Non-healing haematoma!

Re: Non-healing haematoma!

Martin Atkinson — Wed, 01 May 2013 10:48:23 GMT

[quote user="Niall Taylor"]

[quote user="Martin Atkinson"]Awaiting histo. report in next few days[/quote]

... and?..

Niall

[/quote] Was indeed a haemangiosarcoma, No recurrence of the haematoma but skin one side of the wound is ulcerated and not healing well - could be interference with the integrity of the blood supply from dissecting the skin over the surgical site or tumour invasion, also there is already a bit of a swelling/mass below the original site. Owner doesn't want to go any further with treatment, once the wound has healed hopefully it will give it a few months of quality life - seems happy otherwise.

Re: Non-healing haematoma!

Niall Taylor — Tue, 30 Apr 2013 22:44:10 GMT

[quote user="Martin Atkinson"]Awaiting histo. report in next few days[/quote]

... and?..

Niall

Re: Non-healing haematoma!

Martin Atkinson — Thu, 18 Apr 2013 18:32:51 GMT

We had considered this but the owner elected to go for surgery today. In the end it was a piece of p1ss, no marked haemorrhage despite the haemotoma still not having resolved, managed to identify abnormal fragile haemorrhagic looking tissue and resect to visually clean margins, packed the dead space with haemostatic pads, ligated everything that seeped and closed with multiple layers of suturing. Awaiting histo. report in next few days.

Re: Non-healing haematoma!

Kate Richardson — Wed, 17 Apr 2013 11:07:14 GMT

Not being funny, but is it bothering the dog? If not, have you considered just leaving it well alone rather than risk potentially making matters worse by operating?

Re: Non-healing haematoma!

Niall Taylor — Tue, 16 Apr 2013 19:37:16 GMT

[quote user="Martin Atkinson"]Thanks guys, you've all confirmed pretty well what I thought, dog is booked in for Thursday for attempt at surgery/biopsy, owner forewarned that things could go horribly wrong and may bleed excessively but is pragmatic enough to realise that if its that bad then it had limited time on earth anyway and is prepared for PTS if its bleeding out on the table!![/quote]

Oh, look on the bright side - it might be nothing more than a simple arteriovenous anastomosis

Niall

Re: Non-healing haematoma!

Mark Rowland — Tue, 16 Apr 2013 19:31:05 GMT

[quote user="Martin Atkinson"]

owner forewarned that things could go horribly wrong and may bleed excessively but is pragmatic enough to realise that if its that bad then it had limited time on earth anyway and is prepared for PTS if its bleeding out on the table!!

[/quote]

Come Come Martin, I would expect you to be ripping off your shirt and giving it an armful of your blood if that were the case.

Re: Non-healing haematoma!

Martin Atkinson — Tue, 16 Apr 2013 19:08:34 GMT

Thanks guys, you've all confirmed pretty well what I thought, dog is booked in for Thursday for attempt at surgery/biopsy, owner forewarned that things could go horribly wrong and may bleed excessively but is pragmatic enough to realise that if its that bad then it had limited time on earth anyway and is prepared for PTS if its bleeding out on the table!!

Re: Non-healing haematoma!

zoe north — Tue, 16 Apr 2013 18:49:56 GMT

Did look after our local RGT branch for about 5 years, and so have seen more older greyhounds than i normally would have come across. Have had 2 different dogs with lesions as you describe. Both lesions excised and sent for histo- 1st one bleed like stink! Both came back as Haemangioma's. Reports said more common in thin shorted coated dogs with prolonged skin exposed to sunlight. Once we had excised - no reoccurance - both died of other causes. Hope that helps.

Re: Non-healing haematoma!

Gareth Dowdeswell — Tue, 16 Apr 2013 17:21:30 GMT

Saw a near identical case when I was a new grad on a GSD. My boss told me to incise over the swelling, drain the blood as much as possible then biopsy the tissue lining the swelling. It wasn't fun surgery, there was what seemed like a lot of blood but once it was biopsied closed the mass with multiple layers of tight continuous sutures then the pressure stopped any further bleeding. Think we got a diagnosis of something very nasty so didn't do further surgery but I wouldn't worry about the bleeding too much as long as you don't hang around for too long and have plenty of swabs!

