Onco Rounds

Clinical Case Study: Eight-Year-Old Golden Retriever with Collapse

  • Patient Profile: An 88-year-old female spayed Golden Retriever.
  • Presenting Complaint: Acute collapse and "plantation changes" (likely referring to mucous membrane color changes/pigmentation changes).
  • Clinical Signs and Patterns of Concern:
    • Acute collapse at home.
    • Pale mucous membranes (suggested by the context of bleeding).
    • Potential hypovolemic shock resulting from internal bleeding.
    • Pulse Quality: Checking for thready or weak pulses.
    • Overall demeanor: Down or in pain.

Initial Diagnostics and Triage Procedures

  • Immediate Stabilization:
    • Placement of an intravenous (IV) catheter.
    • Fluid therapy: Administration of crystalloid boluses.
    • Re-evaluating blood pressure and clinical status post-bolus.
  • Physical Examination: A quick initial physical assessment to identify signs of shock.
  • Imaging (POCUS - Point of Care Ultrasound):
    • Evaluation of both the abdominal and thoracic cavities (AFAST and TFAST).
    • Objective: Visualization of free fluid (effusion) and identification of masses.
    • Focus: It is a mistake to only scan the belly; both cavities must be assessed.
  • Point of Care (POC) Bloodwork:
    • Packed Cell Volume (PCV) and Total Solids (TS): Essential for assessing anemia and protein levels.
    • Blood Gas and Lactate: Monitoring lactate levels to assess tissue perfusion and shock severity.
  • Abdominal Tap (Abdominocentesis):
    • Procedure: Comparing the PCV and Total Solids of the abdominal free fluid to the peripheral blood PCV/TS.
    • Clotting Characteristics: Abdominal blood resulting from hemorrhage into a body cavity should not "clap" (clot). This is because the serosal linings of the body cavities produce heparin-like substances that prevent the blood from clotting.

Splenic Pathology and the Two-Thirds Rule

  • Differential Diagnoses for Splenic Masses:
    • Hemangiosarcoma (HSAHSA).
    • Hematoma.
    • Extramedullary hematopoiesis (EMHEMH).
  • The "Two-Thirds Rule":
    • A historical rule of thumb stating that 2/32/3 of dogs with a non-traumatic hemoabdomen have a splenic mass, and 2/32/3 of those masses are malignant (specifically Hemangiosarcoma).
    • Re-evaluation of the Rule: Recent studies, particularly out of the UK, have challenged these percentages, suggesting the incidence of malignancy might be lower in some populations. It is important