C10024093 / invoice 10000

Reason: Bitten On The EarPresenting Complaint: Acute swelling of earHistoryFrankie presented for evaluation of acute swelling of the ear noted earlier today.The owners first observed the ear appearing puffy while at home watching a movie. The swelling appeared sudden in onset, with no known precipitating traumatic event.No history of:- Head trauma- Dog fights or bites- Rough play at a dog park- Falls or rolling injuriesOwners report that historically Frankie has chronically pruritic ears, characterized by:- Intermittent scratching of the ears with the hind limb- Head shaking when the ears appear irritatedThese signs have reportedly been present intermittently over several years. Owners suspect a possible allergic component, though the underlying cause has not been definitively diagnosed.Earlier today, Frankie was noted to scratch the ear when pressure was applied, though owners did not observe significant head shaking beyond baseline.Otherwise, Frankie is reported to be systemically well.Appetite / Gastrointestinal Eating normallyNo vomiting reportedNo diarrhea reportedUrination Urination reported as normal. No dysuria or urinary concerns reportedPreventatives Flea/tick prevention: NexGard Last administered within the past few weeksCurrent Medications None.Known Medical Conitions Owners report no known history of cardiac, hepatic, or renal disease.Physical ExaminationMentation: Bright, alert, and responsive.Body Condition: 6/9Hydration: Estimated <5% dehydrationCardiovascular Heart rate: 146 bpm Pulses strong and synchronous with femoral pulses No pulse deficits detected No arrhythmias or murmurs ausculted Mucous membranes pink Capillary refill time <2 seconds Respiratory Patient panting Strong bronchovesicular lung sounds bilaterally No adventitious lung sounds ausculted Increased respiratory effort consistent with pantingAbdominal Abdomen soft and comfortable on palpation No masses or discomfort detected Neurological Cranial nerves grossly intact Normal gait and ambulation No neurological deficits detected Full neurological examination not performedMusculoskeletal Unremarkable.Lymph Nodes Peripheral lymph nodes within normal limits on palpation. Integument Left pinna:- Marked swelling consistent with aural hematoma.- Associated pinna angioedema present.Problem List1. Left aural hematoma2. Pinna angioedema3. History of chronic pruritic ears (suspected allergic otitis)AssessmentFrankie presented with acute swelling of the left pinna consistent with an aural haematoma, characterized by accumulation of blood between the auricular cartilage layers.Aural haematomas typically occur secondary to self-trauma, often associated with underlying irritation of the ear canal.Common primary causes include: Otitis externa (bacterial or yeast infection) vs Allergic dermatitis vs Ectoparasites (e.g. Otodectes) vs Foreign bodiesSecondary causes include: Trauma vsBite wounds vs Mechanical injuryIn this patient, the longstanding history of intermittent ear pruritus and head shaking raises suspicion that chronic allergic otitis or intermittent ear irritation may be the underlying driver.Repeated head shaking or scratching can rupture auricular blood vessels, allowing blood to accumulate within the pinna.Differential diagnoses for the ear swelling include:Aural haematoma (most likely) vs Severe pinna angioedema vs Traumatic pinna swellingBased on the clinical presentation and history, aural haematoma secondary to chronic ear irritation is considered the most likely diagnosis.Without intervention, haematomas may undergo fibrosis and contraction, resulting in permanent pinna deformity.PlanDiscussed three management options with the owners.1. Medical Management- Oral corticosteroid therapy- Repeated aspiration of haematoma- Intralesional corticosteroid injections- Requires multiple veterinary visits- Risk of recurrence2. Surgical Management- Surgical evacuation of haematoma- Placement of multiple sutures through the pinna to eliminate dead space- Allows continued drainage through small incisions- Generally higher success rate- Requires general anesthesia and postoperative care3. Conservative Management (“Benign Neglect”)- No active treatment- Haematoma allowed to resolve naturally- Often results in fibrosis and pinna deformity (“cauliflower ear”)- May be uncomfortable during healingDiscussed that long-term management should ideally be coordinated with the patient’s regular veterinarian, particularly to investigate and manage potential underlying ear disease.Owners elected to take time overnight to consider treatment options and will follow up with their regular veterinarian to determine the preferred management approach.Immediate planAnalgesia- Buprenorphine 0.02mg/kg IMSteroid- Prednisalone 0.25mg/kg PO q24h 3 tablets prescribed until able to visit regular vet.    Vital Signs