What diagnostics are often employed when working up a potential splenic mass?
- abdominocentesis- possible to tap non-clotted blood, high hematocrit, malignant cells
- abdominal radiography- ID mass effects, mass
- ultrasound- measure spleen
- chest rads- look for mets
- echocardigraphy- look for right heart mass
- advanced imaging
What are differentials for a large splenic mass? (4)
- other sarcomas
Can you differentiate a metastatic from a benign splenic mass on gross observation?
What is the prognosis for hemangiosarcoma?
mean survival time with surgery (2-4 months), with surgery and chemotherapy (6-8 months)
What is the prognosis for splenic hematoma?
prognosis good to excellent
What are predictive factors for hemangiosarc? (5)
- DIC, schistocytes
- ventricular arrhythmias (39% of dogs with HSA have one)
Describe the approach to splenectomy for HSA. (3 principals)
- incise xyphoid to prepuce (these masses are usually ginormous)
- remove falciform ligament
- use a balfour retractor to open the abdomen
What are the techniques for splenectomy? (2)
- hylus method
- 3 pedicle ligation technique
What vessels branch off the spleen and will be compromised during splenectomy?
- short gastric arteries
- branches to pancreas
- greater omentum
What are methods of ligation for the hylus method of splenctomy? (3) Briefly describe each.
- LDS- ligate and divide stapler, small vessels only, dissect fat away from vessels first, expensive$$$
- Ligasure- seals arteries up to 7mm, sutureless, electrosurgical device, expensive machine$$
- Harmonic scalpel- cuts and seals vessels, sutureless, expensive device
What are the important points of the 3 pedicle ligation method for splenectomy? (3)
- performed with suture
- technically simple and fast
- MUST preserve pancreatic artery
What are oncologic principals of splenectomy for HSA?
- change gloves and instruments after removal of cancerous spleen (seeding possible)
- lavage a lot
How should you approach an incidental nodule on the spleen?
- partial or complete splenectomy (complete is easier and less risky)
- intraop cytology
- send out biopsy
You see brownish-gray plaque-like lesions all over the spleen of an old dog. What is it?
siderotic plaques- benign in old dogs
70-80% of dogs with hemoabdomen are bleeding from...
the spleen (20-30% are bleeding from the liver, kidney, adrenal)