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Friday, January 16, 2009
Solution for case 11

Radiographic findings:

Skull radiographs showed massive loss of turbinate bones. Loss of alveolar bone on the maxillary side, showing clear tooth roots.

Tentative diagnosis: Tumor (Nasal adenocarcinoma)

Further tests: Nasal biopsy histopathology/cytology, rhinoscopy, bacterial cultures, fungal cultures, nasal swab/lavage, thoracic radiographs.

Differentials:
  • Bacterial sinusitis
  • Aspergillosis
  • Trauma
  • Tooth root abscess
  • Foreign body
  • Coagulopathy

Nasal tumors are rare but found primarily in long-nose breeds. Adenocarcinoma is most common nasal tumors in dogs. The average age for the onset of canine nasal tumors is seven years. The clinical signs typically associated with nasal tumors are sneezing, nasal discharge, epistaxis, exophthalmia, facial swelling, nasolacrimal duct obstruction and, sometimes, neurological disturbances. Deformation of the facial bone, hard palate, or maxillary dental arcade may be visible. These signs are non-specific since they mimic bacterial or mycotic rhinitis, sinusitis, dental diseases, nasal trauma or foreign bodies lodged in the upper respiratory tract. Definitive diagnosis of nasal tumors is achieved by cytology or histopathology. However, the final diagnosis is generally reached at a time when the tumor is already in an advanced stage, and has invaded adjacent nasal structures or more distant organs, such as the brain. The prognosis is generally poor as most nasal tumors are malignant. Radiotherapy and chemotherapy can prolong survival rates and improve the quality of life of dogs. Without treatment, the survival following diagnosis of nasal tumors is usually only a few months.

Aspergillosis, in dogs, is typically localized to the nasal cavity or paranasal sinuses and is usually caused by infection with A fumigatus. Nasal aspergillosis is seen mainly in dolichocephalic breeds. It begins in the posterior region of the ventral maxilloturbinate with signs of lethargy, nasal pain, ulceration of the nares, sneezing, unilateral or bilateral sanguinopurulent nasal discharge, frontal sinus osteomyelitis, and epistaxis. Gross lesions vary considerably with site of infection, but a layer of gray-black necrotic material and fungal growth may cover the mucosa of the nasal and paranasal sinuses. The mucosa and the underlying bone may be necrotic with loss of bone definition on radiographs.

Treatment: The patient was given Cefazolin 500mg (5ml) three times a day. A triple antibiotic ointment was also used when discharge was cleaned off. Tissue biopsy confirmed the adenocarcinoma. As it was a rescued animal, owned opted for euthanasia. If not euthanized we can go for surgery, radiation therapy and chemotherapy, but prognosis is poor.

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posted by Dr Banga's Websites @ 12:00 AM  
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