Overview:

‘Splenic hematoma’ and ‘nodular hyperplasia’ are the most common non-cancerous lesions found in the spleen and account for 20–41% of all splenic lesions. They are benign (not harmful) masses of clotted blood. Surgical removal is curative.

Hemangiosarcoma is a common malignant (dangerous) tumour of the spleen usually seen in older dogs (8–10 years of age). Any large breed dog appears to be at an increased risk, especially German Shepherds, Golden Retrievers, Labradors, and Poodles.

Signs and Symptoms:

Signs associated with splenic masses can be subtle and include weakness or could be more obvious, e.g. collapse and sudden death if the mass ruptures and bleeds internally. Mucous membranes, such as the gums, may be pale and heart and respiratory rates can be increased. Other signs can include

  • Abdominal bloating.
  • Weight loss.
  • Inappetence.
  • Fainting or weakness.

Diagnostics:

Figure 1. Radiograph of a dog showing a large splenic mass occupying most of the abdomen

Your primary care veterinarian may run several tests to obtain a presumptive diagnosis and to prepare for surgery. These may include blood tests, urinalysis, a clotting profile, examination of fluid obtained from the abdomen, and chest and abdominal radiographs (Figure 1). Abdominal ultrasound is another useful method to identify and characterize masses in the abdomen as well as look for free fluid or blood. Echocardiography (ultrasound of the heart) may be recommended as some dogs may have tumour spread to the heart.

Treatment:

Figure 2. A spleen with a large splenic mass following complete removal of the spleen at the surgery

Surgery is the primary method of treatment for dogs with splenic masses. This involves the removal of the spleen (splenectomy). Removal of the spleen is preferred to a biopsy (sample) as it serves as both a diagnostic and therapeutic procedure (Figure 2). Patients are stabilized prior to surgery. This may require fluid therapy or blood transfusion and intensive care monitoring.

The final diagnosis relies on microscopic examination of the mass after surgical removal. Splenic hematomas and hemangiomas, as well as other benign diseases, can have a similar clinical presentation and must be differentiated from hemangiosarcoma. Up to 2/3 of dogs with splenic masses have a malignant tumour (2/3 of these are hemangiosarcoma). Dogs with a ruptured splenic mass requiring a blood transfusion are more likely to be diagnosed with hemangiosarcoma. The remaining patients have benign masses that are effectively treated with splenectomy.

Aftercare and Outcome:

Your dog’s activity should be restricted to short leash walks only during the first two weeks of healing. Your dog may need to wear an E-collar (cone-shaped collar) or tee shirt to prevent self-trauma to the surgical site.

Benign splenic masses are effectively cured with surgery. Unfortunately, survival times with surgery alone for dogs with hemangiosarcoma could be 2–3 months or less. One-year survival is less than 10%. Ultimately dogs die from metastatic (spreading) disease. Chemotherapy may increase survival times up to 6–8 months.

Complications that may be associated with surgery include haemorrhage (ongoing bleeding), cardiac arrhythmias (irregular heart rhythm), and pancreatitis (often manifested by vomiting). An ECG to look for arrhythmias is recommended after surgery. While this may require treatment, most arrhythmias resolve within 24–48 hours.

Splenectomy in a dog using Ligasure: