# Hemangiosarcoma in Dogs: Splenic Rupture Emergency and Recovery Support


## Key Takeaways

- Hemangiosarcoma (HSA) is an aggressive, malignant cancer of endothelial cells, most commonly affecting the spleen in dogs, characterized by rapid growth and early metastasis.
- Splenic rupture leading to hemoperitoneum is a life-threatening emergency presenting as sudden collapse, weakness, pale mucous membranes, and abdominal distension, requiring immediate splenectomy.
- Diagnosis involves imaging (ultrasound, CT), bloodwork, and definitive histopathology; novel biomarkers like circulating microRNAs are under investigation for earlier detection.
- Standard treatment combines emergency splenectomy to control hemorrhage with adjuvant chemotherapy, typically doxorubicin-based protocols, to manage micrometastatic disease.
- Prognosis is generally poor, with median survival times measured in months, significantly influenced by the presence of metastasis, particularly to the liver.
- Risk factors include advanced age (mean 10.4 years) and large breed dogs, though non-neoplastic splenic lesions like nodular hyperplasia and hematomas are also common differentials.

---

If your [dog](/knowledge/veterinary-medicine/clinical-methods/dog) has been diagnosed with a splenic mass, the possibility of hemangiosarcoma (HSA) is a primary concern. Hemangiosarcoma is an aggressive, malignant cancer of the blood vessel walls (endothelial cells). In the spleen, it is the most common tumor and carries a grave prognosis due to its rapid growth and early metastasis [<a href="#ref-1">1</a>][<a href="#ref-2">2</a>]. A splenic rupture, leading to internal bleeding (hemoperitoneum), is a life-threatening emergency that requires immediate veterinary intervention. This article provides a definitive, source-grounded overview of the emergency management, diagnostic process, treatment options, and recovery support for dogs facing this disease.

**Owner Triage Summary:** If your dog suddenly collapses, shows weakness, has pale gums, or a distended abdomen, treat this as a critical emergency. Do not wait to see if they improve. Transport them to an emergency veterinary clinic immediately. Time is the single most critical factor in stabilizing a dog with a ruptured splenic tumor.

## At a Glance: Splenic Hemangiosarcoma

| Feature | Description |
| :--- | :--- |
| **What is it?** | An aggressive, malignant cancer of the endothelial cells lining blood vessels, most commonly found in the spleen [<a href="#ref-1">1</a>][<a href="#ref-2">2</a>]. |
| **Common Presentation** | Often asymptomatic until it ruptures, causing acute weakness, collapse, pale mucous membranes, and abdominal distension due to internal bleeding [<a href="#ref-2">2</a>][<a href="#ref-3">3</a>]. |
| **Diagnosis** | Imaging (ultrasound, CT), bloodwork, and definitive diagnosis via histopathology after surgical removal. Newer biomarkers like microRNAs are being investigated [<a href="#ref-4">4</a>][<a href="#ref-5">5</a>]. |
| **Emergency Treatment** | Stabilization with IV fluids and oxygen, followed by emergency splenectomy (surgical removal of the spleen) to control hemorrhage [<a href="#ref-2">2</a>]. |
| **Standard Treatment** | Splenectomy followed by adjuvant chemotherapy, most commonly with doxorubicin [<a href="#ref-2">2</a>][<a href="#ref-6">6</a>]. |
| **Prognosis** | Generally poor. Median survival times are short, often measured in months, even with aggressive treatment [<a href="#ref-2">2</a>][<a href="#ref-7">7</a>][<a href="#ref-6">6</a>]. |
| **Key Prognostic Factor** | Presence of metastasis at diagnosis, particularly to the liver, significantly worsens the outcome [<a href="#ref-7">7</a>]. |

## What is Hemangiosarcoma?

Hemangiosarcoma is a highly malignant neoplasm that originates from the endothelial cells, which are the cells that line the interior surface of blood vessels [<a href="#ref-1">1</a>]. Because blood vessels are everywhere in the body, HSA can arise in any tissue, but it has a strong predilection for the spleen, right atrium of the heart, and the skin [<a href="#ref-2">2</a>][<a href="#ref-3">3</a>].

In the spleen, HSA is the most frequently diagnosed tumor [<a href="#ref-1">1</a>][<a href="#ref-8">8</a>]. Its biological behavior is characterized by rapid growth and a marked tendency to invade local tissues and spread (metastasize) early in the disease course [<a href="#ref-2">2</a>]. This early metastatic dissemination is the primary reason for the poor prognosis associated with the disease. By the time of diagnosis, many dogs already have micrometastatic disease that is undetectable by standard imaging [<a href="#ref-2">2</a>][<a href="#ref-7">7</a>].

## The Splenic Rupture Emergency

The most common and dangerous clinical presentation of splenic HSA is a sudden, life-threatening hemorrhage into the abdominal cavity, known as hemoperitoneum [<a href="#ref-2">2</a>][<a href="#ref-3">3</a>]. The tumor grows rapidly and develops fragile, aberrant blood vessels that are prone to rupture. This rupture can happen spontaneously or after minor trauma.

