Brandy is a 2 year old Terrier mix weighing 24 pounds. She was a rescuce dog that presented to my clinic for a second opinion. Upon presentation Brandy had a large firm swelling above the right eye. It was firm like bone with a softer central region. The swelling was about 3 cm in diameter. It is not painful – but it appears that purulent material is draining over the right eye. When I press on the soft center more purulent material covers the eye. 

Brandy is a 2 year old Terrier mix weighing 24 pounds. She was a rescuce dog that presented to my clinic for a second opinion. Upon presentation Brandy had a large firm swelling above the right eye. It was firm like bone with a softer central region. The swelling was about 3 cm in diameter. It is not painful – but it appears that purulent material is draining over the right eye. When I press on the soft center more purulent material covers the eye. 

This mass was seen by another clinic. The mass was explored twice and biopsies taken. As you can see from the x-rays there is wire suture in the area explored.

Culture:

Negative for aerobes and anarobes. Fungal culture not done

Biopsy- summary: lymphocytic/plasmacytic osteomyelitis.

CBC and Profile: WNL

An e mail from the previous clinic:

“… the most we could figure out was that she had a previous penetrating injury to the sinus cavity and dveloped a large abscess in that are. It has been surgically drained twice but continues to recur. We attempted to place a “long term” drain but she kept getting her e collar off and removed the drain herself. We did send biopsies and there was no sign of neoplasia. I discussed marsupializing the sinus cavity, possibly to that it can drain out the nose- but that is something this is beyond our capabilities. Our orthopeidic specialist who performed one of the surgeries, feels that unless all the abnormal tissue from the inside of the sinus cyst is removed, it will continue to recur.”

We recently spayed Brandy and while under anesthesia we x-rayed the skull from many angles. I am only showing 2 of the images on this forum. I also did an ultrasound of the “mass” and as you can see there is a soft tissue core that has the appearance of purulent material. In the last cine you can see the mass and the globe of the eye at about the 2 o’clock position.

I aspirated the purulent material with an 18 guage needle and got some material out. Upon review it appears that it is a sterile abscess.

My questions:

1. Has anyone seen anthing like this before? A list of differentials would be appreciated.

I have suggested to the owner that a CT scan to clarify the exact pathology would be a good idea before considering radical surgical exploration. Since this is a rescue dog- I am not certain how far the owner is willing to go.

This was an interesting case- and I would appreciate your feedback.