A 6-month-old F mixed breed dog was presented for a routine ovariohysterectomy. The puppy also had a history of unilateral epistaxis, presumably due to trauma. The owner reported that she would bleed intermittently from the nostril. Pre-surgical blood work and a PT/PTT were performed. No abnormalities were noted on the serum biochemical profile, however, the CBC revealed a low hematocrit (33.5), low RBCs (4.78), and a monocytosis. The PT and PTT were both within normal range. Surgery was uneventful and no excessive bleeding was noted, but the uterus was underdeveloped. Nasal and oral cavities were examined; a wound was seen on the lateral surface of the nares and a pin sized puncture hole was observed in the patient’s mouth. Radiographs, rhinoscopy, and a possible CT scan were recommended. Radiographs were performed and the lateral and anterior posterior views showed an increased opacity suggestive of soft tissue or a blood clot. The patient was discharged from the hospital with post-operative analgesia. A recheck exam 4 days post-operatively found the patient to be pyrexic, but she was no longer bleeding from the nostril, her mucous membranes were pink with a CRT<2 seconds. Heart and lungs sounds did not show any abnormalities. A swelling on the right side of the cranial abdomen was present and she was painful on abdominal palpation. Recheck blood chemistry was within normal limits. The CBC revealed an anemia, leukocytosis, neutrophilia, and monocytosis. The PT and PTT were both within normal limits. Lateral and V/D abdominal radiographs showed a soft tissue opacity on the right side of the cranial abdomen. An emergency ultrasound +/- exploratory surgery was advised.
