Re: [SPAM] Unusual case

[Guest guest]

Deb,

When we had our practice in California, we used to see a lot of

cervical masses that would come up acutely, be painful, cause dysphagia

and sometimes even cause acute upper respiratory dyspnea. Typically

they were worked up similarly to what you are describing but they were

also biopsied and cultured. Frequently the cultures came up negative

because of the antibiotics they were on but if positive, usually grew

actinomyces or nocardia. Almost always, the histo showed

pyogranulomatous inflammation. Occasionally tumor (thyroid carcinoma

most often). Most of the time, the root cause was a foxtail but any

foreign body can do it. I explored some but it is very difficult to

find the FB surgically. The masses are difficult to remove because of

inflammation, hemorrhage and adhesions. Usually we just had to treat

long term with Clavamox or the appropriate antimicrobial based on the

C/S. Almost always they would reduce in size but rarely did they

resolve completely. Sometimes they became an active infection again

and had to be treated again with antimicrobials. It is odd that the

process appears to have affected two dogs in the same household. I

don't have a theory for that unless it is an infectious contagious

agent, or just coincidence. My questions are:

What did the result of the FNE show?

Where is the mass located?

Has anyone recommended biopsy and culture?

I think biopsy and C/S is the next logical step.

Hope this helps.

Mark B. Parchman, DVM, DACVS, CVA

wizofpaws@... wrote:

Hi there - I have an interesting case with a problem not

directly related to rehab but could use some advice for the client.

The dog is a 5 year old Belgian Terv - neutered male. I have

been seeing him for an Iliopsoas strain. 6 weeks ago - his 9 year old

housemate Terv was suddenly unable to open her mouth - yawning, eating,

caused intense pain. They were treated by their primary vet with

Baytril and NSAIDs. The 5 year old developed the same symptoms 3 days

later and was treated with the same course. Both resolved within 1

week and now have normal TMJ movement and function.

So, on November 16th, the male became acutely lethargic, quiet

and had difficulty swallowing. His throat was sore to the touch and

was febrile. He was taken to a board certified internist - radiographs

were performed under sedation, and ultrasound was performed, endoscopy

performed and a fine needle aspiration. There was no definitive

diagnosis but 24 hours after the procedures, the mass size increased

and the dog was unable to swallow without significant difficulty. SNaP

4Dx was negative. The owner returned to the same practice and was

started on metacam and clavamox. The dog has also began to scratch at

the mass and irritate the area and was started on topical animalx. The

dog is not a known chewer on foreign objects, etc.

The mass has decreased but is still palpable.

The owner sought another opinion on 12/4/08 by another board

certified internist. Neuro exam is normal. Radiographs demonstrated

soft tissue swelling but no obvious foreign body. Ultrasound

demonstrated soft tissue abnormalities appearing like scar tissue of

inflammation. A surgeon also looked at the area while he was in the

office and believes it is scar tissue from a resolving cervical abscess

and recommended 2 more weeks of antibiotics and if it does not resolve

to perform exploratory surgery. However, the surgeon did comment the

surgery would make the problem worse initially and the owner will not

proceed with this. A MRI is recommended and will be performed next

week.

Conservatively, the mass responds to laser therapy - we have

attempted to reduce the inflammation.

My concern is the unknown incident of the TMJ issues prior to

this with the two dogs in the household.

Any ideas - thoughts? The owners will do anything for this guy

and 'my gut' is telling me there is more to this than an abscess. From

a rehab standpoint, I can only observe the issues but would like to

help point them in another area of guidance.

Thank you.

Deb

Debbie Gross Saunders, DPT,

MSPT, OCS, CCRP

Wizard of Paws Physical Rehabilitation for Animals, LLC

www.wizardofpaws.net

Stay in touch with ALL of your friends: update your AIM, Bebo,

Facebook, and MySpace pages with just one click. The

NEW AOL.com.