I’ve had several splenic masses lately, and was not sure if FNA is appropriate for all of them? Any contraindications?
I’d been taught previously that FNA of HSA won’t yield much but blood and carries the risk of rupture. If there is already hemoabdomen (as in one of my images, the free fluid showed blood on a tap)…. still worthwhile to FNA if O are not ready to pursue surgery, but might like an answer?
Thank you!
Karen Ebersole
I’ve had several splenic masses lately, and was not sure if FNA is appropriate for all of them? Any contraindications?
I’d been taught previously that FNA of HSA won’t yield much but blood and carries the risk of rupture. If there is already hemoabdomen (as in one of my images, the free fluid showed blood on a tap)…. still worthwhile to FNA if O are not ready to pursue surgery, but might like an answer?
Thank you!
Karen Ebersole
Comments
yuk! thats multicentric
yuk! thats multicentric splenic badness at least sarcoma of some sort likely hsa given the multiple lesions and hemoabdomen. I would say needs sx asap if liver and omentum is ok given the bleed. Single splenic masses : 50% are benign according to one paper but mutiple lesions that number goes up to the 75+% range as malingnant if I recall correctly. Sx is the best option here but position 3 sdep echo first to check for cardiac mets and pericardial effusion as well as 3 view chest rads or lung CT. Regarding fna and HSA my only luck has been to 25g fna the parenchymal portion of the mass in transition zone between normal and abnormal and its dicey at that getting a cyto dx. Bx that same transition zone as well post sx for best dx sample. The cavitated areas are useless diagnostically.
Thank you for the suggestions
Thank you for the suggestions on where to get samples for best diagnostic value…. that helps.
The 2 pictures are actually separate cases from this week…. the first one had hemoabdomen, questionable areas in the liver and was euthanized.
The second picture tho….. no free fluid but was anemic and had drastic weight loss. Would you ever FNA one like that?
Thanks so much!
If your dog is very active
If your dog is very active there is some risk. I remember doing a FNA of a spleen and the dog moved. I was using a 22 guage needle and the needle scraped accross the spleen causing him to bleed. Clinical signs took most of the day to show up and we ending up euthanising the pet later in the day.
Moral of the story-
1. Sedate if possible
2. Use a 25 guage needle
3. Do your aspirates where EL suggested.
Thank you Randy. I’m so
Thank you Randy. I’m so sorry you had that complication. I completely agree with sedation and 25G needles…. I had been questioning if I should have offered FNA for these 2 cases. Good to know that my initial thought was reasonable.
Lots of badness found on US this past week…. here’s to hoping for some happier cases this week. 🙂
That same thing had happended
That same thing had happended to me… body wall goes one way on tension and needle becomes a scalpel.. happens once:(