Sam Cantrell is a 2-year-old F intact German Shepherd who presented with an uncommon but fascinating condition called hypertrophic osteopathy. This disease causes periosteal reaction and bone thickening in the distal limbs (in her case, around her ankles and wrists) due to a mass in the chest, in Sam’s case the mediastinal area.
She was seen by Dr. Cletzer on 1-15 for a CT scan and aspirates of the mass. The CT revealed that the mass involved the ventral aspect of her right cranial lung lobe, with local extension into her mediastinum (the tissues in front of the heart and below the lung lobes). Initial cytology raised concern for carcinoma.
Sam was taken to surgery on Jan. 27th, where her sternum was opened to safely remove the mediastinal mass and the bottom of her lung lobe using a stapling device. A chest tube was placed to collect any air or fluid postoperatively. She produced very little overnight, the tube was removed the next day, and she was sent home in her adorable recovery suit.
Her biopsy results are now back: the mass was not cancerous, but severe pyogranulomatous inflammation. Dr. Gibson, our internist, performed additional testing to determine the cause. The biopsy site was tested for acid-fast organisms (mycobacteria), and her blood was checked for fungal infections — all negative. The current theory is that Sam may have inhaled a foreign body into her lung, with the infection extending into her mediastinum.
We plan to monitor her chest radiographs in 2-3 months, but Sam is doing fantastic at home. This case highlights the incredible collaboration between oncology, radiology with Dr. Sepulveda (for both CT and x-ray interpretation), surgery (for mass removal), internal medicine (for fungal testing and ongoing care/follow-up), and the hospitalized medicine team who managed her overnight care.
