Dear Patty:
>Cisco is a six year old male sable who underwent double adrenal surgery
>April 2000.  The left gland was removed and the right debulked as much
>as possible.  The biopsy confirmed adrenacarcinoma.  His belly started
>swelling recently and at first I thought it was the tumour growing back.
>Xrays showed his belly full of fluid, when we tapped it the fluid had
>blood in it.  We drained off 100cc but there is still at least another
>100ccs there.  The vet is afraid to draw off too much fluid, Cisco might
>crash and the vet says the body will reabsorb the blood cells.  Ultrasound
>showed a massive right tumour (approx 4cm) which appeared to be segmented
>and lobular.
>
>Subsequent x-ray showed some fluid in his lungs as well as the remaining
>fluid in his belly.  Right now he is on Lasix to try and reduce the fluid
>in his lungs but don't know if anything can be done about his poor belly.
>My questions are: Where is the fluid coming from?  Is it possible the
>blood is leaking from the tumour?  After his belly was tapped, Cisco was
>much more active so whatever is going on inside him is not causing him a
>lot of stress but I've never seen this before.
>
>Help Please Patty and Cisco (The last of the 5)
 
Of course, I don't have to tell you that this is not a good thing.  There
are several possibilities for the fluid -
1) That he is in heart failure, and the fluid represents ascites, or the
backup from a failing heart.  There is always a blood tinge to ascites, and
the fluid in the lungs could also result from a failing heart.
2) That you are seeing hemoperitoneum from a large recurrent adrenal
malignancy - with these tumors, as they hit a large size, they have a
definite propensity for blood vessel rupture.  In truth, the chances of a
ferret with an adrenal malignancy dying of hemoperitoneum is far greater
than dying of metastatic disease.
3) That this is neoplastic ascites - some tumors either leak tremendous
amounts of blood (such as hemangiosarcoma, a tumor of blood vessels) or
mesothelioma, a tumor affecting the periotneum which produces prodigious
amounts of fluid.
 
At this point, my suggestions would be
a) to run a CBC and check and see if Cisco is anemic.  You can also run a
PCV on the fluid of the abdomen to see if it is real blood, or just blood
tinged fluid.  It is important to see if Cisco is losing significant
amounts of blood into the abdomen.  If he is not anemic, it points a bit
more toward heart disease.
2) Do a chest radiograph to evaluate the shape of the heart.
 
The lasix should help as a stopgap measure, and periodic taps of the
abdomen may also help, at least until a definitive diagnosis is reached.
The fact that there is a 4cm tumor in there is not good at all.  If the
heart checks out, then you face surgery very quickly to remove that tumor,
with a significant risk of intraoperative death.  However, a bleeding 4 cm
tumor offer little hope for survival at this point.  I would be prepared
for some action within 48-72 hours at most.
 
With kindest regards,
Bruce Williams, dVM
[Posted in FML issue 3321]