9 year-old, Female, Spayed , English Springer Spaniel

This case was discussed in virtual Abdominal Rounds with Donald E. Thrall DVM, PhD, DACVR in October 2020. If you would like to be included on the invitation list to join rounds please read more.

History: Owner noticed a mass on the left flank.  10 days ago, the dog collided with another dog but seemed fine after.

Plan: Abdominal Radiographs

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Figure 1. Lateral view of the abdomen
Figure 2. Ventrodorsal view of the abdomen, with a closeup view of the region of the mass.
Figure 2. Ventrodorsal view of the abdomen, with a closeup view of the region of the mass.

Findings:

•Heterogeneous soft tissue mass in the midportion of the left abdominal wall (Figure 2). 

•Thickening of left abdominal wall (Figure 2)

•Heterogeneous appearance to the mesenteric fat just medial to the mass (Figure 2). 

•Focal area of mineralization just caudal to the left kidney (Figure 3).

•Focal nodular, potentially minimally mineralized, opacity just ventral to the terminal portion of the descending colon, superimposed on the dorsal aspect of the urinary bladder (see Figure 4). 

Figure 3. Focal nodular opacity caudal to left kidney (arrow).
Figure 4.

Conclusions:

•The mass lesion within the left abdominal wall is nonspecific. 

•Considerations include hematoma, abscess and a soft tissue neoplasm, such as soft tissue sarcoma or possibly hemangiosarcoma. 

•There is concern for involvement of the mesenteric fat immediately subjacent to the mass and with the small focal opacity just caudal to the left kidney, a specific consideration at this time would be a suture abscess associated with the previous ovariohysterectomy leading to regional peritonitis and abscess formation.  The timing of the ovariohysterectomy is not known.

•The small opacity ventral to the terminal portion of the descending colon could also represent an abscess associated with a uterine stump suture.

•It is not clear whether this mass is related to the reported trauma.

•The duration of the mass is also unclear.  A body wall mass can be present for many months without detection.

Discussion:

•Unfortunately, there is not a definitive diagnosis in this patient.  The value of this case is to revisit the syndrome of abdominal abscess formation secondary to ovariohysterectomy, especially when non-absorbable suture is used.

•Fortunately, abdominal abscess formation secondary to ovariohysterectomy has decreased with the use of modern suture material, but can still be encountered.

•For further evaluation of this patient, an ultrasound guided aspirate, ultrasound imaging of the abdomen or CT imaging of the abdomen would have been useful.

Photo by Dan on Unsplash

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