An 8 year old intact male Doberman Pinscher was presented to Cornell's Emergency Service for a 3 day history of hematuria and worsening tenesmus. He was initially evaluated by the referring veterinarian where a urinalysis showed >10 cocci/hpf, 0-2 WBC/hpf and too numerous to count RBC/hpf. Abdominal radiographs at an emergency hospital showed symmetrical enlargement of the prostate and he was treated with enrofloxacin for presumptive prostatitis. The patient has a history of cervical issues (Wobblers), an arrhythmia, and hypothyroidism which once treated improved Holter monitor findings. A recent recheck echocardiogram performed was normal.

On presentation to Cornell's Emergency Service, the patient was alert and obviously painful with a kyphotic stance. His physical examination revealed swelling of the perineal area and blood around the anus. A brief abdominal ultrasound was negative for free fluid and point of care blood work was unremarkable. A cystocentesis was preformed to collect urine for a urinalysis (very dark brown, USG >1.060, 3+ protein, large bilirubin, >100 RBC/hpf) and culture (no growth). Abdominal radiographs showed prostatomegaly with possible mineralization. An abdominal ultrasound performed the morning after admission revealed a large mass suspected to be associated with his prostate and a small amount of free fluid in his abdomen. Analysis of the free fluid was consistent with a hemorrhagic effusion and a prostatic wash showed no abnormal cells. During the ultrasound, symmetrical dark red bruising was noted around the patient’s scrotum and medial thighs. The bruising markedly worsened and his hematocrit decreased by 12% over 48 hours. A plasma transfusion was administered without complication and samples were submitted for coagulation tests. Once the patient was stable, a computed tomography (CT) scan was performed under general anesthesia to further evaluate the pelvic mass.

This report will discuss the diagnostic approach to a possible coagulopathy, and the differential diagnosis of a pelvic mass.