If you are not familiar with the rest of Icy's story you might want to check these out first...
How we got her
Post-op pics first hernia surgery
So when we first arrived at the teaching hospital we repeated the bloodwork along with some clotting times. The clotting times were important for a few reasons-if they are prolonged it can be an indicator of liver failure and also the inability to clot adds risk to the biopsy procedure. The clotting times were normal as was the chemistry panel-unusual because we were suspecting liver pathology. She was slightly more anemic than previously. Her original Packed Cell Volume or PCV was 21%. PCV is the percent of blood that is made up of red blood cells and normal is roughly 25-45%. On Friday it was 17%.
During the first attempt at ultrasound Icy was too wiggly and would struggle to breathe if she got stressed so we decided to anesthetize and intubate her to do it safely. An IV catheter was placed and she was sedated and returned to ultrasound. The problematic area appeared to be a large encapsulated structure. Differentials included a cyst, abscess or the largest gallbladder ever seen in a cat. The next step was to aspirate or pull fluid out of the structure. The fluid was bloody-so now we know where the blood was going. As the fluid was pulled off the pressure was relieved and the clot disrupted and we noticed active bleeding into the structure. You could literally see blood pulsing with every heartbeat. In the end the ultrasound left a room full of veterinarians dumbfounded. The radiologist literally said "I have no idea what it is, I've never seen anything like it." So because of the bleeding we stopped the aspirating and sent the fluid for analysis. Icy was taken back to ICU to recover and I was left with the realization that surgery may be indicated to determine what was going on and stop the bleeding. Meanwhile, recheck of Icy's PCV after aspiration revealed a drop to 12% so a transfusion was started while we waited on the test results.
The fluid analysis showed only inflammation and blood and small lymphocytes but no evidence of neoplasia (cancer). Since we had no reason to believe this might not be a curable problem I decided to take the chance on surgery. Icy finished her transfusion uneventfully and was anesthetized again. An additional catheter was placed in her jugular in case large volumes of fluids needed to be administered and an arterial line was placed for direct blood pressure measurements. Ninety minutes into surgery the tech came out to let me know that she was doing fine but it would be awhile as there were lots of adhesions to break down before they could even get to the mass, likely in part due to her previous surgery. Another hour and a half later the surgeon came out to let me know it had gone very well and they were able to remove the whole thing. It was a large, smooth, cystic structure coming off the liver so they also removed the liver lobe it was attached to. The rest of the liver and organs looked good. It's very possible this was just a benign growth or cyst and that surgery was curative-we will know when the pathology report comes back. Why she would be bleeding into a benign structure such as a cyst is still a mystery.
Her post-op PCV was a scary 7% so another transfusion was given. As of this morning she was back up to 17% and doing very well considering her ordeal. If she is still doing well tomorrow we may be able to bring her home.
I'm pretty sure this is now the most expensive stray cat on the planet. I have requested of Icy that there is no "Part Three" to this story!
Apparently they took a lot of photos during surgery. I'm anxious to see them and I'll post some when I get them.