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Cyanosis 231

○ Basal cell tumor: well-circumscribed, sym- Acute General Treatment • Subcutaneous hemangiosarcoma: poor
metrical proliferation of basal epithelial • Basal cell tumor: surgical excision is curative. • Excised solitary histiocytoma: excellent
VetBooks.ir ○ Basal cell carcinoma: circumscribed, • Hemangiosarcoma: aggressive surgical exci- PEARLS & CONSIDERATIONS Diseases and Disorders
cells that has a broad zone of connection
• Hemangioma: surgical excision, cryotherapy,
to the overlying epidermis
or electrosurgery is usually curative.
irregular dermal mass comprising multiple
• The most effective way to separate benign
of subcutaneous tumor is difficult.
epithelial cell aggregates embedded in a sion is treatment of choice; complete excision Comments
fibrous stroma that may extend into the • Histiocytoma: spontaneous remission may neoplasms from malignant neoplasms and
underlying subcutis occur within 3 months. Surgical excision is non-neoplastic proliferative skin disease is
○ Hemangioma: proliferation of blood-filled curative for lesions that do not regress. histopathologic examination of biopsied
vascular spaces lined by single layers of • Infundibular keratinizing acanthoma: may tissue.
well-differentiated endothelial cells resolve spontaneously. Surgical excision, • The key to successful management is an
○ Hemangiosarcoma: invasive proliferation cryosurgery, and observation without treat- accurate diagnosis.
of atypical endothelial cells with areas of ment are also options. • Cytologic evaluation of smears may provide
vascular space formation • Trichoepithelioma: surgical excision, cryosur- valuable information about the cell type.
○ Histiocytoma: uniform sheets and cords gery, electrosurgery, or observation without • Immunohistochemistry has markedly
of histiocytes infiltrating the dermis and treatment improved the ability to determine progeni-
subcutis; characteristic high mitotic index • Sebaceous gland hyperplasia/adenoma: tor cells for many skin neoplasms, with a
○ Infundibular keratinizing acanthoma: surgical excision, cryotherapy, or observa- positive impact on treatment selection and
keratin-filled crypt in the dermis that tion without treatment. May recur after on prognostication in some cases.
has an opening to the skin surface surgery. Sebaceous gland carcinomas rarely
metastasize. Technician Tips
Advanced or Confirmatory Testing Fine-needle aspirates of subcutaneous masses
Abdominal and cardiac ultrasonography to Chronic Treatment cannot reliably be interpreted without a micro-
determine whether hemangiosarcoma lesions Hemangiosarcoma: see chemotherapy protocols scope. The water-droplet appearance on a glass
are primary or metastatic and outcomes (p. 424). slide of classic adipose tissue is also observed
with mast cell tumors and other malignant
TREATMENT Possible Complications tissues, not just lipomas. Routine staining and
Hemangiosarcoma: local recurrence and microscopic assessment are essential.
Treatment Overview metastasis are common in dogs; metastasis is
Treatment typically should be localized for local rare in cats. SUGGESTED READING
disease. Systemic attack on cancer should be Miller WH Jr, et al: Muller & Kirk’s Small animal
reserved for generalized disease or disease in PROGNOSIS & OUTCOME dermatology, ed 7, St. Louis, 2013, Saunders, pp
which local therapy alone is not likely to be 774-843.
curative. Treatment options include surgery, • Excised basal cell tumor and trichoepithe- AUTHOR: Edward Jazic, DVM, DACVD
chemotherapy, radiation therapy, cryosurgery, lioma: generally very good EDITOR: Manon Paradis, DMV, MVSc, DACVD
electrosurgery, immunotherapy, and combina- • Intradermal hemangiosarcoma: excellent
tions thereof or observation.

Cyanosis Client Education
Sheet

Clinical Presentation
BASIC INFORMATION • Syncope
DISEASE FORMS/SUBTYPES • Visible cyanosis noted by owner
Definition • Generalized (central) cyanosis: all mucous
A bluish or grayish discoloration of the mucous membranes have a bluish tinge. PHYSICAL EXAM FINDINGS
membranes or skin due to hypoxemia • Differential cyanosis: cyanosis of the caudal • By definition, cyanosis. Check oral mucous
but not cranial half of the body; associated membranes and vaginal/preputial mucous
Synonyms with Eisenmenger’s syndrome (e.g., reverse membranes for differential cyanosis.
Oxidized hemoglobin: oxygenated hemoglobin patent ductus arteriosus) (p. 764) • Mild to severe dyspnea correlates with
Reduced hemoglobin: deoxygenated hemo- • Regional (peripheral) cyanosis: localized severity of the underlying problem.
globin hypoxia (e.g., vessel obstruction such as ○ An exception is right-to-left shunting heart
tourniquet’s effect on a limb, thromboem- disease, which may cause pronounced
Epidemiology bolism [p. 74]) (not discussed further) cyanosis even in a patient with minimal
SPECIES, AGE, SEX dyspnea.
Dogs and cats of any age and either sex HISTORY, CHIEF COMPLAINT ○ Pattern of respiratory distress may suggest
• Exercise intolerance disease localization (e.g., inspiratory
GENETICS, BREED PREDISPOSITION • Respiratory distress distress suggests upper airway obstruction).
Predispositions for underlying causes of • Collapse ○ Thoracic auscultation may suggest disease
hypoxemia (e.g., idiopathic pulmonary fibrosis • Hindlimb collapse (e.g., unexplained periods localization (e.g., crackles suggest pulmo-
in West Highland white and Staffordshire of sitting during walks) in cases of differential nary parenchymal disease, muffled lungs
terriers) cyanosis suggest pleural space disease).

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