Pulse - November 2022 - 10

DIMENSIONS IN SURGERY & CRITICAL CARE
SURGERY
IN SURGERY & CRITICAL CARE ANIMAL SPECIALTY & EMERGENCY CENTER
ANIMAL SPECIALTY & EMERGENCY CENTER
ANIMAL SPECIALTY & EMERGENCY CENTER
Phaeohyphomycosis in a
Golden Retriever
Kristen Behrens, DVM, Surgery Intern
A
3-year-old male castrated Golden retriever was presented to the
Animal Specialty and Emergency Center for further evaluation
of two masses. The masses had been present on the ventral abdomen
for approximately six months, with progressive enlargement. Clients
reported lethargy and hyporexia. Fine-needle-aspirate of one of the
masses revealed suppurative inflammation; aerobic and anaerobic
bacterial culture were negative.
Upon presentation, the patient was febrile with a temperature of 104.3o
F.
There were two mass-like lesions adjacent to the abdominal midline, which
were firmly affixed to the underlying tissues. The right cranial mass measured
4.39 cm in greatest diameter while the left sided, more caudally located mass
measured over 4.37cm in greatest diameter in its subcutaneous location. No
swelling or erythema was observed, and no pain noted upon palpation. An ultrasound
was performed which revealed the lesions were avascular, and there was
a large intra-abdominal extension of one of the lesions (Fig 1-3). Differentials
included gossipyboma from a previous gastrotomy for a foreign body two years
previously, sterile abscess, or necrotic/avascular neoplasia.
Exploratory laparotomy was recommended, and a complete blood count and
biochemistry panel was performed. Complete blood count revealed a marked
leukocytosis (44.41 x109/l) characterized by a neutrophilia (37.56 x109/l) and
monocytosis (3.81 x109/l). Biochemistry panel revealed hypoalbuminemia (1.7
g/dL), hyperglobulinemia (6.4 g/dL) and an increased ALP (464 U/L).
The patient was pre-treated with methadone (0.2 mg/kg IV) and maropitant
(1 mg/kg IV). The patient was induced with midazolam (0.25 mg/kg IV)
and propofol (4 mg/kg IV) to effect. General anesthesia was maintained with
sevoflurane via an endotracheal tube. A midline incision was made along the
previous scar and between the two mass-like lesions. Hemostasis was achieved
using monopolar electrocautery. When attempting to dissect the masses off of
midline, the masses were penetrated and a large amount of purulent fluid with a
coffee-ground-like appearance was drained. The masses were firmly adhered to
the ventral body wall, so a midline laparotomy was performed cranial and caudal
to the masses.
Upon palpation, the superficial masses were found to be connected to a large,
firm intra-abdominal mass, which was adhered to the peritoneal side of abdominal
midline. The affected body wall was resected using the LigaSure (Covidien,
Mansfield, Massachusetts, USA), finally allowing the abdomen to be opened. The
large mass was noted to arise from the greater curvature of the antrum of the
stomach at the level of the angle of incisure (Fig 4). The majority of the greater
omentum was adhered to the mass. Adhesions were transected using the LigaSure,
resulting in near complete removal of the greater omentum. The spleen,
left limb of the pancreas, and their vascular supply were adjacent to the mass
but were able to be spared. A partial gastrectomy was performed using the TA
90 stapler with care to spare as much of the antrum as possible in hopes of still
allowing normal passage of gastric contents. The staple line was over sewn in a
continuous pattern using 3-0 PDS. The subcutaneous extensions of the masses
were excised.
Gloves and instruments were changed and the abdomen was lavaged using
warm sterile saline. The remainder of the abdomen was explored, and was
10
Figure 1: The oval-shaped hypoechoic
mass in the subcutis measures 2.78 x
1.06cm and is surrounded by hyperechoic
fat. This lesion showed no vascularity
when imaged with Doppler.
Figure 2: The subcutaneous mass communicates
through a 1.26cm defect in
the ventral abdominal wall marked by
the " + " cursors.
Figure 3: The heterogeneously hypoechoic
intra-abdominal mass marked
by " + " cursors measures 5.92 x 7.94cm
and is partially beam attenuating. No
vascularity was identified with Doppler
investigation
NOVEMBER 2022
PULSE
Pulse - November 2022

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