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Dr. BJ Hughes
Dr. BJ Hughes, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 4794
Experience:  Licensed w/20 years of experience in private practice/teaching. Strong believer in educating owners.
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Shih tzu: month ago and it was the size of a golf ball..tennis ball

Resolved Question:

My Shih tzu has a large knot growing under the right side of his throat. We first noticed it a month ago and it was the size of a golf ball. Over the next week it grew to the size of a tennis ball. We took him to our vet. who took a biopsy thinking it was carcinoma thyroid cancer. The biopsy came back and indicated no cancer cells. She is stumped as to what it is. He continued to scratch and finally poked a hole in it. It bleed profusely and went down. He has had this same recurrance 2 times over the past 3 weeks. He has no loss of appetite or energy. What could this be?
Submitted: 2 years ago.
Category: Dog Veterinary
Expert:  Dr. BJ Hughes replied 2 years ago.

Dr. BJ Hughes :

Hi there

Dr. BJ Hughes :

Welcome to Just Answer.

Customer:

hello

Dr. BJ Hughes :

Tell me a little more about this -- is is under the muscle of the neck, deep , superfiscial, under the skin, part of the skin, lymoh node, hard, fluid filled -- anything that might give more info ---

Dr. BJ Hughes :

Also -- while there were no cancer cells -- what did the pathology report say ? What organ is involved or type of cells?

Customer:

It is just under his jaw, on his neck/throat area. It appears to be just filled with blood. Just under his skin, as when he scratches do to being shaved, his toe nail scratches through the skin.

Dr. BJ Hughes :

Ok -- a needle aspiration of the fluid needs to be done -- to confirm that this is whole blood versus infection fluid or lymph fluid that is blood tinged .

Customer:

She didn't state what the pathology report stated other than no cancer cells were found.

Dr. BJ Hughes :

Ok -- this is odd -- and this may be a cystic (pocket) formation with fluid filling the pocket of the cavity inside --

Dr. BJ Hughes :

But the size is tremendous -- and removal is an option -- but there would be severeal considerations -

Customer:

it is definately blood. alot of blood but it only bleeds for 15-20 minutes and the knot goes back to normal but over the course of the next week will fill with blood again

Dr. BJ Hughes :

But on a cellular level -- there may be more than just whole blood -- simply because a pocket of whole blood would clot -- and not drain .

Dr. BJ Hughes :

There are also cavernous cancers (that can fill with blood)

Dr. BJ Hughes :

2) the secodn concern on removal is the location -- and whether any large blood vessels are involved or attached.

Dr. BJ Hughes :

(sorry second)

Dr. BJ Hughes :

Was there a simple sampling ? and was it taken with a biopsy (under anesthesia) or with a needle?

Customer:

She has him on antibiotics and a strong ibuprofen. The biopsy was taken under anesthesia and with a needle. She stated that when she inserted the needle, a large amount of blood came out so she isn't sure if she got a "good" sample or not.

Dr. BJ Hughes :

Some of these pocket formations -- even if not cancerous -- require complete removal of the pocket formation or allowing the area to heal from the inside out (which means it is opened, and drain(s) placed) to allow continued drainage from the inside

Dr. BJ Hughes :

Your statement of the biopsy confirmes my concerns -- and the sample makes all the difference. It would be difficult to get a tissue sample if this is a pocket of fluid

Dr. BJ Hughes :

If this were my patient -- I would suggest 1) consideration of removal 2) consideration of drainage with healing form inside 3) re-biopsy with larger sample 3) referral to an internal medicine specialist --- and not necessarily in that order -- as finances also play a role in some decision making processes. But these would all be options at this time if you are looking for a diagnosis and permanent cure (if possible) .

Dr. BJ Hughes :

The formation of a bleeding pocket or pocket of fluids is not unusual -- as for a diagnsois though -- Your vet might consider getting a sample of the fluid and then do cytology or cellular analysis on the fluid (which is simple)

Customer:

thank you. i will take your suggestions to my vet. you are correct, finances, unfortunately, are playing a role. So far charges are over $800.

Dr. BJ Hughes :

Simple cytology could be done by your vet in their office -- at fairly low expense to them. My ideas on this is that your dog may have a fluid filled cyst (which is more simple) OR that this might be a cancer that is very well vascularized (many blood vessels) and has formed a fluid cyst inside (that bleeds readily).

Dr. BJ Hughes :

The only basic things that might be done short term is trimming nails and preventing any injury to the site ; routine drainage might be considered (not a cure but would reduce the size and potential for the cyst portion enlarging over time).

Dr. BJ Hughes :

You are most welcome -- I wish there was a less costly way to deal with this -- but

Customer:

Would he continue to bleed or stop after it "drains"? The bleeding only last a short time and doesn't happen again for another week when he scratches it.

Dr. BJ Hughes :

I would guess that the pocket drains out (since there is a decrease in size) and then it fills over time again --

Dr. BJ Hughes :

There may be some blood from the scratch -- but most is probably the pocketed fluid.

Dr. BJ Hughes, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 4794
Experience: Licensed w/20 years of experience in private practice/teaching. Strong believer in educating owners.
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