Swelling on ventral neck

RE: Swelling on ventral neck

Nicola Cole — Thu, 12 Nov 2015 21:03:26 GMT

Many thanks for the replies. As the 'outer generalised' swelling had gone when I saw it I continued with the initial plan of 2 weeks antibiotics as I had nothing to aim at for surgical exploration (the dog is happy, eating well, no pain on opening jaw/manipulation of area). I am also highly suspicious of a small foreign body but with nothing to aim at (and dog well) was concerned less likely to find it at this stage. Abs course now coming to an end so will see if re-swells and if does will surgically explore. I'll post an update when I know what's happened.

Malcolm-when you go in through a ventral midline incision do you then just 'veer' off towards the lesion? the main area of swelling reported by my colleague at first presentation was a good 2-3cm lateral to midline.

RE: Swelling on ventral neck

grumpyoldman — Fri, 06 Nov 2015 22:26:22 GMT

Nothing ever gets better unless you cut it ,sooner rather than later .

RE: Swelling on ventral neck

Gillian Mostyn — Fri, 06 Nov 2015 21:52:32 GMT

[quote user="Malcolm Ness"]

Despite what Wynne says, I saw a lot of penetrating FB cases as referrals. Typically following several courses of antibiotics and sometimes after one or more attempts at surgical exploration.

Beware spending money on advanced imaging - it is fun and can give some impressive pictures but often it is non-specific (you already knew there was a swelling there, how helpful is it now to have a picture) and the cost often doesn't balance the clinical benefit.

If it comes to surgical exploration, try and resist the temptation to go in through the swelling. I prefer to make a mid-line ventral incision and explore thoroughly from there - but you do need to know your anatomy!

[/quote]

Exactly our experience. We actually had a case last week that developed a neck swelling and forelimb lameness a couple of days after what had initially appeated to be a 'normal' pharyngeal stick injury.

We recommended immediate referral, knowing how bad these can be. It also wasnt insured so we didnt want to spend a fortune on useless symptommatic tteatments. The referral vet (David Crossley...impressive fella) decided imaging wasnt really going to add much (cost had to be considered) and went to immediate surgery...approached midline, as Malcolm suggested.Turned out the stick had gone through'small' pharyngeal wound near a tonsil, sliced through the oesophagus grazed off the bottom of the vertebrae and missed the main arteries by millimetres. The swelling was mainly due to food material in the neck that had come out of the hole in the oesophagus!!!

Doing well now tho!

RE: Swelling on ventral neck

Busybee — Fri, 06 Nov 2015 21:44:55 GMT

Agree to all above - number one would be FB reaction. Our record is a labrador that has had 6 exploratory surgeries on the same swelling at a referral centre and they keep finding more bits of grass/wood! Just to prove these can be a real nightmare.

The last one I had that we thought was a FB has actually turned out to be an unusual molar abscess with associated cellulitis and osteomyelitis - diagnosed on a radiograph after it flared up for a third time.

RE: Swelling on ventral neck

Luca Poddighe — Fri, 06 Nov 2015 17:51:33 GMT

+1 for FB

RE: Swelling on ventral neck

Hannah Wynne Richards — Fri, 06 Nov 2015 09:32:29 GMT

Not something I've ever referred - possibly because it's something high on my list of differentials - so I sort it out satisfactorilly at an early stage.

Wynne

RE: Swelling on ventral neck

Martin Atkinson — Fri, 06 Nov 2015 09:31:31 GMT

Just to throw the cat amongst the pigeons, I had one which was a combination of a sialocoele and foreign body reaction. A grass dart had traveled up and obstructed the parotid duct and was found on excision of the parotid gland. Now you don't see those every day!

RE: Swelling on ventral neck

Malcolm Ness — Fri, 06 Nov 2015 09:16:33 GMT

Despite what Wynne says, I saw a lot of penetrating FB cases as referrals. Typically following several courses of antibiotics and sometimes after one or more attempts at surgical exploration.

RE: Swelling on ventral neck

Will McMullan — Fri, 06 Nov 2015 09:00:47 GMT

I have had a few similar cases. Usually suspect stick injury but most of the ones that I have actually removed sticks from are either severely swollen or in a lot of discomfort. A few that I haven't found any stick fragments in have waxed and waned with antibiotics, but not fully resolved until I've opened up the abcess and broken down the tissues inside it. In fact that is true of other abcesses elsewhere in the body. Sometimes you just need to get in there with a finger and do some damage!

RE: Swelling on ventral neck

Joyce Whitehead — Fri, 06 Nov 2015 08:47:27 GMT

I'd also be strongly suspicious of a FB, and they can be a nightmare to find in my experience. However, we had a working lab owned by a local farmer a couple of months ago come in with a facial swelling, temperature and smelly breath. We anaesthetised her and could see pus coming from a salivary duct, and the swelling was around the parotid area.

As is often the case, they didn't want to spend any money, and 2 courses of potentiated amoxicillin had led to an improvement but then it recurred after a week off the drugs. I had a long chat about advanced imaging/surgery etc but was persuaded by them into a last go with antibiotics on cost grounds. I went for clindamycin. And it went away.

(It'll probably come back in today now I've jinxed it, but that was at least 6 weeks ago)

RE: Swelling on ventral neck

Hannah Wynne Richards — Fri, 06 Nov 2015 08:46:37 GMT

Another vote for a foreign body, probably stick injury as being the most likely. Not often seen in a referral situation, so not top of the list at uni, where most of the teachers have very little practice experience, but definitely top of the list in practice.

Wynne

RE: Swelling on ventral neck

Anthony Dennison — Fri, 06 Nov 2015 08:42:56 GMT

Another one thinking stick injury/FB. Might be worth anaesthetising and having a good prod around the mouth for a draining tract?

RE: Swelling on ventral neck

Kara Gibson — Fri, 06 Nov 2015 03:46:31 GMT

My money would also be on a FB! I would warn the owners these are sometimes hard to find without advanced imaging but wholeheartedly agree with the above recommendation!

RE: Swelling on ventral neck

Utlendigur — Thu, 05 Nov 2015 22:46:47 GMT

What sort of working dog? Collies and spaniels are favourites for stick injuries (with labs and staffies following behind). Owners don't always notice them, or if they do see it happen and the dog seems ok they often don't mention/remember it days/weeks/months down the line. Given the response to antibiotics each time, it sounds like a possible FB. Was there any pain or pyrexia? Sialadenitis might be possible, or a lot of inflammation round a mucocoele but they are usually a lot softer. If further imaging isn't possible I would probably wait to see whether it swells up again - and then explore on the basis that it will be a lot easier to find a tracking FB, which are often quite small, if there's a abscess/tract/swelling to aim for. Might also be worth redoing the ultrasound to see whether there was an artefact on the first, and maybe trying again to aspirate from the lump and stain in house to see whether lymphocytes or neutrophils

RE: Swelling on ventral neck

Catriona MacIntyre — Thu, 05 Nov 2015 21:45:51 GMT

Could it be a sialoadenitis (no clue if I have spelled that properly.... I've been on the go for too many hours today!)

RE: Swelling on ventral neck

Nicola Cole — Thu, 05 Nov 2015 21:36:30 GMT

Hmmm, I put a photo of the ultrasound image on the post but it doesn't seem to be showing it.

i have the photo in 'my photos'-how do I get it to post (on an iPad)?!