C10017581 / invoice 10000

Appointment Notes: lump on legSubjective: 6 months ago attacked by dog - injuries + displaced LFL elbow managed at SASH.Has slowly regained relatively normal function in this leg, particularly over the last 4-6 weeks or so.Wound sites healed wellOR over the past 2 weeks or so Monty has developed a rapidly growing alopecic mass on the lateral aspect of his LFL elbow.Has not been bothering him, no discharge.Otherwise wellDUDE, no V+ or D+BAR in consultObjective: HR/PR/CV: 105, normokinetic, G1 murmur PMI left heart baseMM/CRT/Hydration:  pink and moist, 2 seconds, hydratedRESP/RR: lung sounds clearTemp: n/cGIT/UG:  comfortable on palpationSkin/Ears: 1cm cutaneous circular alopecic mass lateral LFL elbow - mass is mildly crusted and bruised on its distal side.M/S:  Ambulating well in consultEyes: NADDental: n/cLymph Nodes: NADBCS: 5.5/9Laboratory - FNA mass:> Large population of monomorphic round cells, scant neutrophils, 2x rods seenAssessment:> Mass LFL elbow - suspect underlying benign/hyperactive lesion secondary to previous trauma, but cannot rule out neoplasia given monomorphic cell population. Suspect some underlying deep pyoderma also at play> G1 heart murmur PMI left heart base - strong suspicion for underlying MMVD given breed Treatment: > Cephalexin 200mg BID PO for 14 days> Prednisolon 10mg SID PO for 5 days, then 5mg SID PO for 5 days, then EOD PO for 5 more doses then stopPlan: Await Idexx cytology results to determine if needing surgical excision.Monitor heart murmur - if progressing with time or developing cough/exercise intolerance consider echocardiography + thoracic radiographs____________________________INSURANCE HXInitial Assessment >  Cutaneous mass LFL lateral elbowSuspected cause > Unknown - possibly benign process secondary to previous trauma vs neoplasiaDate of first clinical signs > A few weeksAny other conditions / treatments >  None    Vital Signs    Weight: 8.7;