Bleeding after 'cyst' removal - vasculitis?

Re: Bleeding after 'cyst' removal - vasculitis?

Ian Battersby — Fri, 25 Nov 2011 15:40:11 GMT

I have only had tiome to skim read the stream so sorry if i missed something when reading.

But this does remind me of a case i saw as a resident. Coagulation assessment normal suggesting local vascuar disease causing defect in coagulation. The biopsies bleed profusely etc. We were concerned about heamangiosarc, but turn out the dog had multiple cutanous hamartoma.

All the best

Ian

Re: Bleeding after 'cyst' removal - vasculitis?

Bob Russell — Fri, 25 Nov 2011 10:30:58 GMT

The mass has been biopsied by the soft tissue surgeon. Coagulation tests x 3 have all been normal!

There are lots of things that should be going on here and it should not be an overly challenging diagnosis but tests and symptoms are not agreeing at the moment!

Re: Bleeding after 'cyst' removal - vasculitis?

Richard Fox — Fri, 25 Nov 2011 10:18:06 GMT

I don't doubt that the lesion you thought was a cyst is anything different and no I do not think that a 2ndry HSA would seed to the area IMHO - its fairly random TBH - although anything is possible in the world of biology! If for some reason the dog has a bleeding abnormality ( I presume all coagulation tests are recent and have been repeated?) then this still could be a growing haematoma - I doubt that many tumours things grow that quickly - have you aspirated is to see if its full of blood?

Re: Bleeding after 'cyst' removal - vasculitis?

Bob Russell — Fri, 25 Nov 2011 09:48:43 GMT

The 'cyst' was getting larger, hence the decision to remove but the excision site started to swell within 24 hours. Initially I suspected a haematoma/seroma. I also blamed the change in pre-med to Medetomidine thinking that I had not identified a potentially significant 'bleeder'.

Within 2 weeks of surgery the swelling at the op site 'grew' to 10"x3". Apparently it is much larger now (3 days later). Any one know/think that a 2ary haemangiosarcoma might 'choose' to seed to an area with a pre-existing benign pathology?

I am still convinced that the structure removed was a cyst. It had been there for 9 months, getting larger over the last 6 weeks.

Re: Bleeding after 'cyst' removal - vasculitis?

Richard Fox — Fri, 25 Nov 2011 09:34:20 GMT

Or uncovered an underling serious problem ;)

Re: Bleeding after 'cyst' removal - vasculitis?

Bob Russell — Fri, 25 Nov 2011 09:19:55 GMT

[quote user="Braden Collins"]

I would agree that neoplasia is most likely.

I would probably expand on the lesson here and say that any lump that is worth removing is worth sending for histopathology. Our fingers and eyes aren't as good as a microscope.

[/quote]

So do I, in reality so do the referral specialists! In the original thread I said I was kicking myself for not keeping the mass at least!

The dog does have a splenic mass. No results yet from the biopsy samples. By removing this innocuous mass I have certainly stirred up a hornets nest.

Re: Bleeding after 'cyst' removal - vasculitis?

Braden Collins — Fri, 25 Nov 2011 04:20:47 GMT

I would agree that neoplasia is most likely.

I would probably expand on the lesson here and say that any lump that is worth removing is worth sending for histopathology. Our fingers and eyes aren't as good as a microscope.

Re: Bleeding after 'cyst' removal - vasculitis?

Richard Fox — Thu, 24 Nov 2011 21:46:29 GMT

Your case does not sound quite like vasculitis to me. There are generally 2 clinical presentations - 1 punched out areas of necrosis, usually circular presenting as ulcers - second more chronic vasculitis/vasculopathy such that occurring in the ear tips of JR Terriers where there is progressive alopecia and scaling.

Was wondering about something like a haemangiosarcoma - pos splenic or other paraneoplastic disease causing a coagulopathy? The lseion does sound fairly innocuous but one can never be sure?

I presume the bx results are not back yet?