Case Study

Hemoabdomen in a MN Corgi mix dog

Presented for hemoabdomen. The patient was diagnosed with cancer in the right front leg 2 years ago, a mass was removed and radiation therapy performed. The patient had shown no problems until two nights ago when there was reluctance to get up to go outside. Normal urination, and several bowel movements which owner noted was unusual. The next morning the patient was taken to rDVM for lethargy and radiographs, bloodwork and abdominal ultrasound were performed. A mass was noted near the right hip region as well as internal bleeding. The patient was transferred to an emergency hospital for overnight monitoring. A blood transfusion was performed the next morning. There is no history of seizures or allergies. Current medications include Denamarin 1 tab SID (last given yesterday morning) and Rimadyl 1/2 tab PRN (given a week ago).

DX

Peritoneum: Moderate volume free fluid (hemoabdomen according to history). Source of bleeding indeterminate based on the images provided. Consider occult bleeding nodules from either the liver or spleen. Alternatively, carcinomatosis, and although this is not noted on the scan, carcinomatosis lesions are often 1 to 2 mm and perhaps beyond the spatial resolution of the imaging modality. 2. Diffuse hepatosplenomegaly: Possibly normal variant. (Alternatively occult metastatic disease or diffuse infiltrative disease such as lymphoma or mast cell disease). 3. Lungs and lymph nodes: No evidence of metastatic disease. 4. Right stifle: Extensive degenerative disease probably as a result of cruciate ligament instability.

Image Interpretation

Pre- and post-contrast CT was performed. No evidence of pulmonary metastatic disease. Only the caudal thorax was imaged therefore the thoracic lymph nodes were not evaluated. Moderate volume free fluid throughout the dependent abdomen; large volume of fluid in the caudal-most abdomen. No distinct mass lesion within the peritoneum. The jejunal lymph nodes were normal size. Medial iliac lymph nodes appeared normal and were approximately the same diameter as the bifurcation branches of the aorta (approximately 5 mm wide). The adrenal glands were normal diameter (right measured 9.2 mm wide, left measured 7.0 mm wide). No evidence of nodules or masses in the liver. Spleen mildly enlarged, but no distinct mass lesion noted. The pancreas was mildly enlarged in the body region, but this may be a normal variant. Contrast noted within the pelvic regions of both kidneys and the ureters, and urinary bladder. No lesions noted. No distinct evidence of an invasive mass within the abdomen. At the caudal-most edge of the free fluid in the left dependent abdomen there was continuity between the free fluid and the abdominal musculature. This may represent an invasive mass or contiguousness of the free fluid and the intraperitoneal layer. No distinct evidence of the historically reported right-sided mass. The imaging ended prior to the right coxofemoral joint. Extensive degenerative changes in the right stifle. No evidence of aggressive lesions. Possible small volume free fluid adjacent to mildly atelectatic lung lobes in the pleural space.

Outcome

The recommendation is to look for source of bleeding. Abdominal ultrasound may be more valuable in this particular circumstance to look for swollen nodules at the peritoneum, liver or spleen. Alternatively, consider diffuse systemic bleeding disorder (e.g., DIC).