A bearded collie has a large elbow haematoma

Dec 1, 2016.  22 days ago, the Bearded Collie had a big painful swelling above the right elbow. Vet 1 X-rayed and gave anti-flammatory which reduced the swelling considerably. 

Dec 23, 2016. 

But the owner discovered a growing swelling to the lateral side of the elbow. The dog appeared to have licked the right elbow area causing an elbow sore. He consulted Toa Payoh Vets and X-rays were taken. I palpated a soft firm swelling lateral and above the right elbow measuring around 6 cm x 6 cm x 5 cm.

I suspected it would be a haematoma based on the history of the sudden onset painful large swelling seen by Vet 1, a happy vet whom I communicated by phone on Dec 23, 2016. She remembered it was a caudal medial swelling from mid-humeral area to the elbow and gave the anti-inflammatory injection which worked effectively to reduce the swelling. 

Surgical exploration. I used a low dose Domitor + Ketamine 0.4 ml + 0.5 ml respectively IV and gave isoflurane gas. The 7-year-old dog weighed 33 kg

The swelling shot out dark red blood when I electro-incised over the swelling. There were no blood clots. There was a big "dead space" between the skin and the lateral side of the elbow where the blood had accumulated. I stitched up the "dead space" using interrupted absorbable 2/0 sutures. 

So, there was continuous bleeding since this Bearded Collie has been exercised twice a day daily causing rupture of some blood vessels, probably veins as the blood is dark blue. No blood clots but one broken tube looking like a vein was seen. A strange case.

The owner disagreed that the dog had a clotting disorder e.g. low platelets as he said the dog's wound heal easily in the past when bitten by other dogs. So there was no blood test done. 

I advised no more running around for one month to permit healing and clotting. But the owner said the dog needed to exercise before doing his business twice a day.

A very unsual case. Normally, the blood would have clotted and hardened or removed by the body cells. No reservoir of dark blue blood as a haematoma. My hypothesis is that the dog was too active after Vet 1 had given the anti-inflammatory as he felt no pain. So, there was no healing of the blood vessels near the elbow and blood vessels rupture forming a haematoma and some pain and lameness in this beloved dog.