C10021814 / invoice 10000

12/03/2026 HISTORY
Presented for evaluation of a new skin lump identified a few days ago and ongoing reverse sneezing with heavy breathing at night.
Historical Conditions: Previous CT scan of head and chest performed showing nasal inflammation with mucoid discharge in nasal passages. No nasal destruction noted. SASH CT made no mention of chest.
V/D/C/S: Reverse sneezing is the primary concern with heavy breathing at night, easier when resting but still audible. Occasional green nasal discharge when sneezing.
Skin: New lump appeared on back a few days ago, first noticed by owner when dog was scooting. History of pruritic back and feet.
Current Meds: Antihistamines + Apoquel

EXAM
Behavioural: Cooperative during examination, allowed multiple needle aspirations
Eyes: Clear
Ears: Clean
Nose: Audible breathing sounds consistent with brachycephalic anatomy
Cardiovascular: WNL, no murmur
Respiratory: Heavy breathing audible at rest, consistent with brachycephalic airway syndrome, relatively increased inspiratory effort
Abdominal: relaxed
Integumentary: Single cutaneous mass on right dorsum just behind shoulder level, approximately 4mm diameter, red and brown in appearance.
Diagnostics: Fine needle aspirate of skin mass performed twice - samples contained predominantly blood with some white blood cells and possible melanin granules, insufficient cellular material for definitive diagnosis

ASSESSMENT
Cutaneous mass - DDx: hemangioma, hemangiosarcoma, cyst. Cytology inconclusive due to blood contamination but no evidence of lymphoma or mast cell tumour.
Brachycephalic airway syndrome - Consistent with pug breed anatomy, exacerbated by nasal inflammation as documented on previous CT imaging.

PLAN
Diagnostics:
- Cytology samples from skin mass to be submitted to external pathologist for further evaluation
- If pathology results inconclusive or suggest malignancy, surgical excision recommended
New Meds/Tx:
- Meloxicam (anti-inflammatory) prescribed for nasal inflammation and swelling to help reduce breathing difficulties - owner to check if any at home
Additional Discussion:
- Discussed that skin mass could be benign hemangioma or more aggressive hemangiosarcoma, both being blood vessel tumors
- If surgical removal required, could perform under general anaesthesia and examine throat/airways, clean teeth, and address other minor procedures simultaneously
- Humidity therapy recommended (steaming bowl of water or steamy bathroom) to help thin nasal secretions
- Owner able to monitor mass size due to shaved area around lesion

Client Comms:
- Will call with cytology results, expected Monday
- If pathology inconclusive or suggests malignancy, will recommend surgical excision
- Surgical removal would be curative for benign hemangioma; more aggressive tumors would require staging