How In-Clinic CT Led to Rapid Diagnosis and Compassionate Care in a Critical Case

Overview

Taco, an 8-year-old male Poodle mix, presented with acute onset lethargy, facial swelling, and a facial defect following prior extensive dental procedures. Advanced imaging revealed a large, invasive nasal mass and a locally invasive neoplasia; histopathology subsequently confirmed a squamous cell carcinoma. In-house CT enabled rapid diagnostic assessment without the need for referral, facilitating a timely transition from a curative to a palliative management approach focused on maintaining patient comfort and quality of life.

Case Details
Taco: 8-year-old male Poodle mix

Background: According to the owner, Taco exhibited a recent and marked change in behavior, including decreased activity level, anorexia, and signs of discomfort. Several months prior, Taco underwent a routine dental procedure, during which conditions appeared and required extensive intervention, including 24 dental extractions and surgical repair of an oronasal fistula. Postoperatively, he was given a course of prednisone and initially recovered. However, his condition deteriorated, prompting reevaluation.

Physical Examination: Taco was quiet, alert, and responsive but exhibited blepharospasm and increased respiratory effort. A firm, unilateral swelling was noted over the right maxillofacial region. A small cutaneous defect was present on the right side of the face; per owner report, this lesion developed acutely overnight.

Diagnostic Process:

• Given Taco’s previous dental procedure included significant extractions and repair, these new symptoms pointed toward a more serious underlying condition such as possible nasal neoplasia or infiltrative disease.
• After the physical examination, Taco’s veterinary team determined more comprehensive diagnostics were needed including a full blood work panel and urinalysis, followed by facial and neck imaging.
  
  
  • Lab Work: Taco’s lab work showed elevated neutrophils, which can be caused by many factors, including bacterial or fungal infections, stress or trauma, medications (such as prednisone he had taken resulting in a steroid leukogram), or certain cancers like leukemia or squamous cell carcinoma.
    • In Taco’s case, his care team suspected the elevation was caused by the mass on the right side of his face, exacerbated by the effects of prednisone, and needed to investigate further with a diagnostic CT.
      
      
  • Diagnostic Imaging:
    • Imaging revealed fluid buildup and bone structure changes around the nasal and maxillary recess, signaling something serious was going on.
    • To get a clearer picture, Taco was sedated, intubated, and prepped for a CT scan of the head and neck, with and without contrast.
    • Taco’s veterinary clinic recently started offering CT scans in-house. This allowed his veterinary team to conduct a CT without a referral delay to examine his brain, nasal passages, and surrounding structures in detail, and action on results quickly.
      • CT Findings:
        • The CT scan found a large, irregular mass across Taco’s entire nasal cavity and upper jaw. The mass had destroyed part of Taco’s skull and displayed an intracranial extension.
        • The CT also showed that both Taco’s frontal sinuses and middle ear cavities were filled with fluid, along with several enlarged lymph nodes.

The CT findings suggested a malignant tumor, most likely a squamous cell carcinoma. A biopsy of the nasal mass could confirm the diagnosis.

Diagnosis and Treatment

• Because the CT scan revealed a large, irregular mass involving the nasal cavity and the upper jaw with bone destruction, the lab findings supported the diagnosis of a locally invasive process.
• Squamous cell carcinoma was the leading differential diagnosis, given the aggressive nature of invasion and destruction of bone. Other possibilities included lymphoma or fungal causes, which were less likely.
  • Concerns of secondary complications that could be decreasing quality of life such as fluid accumulation in the sinuses, enlarged lymph nodes (explained by the possible metastasis or reactive inflammation) was causing Taco to not want to eat and hide more from his owner at home.
    
    
• To reach a definitive diagnosis, a biopsy of the nasal mass was sent off for histopathology.
  • This included a fine needle aspirate (FNA) of lymph nodes to rule out reactive inflammation instead of metastasis.
  • Depending on results of biopsy, the team planned for the following scenarios: surgery, radiation therapy, chemotherapy, or palliative/hospice care.

• The FNA suggested squamous cell carcinoma. Taco’s veterinary team discussed with owner prognosis and expected outcomes and potential complications.
  • They alsoreferred his owners to oncology for staging, prognosis and discussion of treatment options.
  • Because the owners’ goals were to prioritize comfort and quality-of-life, and curative options were not feasible, focus shifted to pain control, anti-inflammatory, and nutritional support.

Treatment focused on palliative care for Taco’s comfort and dignity; it included pain management (analgesics), and supportive care with hydration, nutritional support, assisted feedings/appetite stimulants. Taco’s care plan was to monitor his response to treatment, pain levels, appetite, and quality-of-life for his remaining time.

Case Impact

An in-house CT helped Taco’s care team reach a rapid diagnosis in a critical situation. His condition was progressing quickly, and the cause was unclear. Having a CT scanner readily available in the clinic meant Taco’s veterinary team could immediately perform advanced imaging without waiting for a referral or traveling to a specialty hospital. This allowed them to identify the presence, size, and extent of the mass, detect bone destruction and brain involvement, and assess fluid accumulation in sinuses and ears.

Taco’s symptoms suggested a serious problem in his head and face, areas where traditional x-rays often miss critical details. CT imaging used in this case provided high-resolution, three-dimensional views of Taco’s nasal cavity, jaw, sinuses, and brain — essential for pinpointing the exact location and boundaries of the tumor, understanding how much bone and tissue were affected.

Advanced imaging helped determine the seriousness of the tumor and why aggressive treatment wasn’t possible — and, importantly, allowed Taco’s veterinarian to discuss prognosis and care options with clarity and empathy. With CT available in the clinic, Taco’s ongoing care could be managed efficiently, with all diagnostics and treatments coordinated in one place.