I had a great case this weekend that turned out to be much, much more rewarding than I originally thought. I was presented with a large breed dog weighing in at a hefty 150 pounds - a mastiff breed. He'd been normal the prior today, but that morning, he'd started vomiting and acting lethargic. He'd become progressively more and more lethargic to the point where he could not rise. After some finagling, the owner was able to get him into the car and to us.
On my physical exam, I found a very quiet/depressed dog. His heart rate was very high for a dog of his size, breed, and current lethargy. His pulses were somewhat bounding. The biggest concern I had however was the mass lying along his abdominal floor. It was huge and took up most of his abdomen. Palpating it did not make him happy, as he hunched his back and hardened his abdomen in response to my touch.
I was a bit stumped, but I recommended to his owner (an MD) that we start with xrays. Xrays were a bit confusing and worrisome. The stomach was being pushed very far cranially, and there was a significant mass effect in the abdomen. My first thought was a liver tumor. Bloodwork findings did not support systemic illness though. The patient had a mild anemia, but his liver enzymes were normal.
Thank god for radiologists. I sent the films off for review. While awaiting a response, I spoke to the owner and relayed my concerns (mass v. something else). She was very sad to hear that this might be a mass, but I cautioned her to not worry yet, as there were other possibilities (who says I don't learn from my mistakes?).
The radiology report came back fairly quickly. Like a typical radiologist, the answer was a list of 10 different possible things. Getting a straight answer out of a radiologist is like trying to nail jello to a wall. It didn't matter, the first differential she listed hit me like a ton of bricks. Splenic torsion.
Splenic torsion occurs for reasons that we fail to understand. In large breed dogs, the spleen will start to twist on its axis, cutting itself off from its blood supply. The spleen rapidly becomes engorged with blood that is trapped, enlarging within the abdomen.
The symptoms fit. A perfectly healthy dog the day before, now vomiting (likely from the massive spleen pushing on the stomach) and lethargic. I relayed the findings to the owners and recommended an exploratory surgery.
Two hours later, the MASSIVE 10 pound spleen was removed, and my patient was alert and recovered from surgery. He did very well post-operatively, and he is now home with his very grateful owners. It was a great end to a very, very hard day.
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