C09978782 / invoice 10000

Weight (Kg):14.20
History:Presenting complaint
Owner discovered a swelling in the right axillary region over the weekend.

History
- 9.5-year-old Cavalier King Charles Spaniel.
- History of Keratoconjunctivitis Sicca (KCS), managed with tacrolimus OD.
- History of a sebaceous cyst on the neck.
- History of suspected intervertebral disc disease (IVDD) in the thoracolumbar region.
- History of two possible seizure-like events, last noted in 2020.
- A single episode of vomiting occurred approximately two weeks ago (mid-February 2026), which resolved without treatment.
- No coughing or sneezing reported.

PEx:
BCS 7/9
BAR
MM PM, CRT <2
HR: no arrhythmia/murmur detected
Resp: normal bronchovesicular sounds, eupneic
Oral: Moderate to severe calculus and tartar buildup with mild to moderate gingivitis noted.
Eyes: KCS noted historically.
Ear: no discharge, no erythema
Integ: Two subcutaneous masses palpated.
1. Sternal mass: located midline, slightly to the right. Approximately 1.5 x 1.5 cm, mobile, semi-firm, and compressible.
2. Right axillary mass: Approximately 3.5 x 2.5 cm, firm but compressible, mobile. Possible attachment to the underlying muscle wall suspected.
Small areas over both masses were clipped and cleaned for sampling.
LN: within normal limits
Abdo: soft comfortable, no obvious organomegaly, no abnormalities detected
MSK: No abnormalities detected on palpation.

Assessment
1. Subcutaneous masses (sternal, right axilla): Primary differential is lipoma given the signalment and feel of the masses. Other differentials include other benign or malignant neoplasia.
2. Dental Disease: Moderate to severe dental calculus and gingivitis present. Dental procedure with likely extractions recommended.
3. History of seizures: Requires consideration for anesthetic protocols.

Treatment
Fine needle aspirates (FNA) of both the sternal and right axillary masses were performed. Samples submitted for external cytology.

Client communication
- Discussed findings of two subcutaneous masses.
- Explained the FNA procedure and the possibility of a non-diagnostic sample.
- Recommended surgical excision of the masses, particularly the axillary mass due to its location and potential to interfere with ambulation if it enlarges.
- Advised that early removal is preferred if there is muscle wall attachment.
- Discussed the patient's significant dental disease and recommended a dental procedure with dental radiographs and probable extractions.
- Advised against performing the mass removal and dental procedure in the same anesthetic event due to the risk of surgical site infection from oral bacteria.
- Provided an estimate for a major dental procedure including pre-anesthetic bloodwork, IV fluids, extractions, and medications at approximately $1,800.
- Discussed anesthetic considerations, including treating the patient as a seizure risk.
- Outlined potential complications of dental extractions, such as suture dehiscence or jaw fracture (rare).
- Provided guidance on initiating at-home dental care post-procedure.
- Advised that cytology results are expected in approximately 5 business days.

Plan
Await cytology results for the two masses.
Vet to call with results
Dental to be organised later

03 Mar 2026 12:25:28 pm
Dental est:
Pre GA's, IV fluids, Major dental, Bupviacaine, meloxicam, codeine = $1795.50
Emailed to client.

BH