Page 1259 - Cote clinical veterinary advisor dogs and cats 4th

630 Mass, Splenic

CONTAGION AND ZOONOSIS ○ Trauma/hematoma • Three-view thoracic radiographs
Several vector-borne (e.g., cytauxzoonosis, ○ Nodular regeneration ○ Pulmonary metastasis
VetBooks.ir virus, brucellosis) infections can cause spleno- DIAGNOSIS ○ Cardiomegaly suggestive of heart
○ Lymphadenopathy
○ Abscess
babesiosis) and contagious (e.g., feline leukemia
failure (congestion) or atrial tumor
megaly. Some are zoonotic (e.g., tularemia,
leishmaniasis) (p. 1282).
(hemangiosarcoma)
Diagnostic Overview ○ Sternal lymphadenopathy may indicate
GEOGRAPHY AND SEASONALITY Splenic mass can be recognized by physical exam abdominal inflammation rather than
Some infectious diseases are associated with a and diagnostic imaging. Although signalment, metastasis
geographic region or seasonality. history, exam, and imaging findings often
provide a strong suspicion about the cause, Advanced or Confirmatory Testing
ASSOCIATED DISORDERS confirmation often requires additional testing, • Abdominal ultrasound
Hemoabdomen, anemia, ventricular arrhyth- frequently including cytology and/or biopsy. ○ Confirmation of origin and consistency
mias, disseminated intravascular coagulation of mass (e.g., cavitated lesions at greater
(DIC), metastasis, vasculitis, thrombocytopenia Differential Diagnosis risk for rupture)
• Liver ○ Assess blood flow (splenic torsion)
Clinical Presentation ○ Hepatic enlargement shifts gastric axis ○ Invasion of neighboring organs
DISEASE FORMS/SUBTYPES caudally ○ Metastatic lesions
Diffuse enlargement or focal mass-like lesion(s) ○ Diffuse hepatomegaly (lymphoma, hepa- ○ Localization of free abdominal fluid
titis, cholangiohepatitis, hepatic lipidosis) • Abdominocentesis (blind or ultrasound
HISTORY, CHIEF COMPLAINT ○ Benign neoplasia (cystadenoma, hepatoma) guided [p. 1056])
Depends on cause but can include ○ Malignant neoplasia (massive hepatocel- ○ Acute hemorrhage: abdominal packed cell
• Minimal clinical signs; incidental finding on lular carcinoma, hemangiosarcoma, biliary volume (PCV) = peripheral PCV
exam carcinoma) ○ Chronic hemorrhage: abdominal PCV >
• Inappetence, lethargy (may be intermittent), • Kidney peripheral PCV
weight loss, vomiting, diarrhea ○ Located retroperitoneally, displacing ○ Previous hemorrhage: abdominal PCV <
• Abdominal distention viscera ventrally peripheral PCV
• Weakness, collapse ○ Neoplasia (renal cell carcinoma, lym- • Coagulation profile
phoma, hemangiosarcoma) ○ Rule out rodenticide toxicity, bleeding
PHYSICAL EXAM FINDINGS ○ Severe hydronephrosis/pyelonephritis disorders
Depends on size of mass and whether mass secondary to obstruction ○ Evaluation for DIC
has ruptured but can include ○ Renal cyst • Electrocardiogram (ECG)
• Palpable midabdominal mass ○ Perirenal pseudocyst ○ Accelerated idioventricular rhythms most
• Abdominal pain • Stomach: fluid-filled pylorus resembles a mass common in patients with splenic masses
• Abdominal distention on right lateral radiographs. and after splenectomy
• Fluid (ballotable wave) • Abdominal cavity ○ Occasional ventricular premature contrac-
• Pale mucous membranes; weak, thready, or ○ Omental mass tion (VPC) usually associated with splenic
nonpalpable pulses; weakness; tachycardia ○ Nodular fat necrosis: Bates body capsule distention
○ Hypovolemic shock caused by mass ○ Gossypiboma ○ Ventricular tachycardia
rupture and massive intra-abdominal • Lymph node ○ Other arrhythmias occasionally
hemorrhage • Adrenal gland • Fine-needle aspiration/cytology of spleen
• Cardiac arrhythmias and pulse deficits; ○ Neoplasia (adenoma, adenocarcinoma, (ultrasound-guided)
murmur due to anemia pheochromocytoma) ○ Only for solitary masses or generalized
• Other findings depend on cause of spleno- splenomegaly; rarely able to differentiate
megaly (e.g., peripheral lymphadenomegaly Initial Database tumor type or benign from malig-
possible with lymphoma, fever due to infec- Varies broadly, with minimal changes possible nant disease (exceptions: lymphoma,
tion or inflammation). • CBC, serum biochemistry profile, urinalysis: mastocytosis)
depends on disorder, but can include ○ For cavitated masses, contraindicated due
Etiology and Pathophysiology ○ Evidence of hemorrhage to low yield; risk of rupture or hemorrhage
• Splenomegaly is discussed on pp. 936 and ■ Acute: nonregenerative anemia, pan- • Echocardiography
1282. hypoproteinemia ○ Rule out right atrial hemangiosarcoma
• Diffuse enlargement (generalized spleno- ■ Chronic: regenerative anemia, hypoal- (8% of patients have splenic and cardiac
megaly) buminemia masses); low-yield test
○ Infiltrative (e.g., lymphoma, mastocytosis ■ A slightly low hematocrit with inter- • Cross-sectional imaging
[especially cats], histiocytic sarcoma, mittent lethargy is highly suggestive of ○ CT to identify the origin of large masses
amyloidosis) periodic minor hemorrhage. ■ Angiography may help identify early-
○ Congestion (e.g., splenic torsion, splenic ○ Evidence of hemolysis (schistocytosis, onset metastatic lesions.
vein thrombosis, right-sided heart failure) spherocytes), red blood cell (RBC) ○ MRI may elucidate benign versus malig-
○ Cellular hyperplasia (e.g., immune- parasites nant lesions but is inherently flawed (long
mediated hemolytic anemia) ○ Other organ system involvement (e.g., scan times and motion).
○ Inflammation/infection (e.g., erythropha- kidney, liver)
gocytosis, infectious disease) ○ Hemoglobinuria/bilirubinuria TREATMENT
• Focal enlargement • Survey abdominal radiographs
○ Malignant neoplasia: cavitary tumors ○ To help identify splenic origin of mass Treatment Overview
(e.g., hemangiosarcoma); solid tumors ○ Poor serosal detail indicates free peritoneal • In many cases, surgery should be performed
(e.g., leiomyosarcoma, liposarcoma) fluid. to remove the spleen after the patient has
○ Benign neoplasia: cavitary (e.g., heman- ○ Size of spleen (larger size does not cor- been stabilized. Remove large, nonbleeding
gioma); solid (e.g., lipoma) respond to worse prognosis) masses before they rupture. Treat hypovolemic

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