Soft Tissue Surgery- Sometimes you're in for a surprise

My first day of Soft Tissue Surgery was a day of surprises- for me, the doctors, my patient and her owner.

I signed up for "A", who was in for a mass removal. We had a long fax from her primary veterinarian with pretty much everything that's ever happened to "A" in her care, including a long string of text messages about hookworms.

As far as I could tell from A's record, she had a mass over her right hip that her owner wanted removed. Talking to her owner, she's had masses for quite some time and they've just been there. She had one that came in more recently and seemed to grow more quickly than the other masses. She also had a murmur that had been noted in her record, but her owner hadn't been informed about (which is an entirely seperate issue! Always tell owners about their pets' medical problems!)

Because of her age and the different kinds of masses she had, we opted to do a 3 view thoracic radiographs (aka, "a met check") to see if any of those skin masses had metastasized because if she had lungs full of tumor, it doesn't make sense to put her under anesthesia for skin tumors. On those radiographs, we found a single very small nodule. We did fluoroscopy and rubbed barium on the masses on her skin at that level to make sure it was really a lung nodule and not just her skin masses projected over her lungs. Sadly, it was a lung mass.

Based on that, we really changed our workup. We ended up doing an abdominal ultrasound, aspirating and looking at all her masses under a microscope, doing bloodwork and a urinalysis and doing an echocardiogram (to evaluate her murmur). All the masses are benign, and she's the picture of health for an 11 year old dog.

Tomorrow, we're going to do a CT scan. We can see smaller masses on a CT than on radiographs. If we see lots of masses she becomes an oncology case (because surgical treatment is no longer a possibility and chemo would be the only viable option.) If not, we're going to do a thoracotomy (cut open the chest) and a partial lung-lobectomy (remove a piece of her lung).


So, surprise! You come in for a mass removal and end up losing a piece of lung instead!