Case Study

Splenic thrombus in a 2 year old SF mixed breed dog with Evans syndrome

A 2-year-old SF mixed breed dog was presented for evaluation of acute onset abdominal pain, polypnea, salivation, and shaking. Approximately a month prior she had been diagnosed with Evans syndrome, which was being managed with azathioprine, prednisone, and aspirin. Survey abdominal radiographs showed a full stomach but no obvious mass/obstruction and a mild hazy pattern in the right cranial quadrant. Abnormalities on laboratory testing were mildly elevated liver enzyme activity. Additional therapy was sucralfate, famotidine, metoclopramide, buprenorphine, omeprazole, ampicillin, and Baytril.

A 2-year-old SF mixed breed dog was presented for evaluation of acute onset abdominal pain, polypnea, salivation, and shaking. Approximately a month prior she had been diagnosed with Evans syndrome, which was being managed with azathioprine, prednisone, and aspirin. Survey abdominal radiographs showed a full stomach but no obvious mass/obstruction and a mild hazy pattern in the right cranial quadrant. Abnormalities on laboratory testing were mildly elevated liver enzyme activity. Additional therapy was sucralfate, famotidine, metoclopramide, buprenorphine, omeprazole, ampicillin, and Baytril.

DX

Splenic thrombus

Sonographic Differential Diagnosis

Splenic vein thrombosis. Thrombosis may eventually continue into the portal system causing portal vein hypertension and development of ascites. Pain was noted on palpation of the right kidney, which is suggestive of a thromboembolic event.

Image Interpretation

Thrombosis was noted in the splenic vein, and the spleen itself was volume contracted. No free fluid was noted at this time.

Outcome

No further outcome at this time.

Comments

Plavix therapy, aggressive fluid support, and potential plasma transfusion are recommended. The patient is at high risk for sudden death owing to thromboembolic disease. Chest radiographs would be recommended in order to monitor for any densities in the lung field that would be consistent with pulmonary thromboembolic disease. Gastrointestinal protectants and endoscopy would be warranted if retention of ingesta is maintained. Recheck sonogram is recommended in 3-4 days to assess any potential of emerging portal hypertension owing to potential evolving thrombosis as well as assess the status of the splenic vein and right kidney.

Clinical Differential Diagnosis

Severe abdominal pain – stomach pathology (torsion, ulceration with perforation and focal peritonitis, foreign body), splenic pathology (torsion, splenitis, neoplasia such as lymphoma/histocytosis), renal pathology – renolith, hydronephrosis, peritonitis.