Presentation
Decreased activity and appetite, weight loss. Progressive anemia, now 16% hematocrit.
Patient Data
There are two masses in the abdomen. The first is visible on the lateral and v/d, between the left kidney and the fundus of the stomach. The second is in the caudoventral portion of the abdoman, and is only visible on the lateral projection.
The dorsal mass is in the location of the proximal extremity of the spleen, and the distal mass is in the location of the distal extremity. The more dorsal mass is causing a mass effect and displacing the left kidney caudally (compare to right kidney)
Multiple splenic tumors - hemangiosarcoma with metastatic disease to the lungs.
There are diffuse soft tissue opacity nodules throughout the lungs, indicating metastatic disease.
Case Discussion
The location of the masses are key to identifying splenic origin. The presence of nodules on the edge of the abdominal films should prompt you to take thoracic radiographs. Metastatic disease places neoplasia at the top of the list of differential diagnoses. The anemia could have been caused by hemorrhage, RBC destruction in the spleen, or anemia of chronic disease. There was no evidence of effusion on these radiographs.
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