Hygroma of the hock

RE: Hygroma of the hock

Anthony Todd — Mon, 08 Jan 2018 22:38:29 GMT

[quote user="Julian Earl"]The course was Wound Management/ Hard-to-heal-wounds, back in June 2010. Hygromas were specifically mentioned re. steroids[/quote]

Yes, the link I quoted about problems with steroids and hygromas seemed to be about the disastrous surgery results too, and the steroids were a sort of an aside.

Can you see if you can download my link 'cos all I can get is the summary. [it may be where your opinion on the course came from.....]

I can see where any surgery on the posted example might be fraught with or without anything!

RE: Hygroma of the hock

Julian Earl — Mon, 08 Jan 2018 21:08:20 GMT

[quote user="Anthony Todd"]

Er, diagnosed on the basis of "a few white cells"" ?

Don't ever let them take a blood sample; you'll be in intensive care in minutes....

BTW what was the course??

I accept your point Anthony. I do not think that one could diagnose a deep pyoderma just by the presence of a few neutrophils. The course was Wound Management/ Hard-to-heal-wounds, back in June 2010. Hygromas were specifically mentioned re. steroids and avoiding surgery so that was why I passed on the information. It seemed relevant to this discussion?

[/quote]

RE: Hygroma of the hock

Anthony Todd — Mon, 08 Jan 2018 18:54:46 GMT

[quote user="Julian Earl"]As a deep pyoderma it could be disastrous.[/quote]

Er, diagnosed on the basis of "a few white cells"" ?

Don't ever let them take a blood sample; you'll be in intensive care in minutes....

BTW what was the course??

RE: Hygroma of the hock

Julian Earl — Mon, 08 Jan 2018 13:43:00 GMT

[quote user="Anthony Todd"]Let us know what happens and what you decide to do. I must say that the one reference I could find showed a disaster after corticosteroids even if this wasn't my experience.[/quote]

M notes from the course at Dick White Referrals said I big capital letters not to inject steroids. Make what you will of that! As a deep pyoderma it could be disastrous.

RE: Hygroma of the hock

orik — Mon, 08 Jan 2018 06:40:40 GMT

The dog at the moment is stable and limps only sometimes, symptomatic treatment as needed is my current approach, but as I said I suspect that Leishmania might be involved in this problem.

RE: Hygroma of the hock

Anthony Todd — Sun, 07 Jan 2018 22:58:03 GMT

[quote user="Julian Earl"] In my experience treating them like a deep pyoderma with very prolonged antibiotics is the best option.[/quote]

Whoops, sorry, missed the aspirate result, or ignored it, sorry.

Sorry again, had a rethink. and I really doubt if "a few leucocytes" and no pain indicates an active infection, as they could be there in any biopsy of anything anywhere.

Let us know what happens and what you decide to do. I must say that the one reference I could find showed a disaster after corticosteroids even if this wasn't my experience.

J Am Vet Med Assoc. 1975 Aug 1;167(3):213-9.

RE: Hygroma of the hock

Julian Earl — Sun, 07 Jan 2018 22:25:23 GMT

[quote user="Anthony Todd"]PS What have you got to lose?[/quote]

A leg? Reputation? A client? All unlikely hopefully! In my experience treating them like a deep pyoderma with very prolonged antibiotics is the best option.

RE: Hygroma of the hock

Anthony Todd — Sun, 07 Jan 2018 18:52:41 GMT

PS What have you got to lose?

RE: Hygroma of the hock

Anthony Todd — Sun, 07 Jan 2018 16:30:03 GMT

Back in the day, I would instill Dmed into it and repeat as necessary, expecting resolution after 2 or 3 instillations.

Instilled Dmed worked magically, intra or sublesionlly, 25G needle, on a variety of chronic inflammatory lesions.

Surgery I would suspect to be very fraught with complications.

RE: Hygroma of the hock

Julian Earl — Sun, 07 Jan 2018 12:31:23 GMT

[quote user="Niall Taylor"]first question remains, when should I recommend surgical excision if the hygroma doesn't become infected/ulcerated? After 3-4 weeks of compressing bandages and neoprene sleeve[/quote]

Short answer is never. It will break down. It will almost certainly recur. After biopsy, then appropriate medical therapy might be long-term antibiosis, anti-inflammatories, but excisional-surgery could be a huge step backwards.

Sorry for the grim prognosis but that's how it is!

RE: Hygroma of the hock

orik — Thu, 21 Dec 2017 22:21:15 GMT

I have got back the results of the biopsy and there is nothing except for a mild presence of leukocytes that indicates chronic inflammation.