Re: Non-healing haematoma!

David Mills — Tue, 16 Apr 2013 14:14:55 GMT

I would just caution that it may not be -sarcoma but could easily be a 'benign' haemangioma or haemangiopericytoma. All can invade locally, quite agrressively. Spindle cell tumours can be impossible to tell apart clinically and both show local invasion. There has been some success with soft tissue sarcomas and TKIs post-surgery though radiotx does appear to offer the best modality in conjunction with sx. I'd be taking a good bite of this without worrying too much about margins and working from the histo result.

Re: Non-healing haematoma!

Martin Atkinson — Tue, 16 Apr 2013 12:35:29 GMT

[quote user="Mark Rowland"]Sorry forgot to add its worth some imaging to make sure it's not a metastatic mass.

[/quote] X-rayed chest was clear.

Re: Non-healing haematoma!

Mark Rowland — Tue, 16 Apr 2013 11:33:11 GMT

Sorry forgot to add its worth some imaging to make sure it's not a metastatic mass.

Re: Non-healing haematoma!

Kirsten Simpson — Tue, 16 Apr 2013 10:38:49 GMT

Ive only seen one before - ancient German Shepherd with CDRM + arthritis and she got it on the point of her hock. Resected as much as possible but was unable to get clear margins, it broke down slightly due to tensions but didn't bleed excessively surprisingly. Was healing well when I left (locumming). Its kinda have a go or wait I supose with that :/ Theres always the possibility it could damage that area somehow and bleed out from there I guess. Plus its an ancient dog! Erk

Re: Non-healing haematoma!

Martin Atkinson — Tue, 16 Apr 2013 10:36:50 GMT

Thanks Mark. I feel this will be impossible to get clear margins in this area but probably need a biopsy to get a diagnosis.

Re: Non-healing haematoma!

Mark Rowland — Tue, 16 Apr 2013 10:25:55 GMT

I resected it and it was a horrible op, I was peeling it off the surrounding tissues. Margins were impossible as it was on her cranial hock. But 3 weeks of radiotherapy and it looks fine, no regrowth. She got some nasty radiation burns. According to S North, they rarely if ever metastasise so If you can get margins that should fix them. I didnt want to amp her leg (shes a clumsy spinone). so opted for radiotx instead and so far im glad i did.

Re: Non-healing haematoma!

Martin Atkinson — Tue, 16 Apr 2013 10:18:24 GMT

[quote user="Mark Rowland"]

Me too, my own dog had one on her leg (Now radiotherapied). Did just the same as yours

[/quote] Did you do any surgical resection or just the radiotherapy Mark?

Re: Non-healing haematoma!

Martin Atkinson — Tue, 16 Apr 2013 10:17:04 GMT

[quote user="Kirsten Simpson"]

Hmmm I would be thinking of a subcut haemangiosarcoma personally, just from the fact that it hasn't resolved on its own! Rsection really the only option to remove the cause I suspect :S

[/quote] Is what I thought but it frightens me that I may not find something to clamp off!

Re: Non-healing haematoma!

Mark Rowland — Tue, 16 Apr 2013 10:16:13 GMT

Me too, my own dog had one on her leg (Now radiotherapied). Did just the same as yours

Re: Non-healing haematoma!

bob lehner — Tue, 16 Apr 2013 10:12:31 GMT

[quote user="Kirsten Simpson"]Hmmm I would be thinking of a subcut haemangiosarcoma personally,[/quote]

Me too - I do remember seeing one on a chest wall.

Re: Non-healing haematoma!

Kirsten Simpson — Tue, 16 Apr 2013 10:03:44 GMT

Hmmm I would be thinking of a subcut haemangiosarcoma personally, just from the fact that it hasn't resolved on its own! Rsection really the only option to remove the cause I suspect :S