that it might have been a little larger than normal for a few months.
Rex had been seen for a physical 3-4 months previously and had seemed normal at that time. Rex’s only other known medical issue was hypothyroidism (low thyroid levels which causes decreased metabolism and can present as subtle problems such as weight gain, skin issues, etc.). He was on a Thyroid supplement for this problem already.
On Rex’s physical examination that day his gum color was a little pale (concerning for anemia or some mild shock/poor perfusion with blood or blood pressure abnormality), his heart rate was faster than normal (also concerning for anemia, shock or pain), he was mildly overweight and when his belly/abdomen was palpated there seemed to be an abnormal firm structure in his abdomen behind his rib cage.
X-rays (radiographs) were taken of Rex’s abdomen and revealed a large mass in his abdomen that appeared to be in the location of his spleen or liver. He also had a decreased amount of detail to his other abdominal organs concerning for the presence of free blood in his abdomen (which is not normal). These findings were concerning for a possible bleeding mass in his abdomen.
Rex was started on supportive care including intravenous fluids, blood pressure monitoring and it was recommended that he have chest x-rays (to look for any possible additional masses in his chest that might raise our concern about a cancerous process that had already spread to his chest). He was scheduled for an ultrasound with a veterinarian who is board certified in radiology later in the morning. At Atlantic Street Veterinary Hospital/Pet Emergency Cetner we have a radiologist on-site at our clinic on a scheduled basis 3 days a week and available other days if needed. This ultrasound was performed soon after Rex arrived.
Rex’s chest x-rays did not show any evidence of cancer in his chest. His ultrasound showed that the large mass in his abdomen was likely originating from his spleen and he did have some free blood in his abdomen that seemed to be due to bleeding from the mass. No other masses were seen in his abdomen or chest (the most common tumor seen in the spleen of Labrador Retreivers is hemangiosarcoma and when this tumor starts to spread/metastasize it often spreads to the liver, lungs and/or base of the heart).
Rex’s owners elected to have his spleen surgically removed and then have the tissue submitted to a laboratory for analysis to see what type of cells it was composed of to guide any further treatment or followup care he might need.
On bloodwork run prior to anesthesia Rex was moderately anemic with a red blood cell PCV of 28%. His total protein level was normal (in cases of sudden/acute blood loss normally the total protein level drops first and then the red blood cell level drops so this was more consistent with a more chronic, slower bleed). His platelet count was moderately low at 82,000 platelets (also consistent with bleeding in the body where platelets are used by the body to stop the bleeding by forming a clot). His lactate was very mildly elevated at 3.05 (this value goes up when animals are not getting good perfusion or oxygen of their tissues or when there is significant tissue death in the body). This also supported the other findings of blood loss.
Rex was taken to surgery (approximately 3 ½ hours after arriving at our clinic) and a balanced anesthesia protocol and anesthesia and patient vitals monitoring were used during the procedure. During surgery Rex’s heart rate, heart rhythm, blood pressure, carbon dioxide levels, respiratory rate and effort, anesthetic concentration levels, blood oxygen saturation, temperature and level of consciousness were constantly monitored. As surgery began his PCV was 27% and his TP was 5.2. At the start of surgery he was given transfusions of blood products including packed red blood cells and fresh frozen plasma that our hospital obtains from an animal blood donor bank.
Rex’s surgery involved removing his spleen which was very enlarged and irregular in appearance with active hemorrhage/bleeding occurring. The removed spleen weighed 8.14 lbs. Rex was then monitored closely for any ongoing bleeding from the vessels that had been feeding the spleen (these blood vessels had been ligated/tied to prevent bleeding when the spleen was removed). At the end of surgery no ongoing bleeding was seen and Rex’s PCV was 27%, TP was 6.0. Other than a mildly decreased blood pressure early in surgery (which improved after Rex’s transfusions and a dopamine drip were started) Rex did very well while under anesthesia and did not have any significant change in his vitals.
Rex remained in the hospital for pain control, monitoring of his red blood cell and total protein levels (as ongoing blood loss is a concern after this type of surgery) and other supportive care for the following 2 days and then went home to have some follow-up bloodwork rechecks to be done as an outpatient. He went home on a pain medication (Tramadol), with a pain patch on (Fentanyl that delivers a steady rate of pain medicine through the skin) and with an e-collar (plastic cone head) so that he wouldn’t try to bother his surgery incision.
Rex had a recheck examination with his regular doctor a few days later to make sure that his anemia was resolving and to remove his pain patch. He then had his surgery skin staples removed approximately 10 days after his surgery at PEC.
Rex’s histopathology (microscopic examination of his spleen) was reported by the clinical pathology as extensive hemorrhage/hematoma around benign hyperplasia with no cancerous cells seen. In other words the cells did not look like cancer but looked like benign/harmless growth of the spleen with bleeding around them. If the histopathologic findings are correct, studies show that of other senior dogs with this finding at the time of splenectomy 85% survived the immediate post-operative period (48 hours) and 65% of those dogs were alive at the end of 12 months with the majority of animals who did die during that period having died from something unrelated to their splenic hematoma/hyperplastic nodules and surgery.
However, there are some cases where a more dangerous cancerous process (such as hemangiosarcoma) can have this appearance. In those cases the large amount of bleeding within the spleen can displace the cancerous cells so that they can no longer be identified. Because of this concern, it was recommended that Rex have recheck x-rays of his chest and recheck ultrasounds done every 6 months to look for any evidence of new or spreading cancer.
NOTE: Hemangiosarcoma is a very common cause of masses in senior dogs with certain breeds (especially large breed dogs) affected more commonly than others. In many cases the animal seems fine while the tumor is growing and clinical symptoms of a problem aren’t seen until the mass begins to hemorrhage/bleed. The majority of these animals present for weakness, lethargy or other relatively vague symptoms and diagnostics including the physical examination, bloodwork, x-rays and ultrasound are utilized to diagnose the problem. The most common sites the tumors are found include the spleen, liver, lungs and base of the heart.
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