I prescribed a short course of steroids at immunosuppressive dosage and it worked, the dog stopped limping and the swelling decreased but now, after the treatment, it started building up again and the dog doesn't put much weight on the leg on rest but it doesn't limp neither.

I forgot to mention that the dog has got Leishmaniasis but still under control (no clinical signs).

Could it be an immunomediated arthritis? I have also read that Leishmaniasis can cause joint effusions.

A colleague suggested a CT but I don't think we have the money for that.

RE: Hygroma of the hock

Niall Taylor — Tue, 24 Oct 2017 15:46:26 GMT

[quote user="orik"]Thank you, in my opinion it is a hygroma because is soft (fluid filled consistency) and if I massage the bigger lump it becomes softer, the other pocket harder and vice-versa. I will proceed with the biopsy anyway so I can drain the hygroma at the same time (I know recurrence rate is high). However my first question remains, when should I recommend surgical excision if the hygroma doesn't become infected/ulcerated? After 3-4 weeks of compressing bandages and neoprene sleeve?[/quote]

It ain't a hygroma - read the thread again, all the reasons it ain't a hygroma have been given. Ergo, your question is irrelevant.

Niall

RE: Hygroma of the hock

orik — Tue, 24 Oct 2017 15:41:35 GMT

Thank you, in my opinion it is a hygroma because is soft (fluid filled consistency) and if I massage the bigger lump it becomes softer, the other pocket harder and vice-versa. I will proceed with the biopsy anyway so I can drain the hygroma at the same time (I know recurrence rate is high). However my first question remains, when should I recommend surgical excision if the hygroma doesn't become infected/ulcerated? After 3-4 weeks of compressing bandages and neoprene sleeve?

RE: Hygroma of the hock

J G Wray — Tue, 24 Oct 2017 08:56:36 GMT

Rarely one to comment on clinical cases, but, in my experience hygromas turn up in three sites, the occiput, olecranon and os calcis, i.e caudal or caudolateral hock.

If solid then biopsy. If fluid filled on FNA, check out cytology and decide on careful dissection and post op wound management - this can be prolonged, so let the owners know - or conservative approach and an odd looking dog.

Anecdote time - once had a patient with a hygroma on the occiput owned by a volatile client, who also happened to be a volatile solicitor. I was young and foolish and thinking I could deal with the whole case, but my older colleague advised me to refer and so the ire was directed at the Referral centre as the wound site refilled. The client was warned and this was clearly documented which blunted the silliness that followed. The dog ended up with a scarred lump on the back of its skull - result.

RE: Hygroma of the hock

Mark Rowland — Mon, 23 Oct 2017 23:05:35 GMT

My Italian Spinone had a sub cut heamangiosarcoma in the same place. I would biopsy.

Mark

RE: Hygroma of the hock

Lindsey Edwards — Mon, 23 Oct 2017 19:47:35 GMT

[quote user="Jill Butterworth"]

Hygromas aren't usually painful unless infected. The change in the mass, the site and the breed would make me want to biopsy...in case the FNA was wrong [/quote]

many sarcomas do not exfoliate cells for FNA; hygromas generally would have free fluid and easily aspirated; an 'empty' FNA always rings alarm bells, especially if fluid was expected

RE: Hygroma of the hock

Jill Butterworth — Sun, 22 Oct 2017 22:45:39 GMT

Hygromas aren't usually painful unless infected. The change in the mass, the site and the breed would make me want to biopsy...in case the FNA was wrong

RE: Hygroma of the hock

Dinu Catilina — Sun, 22 Oct 2017 19:23:56 GMT

I would use NSAID and paracetamol initially.

RE: Hygroma of the hock

orik — Sun, 22 Oct 2017 16:15:16 GMT

Okay, so next step biopsy to confirm and do you recommend in the meantime gabapentin + NSAID?

RE: Hygroma of the hock

Joyce Whitehead — Sun, 22 Oct 2017 11:12:40 GMT

We had what looked clinically like a hock hygroma, when we biopsies as we couldn't get anything on FNA we biopsied. Turned out to be a soft tissue sarcoma, which sadly spread despite radical surgery.

RE: Hygroma of the hock

Dinu Catilina — Sun, 22 Oct 2017 11:07:43 GMT

I would do a biopsy and take some radiographs prior to starting a treatment. You can not have hygroma on the medial aspect of the joint.

I apologise, I see you took radiographs. Edited post for this.