5 year old mn Pit Bull presented to emergency clinic 2 weeks ago for acute onset subcutaneous hematomas and bruising.  There was no history of trauma.  This dog had no bleeding problems at time of castration or in the years thereafter.

Emergency clinic noted prolonged clotting times and treated with vitamin K and plasma.

• 5 year old mn Pit Bull presented to emergency clinic 2 weeks ago for acute onset subcutaneous hematomas and bruising.  There was no history of trauma.  This dog had no bleeding problems at time of castration or in the years thereafter.

• Emergency clinic noted prolonged clotting times and treated with vitamin K and plasma.

• Dog returned to primary veterinarian who had to treat with whole blood transfusion due to severe drop in PCV.  Testing for Von Willebran’s factor was negative.  The dog responded favorably to the transfusion and did well at home until today.

• The dog presented today with a large SQ mass over the left caudal thorax and cranial abdomen.  Clotting times were normal.  The PCV was 39% and the WBC was normal.  Platelets have dropped to 80,000.  The dog also has diffuse echymosis visible on the ventral thorax, ventral abdomen, axillary, and inguinal regions.  It was unknown at the time of the scan if the dog was still on Vitamin K.

• Abdominal US shows a normal abdomen with no evidence of any effusions or metastatic disease.  Ultrasound of the SQ mass shows an approximately 10cm x 9cm solid mass with multiple small anechoic cavitations.  No communications were seen between the mass and the abdominal and thoracic cavities on ultrasound and radiographs.  No foreign bodies were seen within the mass.

• Fine needle aspirates of the mass obtained after premedicating with DexSp and diphenhydramine showed blood.  Core biopsies of the mass were declined.

• My rule out list for the SQ mass includes neoplasia (hemangiosarcoma, mast cell tumor, hemangiopericytoma, other sarcoma), hematoma, and less likely migrating SQ foreign body.  Rule outs for the echymoses include DIC secondary to neoplasia, rodenticide toxicity.

• I did not see any SQ foreign bodies and have it low on the list due to the concurrent diffuse echymosis.  The dog is not pyrexic and does not have an elevated WBC ct.  No bacteria were seen on FNA’s of the solid portion of the mass.  Would you agree that these factors would put SQ foreign body lower on the list?

• Where would you go next with this case?  Core biopsy?  Surgical biopsy?  CT to confirm no FB?