What’s your interpretation?

Jason Crawford, DVM, DACVR

“Henry” is an 8 year old neutered male Lhasa Apso mix who presented to the emergency department with acute onset of pain and lethargy. There was no history of trauma or foreign material ingestion. On physical exam, TPR was normal and the mucous membranes were pink. “Henry” was painful on abdominal palpation, with abdominal splinting and vocalization. A CBC displayed a stress leukogram and a chemistry profile was unremarkable. Abdominal radiographs were performed.

On abdominal radiographs, there is a large, ill-defined soft tissue mass effect in the dorsal aspect of the abdomen (white arrows). The kidneys cannot be identified and there is generalized loss of detail dorsally. The stomach has a small amount of gas in it, but is otherwise empty. The small intestines and colon are displaced ventrally and the serosal surfaces of the intestinal tract are clearly defined. The liver is normal in size and shape. The spleen cannot be seen on the lateral view, but the head of the spleen is normal in size and shape on the VD view.

Due to the displacement of the intestinal tract ventrally, the loss of the renal silhouettes, and good serosal detail in the peritoneal space, the mass effect is considered to be retroperitoneal in origin, as a result of retroperitoneal fluid accumulation +/- a soft tissue mass. Retroperitoneal hemorrhage is the most common cause of fluid accumulation, and can be due to trauma, retroperitoneal neoplasia, or a coagulopathy. Other causes of retroperitoneal effusion include urine accumulation due to a ruptured ureter, or inflammation and abscessation in the retroperitoneal space.

An abdominal ultrasound was performed for further evaluation. There was a large hypoechoic, avascular, mildly heterogenous mass effect in the retroperitoneal space that was most consistent with hemorrhage and hematoma formation (white arrows). The kidneys and the adrenal glands were normal in size and shape and there was no evidence of a retroperitoneal tumor. Based on the lack of a tumor and no evident cause of hemorrhage, a coagulopathy was considered the primary differential.

Following the ultrasound exam, a clotting profile was performed which was markedly prolonged (APTT > 200 secs, PT > 35 secs), and the PCV had dropped to 27%. Coagulopathy secondary to rodenticide ingestion was presumed, and medical management was initiated. Fortunately, “Henry” made a good recovery and was discharged from the hospital following several days of intensive care.

Hemorrhage due to rodenticide toxicity may occur externally or internally, and the severity of clinical symptoms will depend on the location of the hemorrhage as well as the amount of hemorrhage and the length of time before a diagnosis is made. Hemorrhage due to rodenticide may occur in numerous “spaces” of the body, resulting in effusion and/or a mass effect, including the pleural space, mediastinum, pericardial space, intracranial cavity, the peritoneal space, or as in “Henry’s” case, the retroperitoneal space. Pulmonary hemorrhage may also occur, resulting in a patchy to generalized alveolar pattern in the lungs. Early recognition of radiographic signs of hemorrhage, in addition to physical exam findings and biochemical abnormalities, can help lead to the diagnosis of rodenticide toxicity and other coagulopathies at earlier stages, leading earlier initiation of medical treatment and improved clinical outcomes.

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