Case of the Week: Bella

Case of the Week: Bella

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Case History

Bella, a 1 year old, female, Doberman Pinscher dog was seen at her primary veterinarian for a swelling on the right elbow. Per owner, two injections were given, and the owner was instructed to keep a sleeve over the patient’s limb. The patient would remove the sleeve and the owner returned for more injections and was referred to a specialist for further evaluation. Over the previous 4 days, the entire limb had become swollen, with swelling currently extending into to the chest area on presentation. Direct preparations of fluid (sample type) labeled as joint (site) are submitted.

Scopio Practice Tip

In a case like this, a description of where the sample was obtained is important to interpretation. In the Scopio drop-down menu, there are options that are bodily fluid specific (eg. synovial fluid), or general and location specific (eg. joint). Because fluids associated with synovial structures may be aspirated from within the joint itself (synovial fluid), or from masses and fluid pockets adjacent to joints, clarification of where the sample was aspirated should be included in the clinical history for the clinical pathologist to review. This allows more specific and fine-tuned interpretive comments.

Webcam images with user chosen scan area denoted by thin green line.

Cytologic Features

Highly cellular sample with proteinaceous material, nuclear debris, mild hemorrhage.

Stain precipitate and backrground material can obscure or mimic bacteria!

Ideally, bacteria can be seen phagocytosed by degenerate neutrophils for confirmation.

Interpretation: Infectious neutrophilic abscessation (cellulitis).

Additional interpretative language: Septic suppurative/neutrophilic inflammation.

How do we get to infectious or septic in a report? When bacteria are microscopically confirmed with confidence, seen phagocytosed by neutrophils, and are associated with an inflammatory response.

When might we recommend culture without those findings? In synovial fluid, specifically, where bacteria can be few and far between, adhere to the synovium, and neutrophils often retain their non-degenerate appearance. In cases with conflicting factors, such as debris/contaminant or a lack of expected inflammatory response.

Case of the Week patient information has been altered for client confidentiality.

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