### Clinical Signs of a Ruptured Splenic Tumor

The clinical signs of a splenic rupture are often peracute (very sudden) and can be mistaken for other conditions. Owners may report that their dog was perfectly normal and then suddenly collapsed. Common signs include:

- **Collapse or sudden weakness:** This is often the first and most alarming sign.
- **Pale or white mucous membranes (gums):** This indicates significant blood loss and shock.
- **Abdominal distension (a swollen belly):** This is caused by the accumulation of blood in the abdominal cavity.
- **Lethargy and depression.**
- **Hyporexia or anorexia (loss of appetite).**
- **Rapid, shallow breathing (tachypnea) or difficulty breathing (dyspnea).**
- **Signs of shock:** Weak, rapid pulse; cool extremities.

In some cases, the bleeding may be slow and self-limiting for a period, leading to more chronic signs of lethargy and weakness before a major rupture event occurs [<a href="#ref-3">3</a>]. However, any of these signs warrant immediate veterinary attention.

## Risk Factors and Epidemiology

While any dog can develop hemangiosarcoma, certain factors are associated with a higher risk.

- **Age:** The mean age at diagnosis is around 10.4 years, making it a disease of middle-aged to older dogs [<a href="#ref-8">8</a>].
- **Breed and Size:** Large-breed dogs and certain pure breeds are at an elevated risk [<a href="#ref-8">8</a>]. Medium-sized dogs living in urban areas were also noted to be most affected in one study [<a href="#ref-8">8</a>].
- **Sex:** The risk of HSA can vary by sex, with some studies showing a higher incidence in males or females depending on the population [<a href="#ref-8">8</a>].

It is crucial to understand that breed-level information cannot predict an individual dog's outcome. A diagnosis of a splenic mass in a breed predisposed to HSA does not confirm the diagnosis, nor does it dictate the prognosis for that specific animal.

## Differential Diagnoses for Splenic Masses

Not all splenic masses are hemangiosarcoma. In fact, a significant portion of splenic lesions are non-cancerous. It is essential to consider the full range of differentials:

- **Non-Neoplastic Lesions:** These are the most common findings in some studies, accounting for 54.3% of splenic lesions [<a href="#ref-8">8</a>]. They include:
    - **Nodular Hyperplasia:** Benign overgrowth of splenic tissue.
    - **Hematoma:** A benign blood-filled mass, which can also rupture and cause hemoperitoneum.
    - **Congestion:** An accumulation of blood within the spleen.
- **Neoplastic Lesions:** These account for 45.7% of lesions [<a href="#ref-8">8</a>]. While HSA is the most common (54.5%), other cancers include:
    - **Other Sarcomas:** Such as fibrosarcoma, leiomyosarcoma, or undifferentiated sarcomas.
    - **Lymphoma:** A cancer of lymphocytes.
    - **Mast Cell Tumor:** A cancer of mast cells.
    - **Metastatic Tumors:** Cancers that have spread to the spleen from elsewhere [<a href="#ref-9">9</a>].

The only way to definitively diagnose the type of splenic lesion is through histopathology, which is the microscopic examination of the tissue after it has been surgically removed [<a href="#ref-8">8</a>].

## Veterinary Examination and Diagnostics

When a dog presents with suspected splenic rupture, the diagnostic process is two-fold: stabilize the patient and identify the source of bleeding.

### 1. Emergency Stabilization

The immediate priority is to stabilize the dog's cardiovascular system. This typically involves:

- **Intravenous (IV) Fluid Therapy:** To replace lost blood volume and support blood pressure.
- **Oxygen Therapy:** To ensure adequate oxygen delivery to tissues.
- **Pain Management:** To keep the patient comfortable and reduce stress.
- **Blood Transfusion:** In cases of severe blood loss, a transfusion may be necessary to restore red blood cell mass and clotting factors.

### 2. Diagnostic Imaging

Once the dog is stable enough, or sometimes concurrently with stabilization, imaging is used to confirm the presence of abdominal fluid and a splenic mass.

- **Abdominal Ultrasound:** This is a rapid, non-invasive way to visualize the spleen and confirm the presence of free fluid (blood) in the abdomen. It can often identify a mass on the spleen.
- **Abdominocentesis:** A sample of the abdominal fluid is collected with a needle and syringe. If the fluid is free-flowing blood (not clotting), it is highly suggestive of a ruptured splenic mass.
- **Computed Tomography (CT):** CT provides a more detailed, cross-sectional view of the abdomen and can be used for staging, looking for evidence of metastasis in other organs like the liver and lungs [<a href="#ref-10">10</a>][<a href="#ref-11">11</a>]. It is particularly useful for surgical planning.

### 3. Laboratory Testing

- **Complete Blood Count (CBC):** This will often reveal anemia (low red blood cells) and thrombocytopenia (low platelets), which are common findings in dogs with splenic HSA [<a href="#ref-3">3</a>].
- **Biochemistry Panel:** This assesses organ function and can reveal other issues like azotemia (elevated kidney values) [<a href="#ref-3">3</a>].
- **Coagulation Profile:** HSA can cause abnormalities in the blood's ability to clot, and a coagulation panel can help assess this risk [<a href="#ref-12">12</a>].

### 4. Novel Diagnostic Biomarkers

Research is actively looking for better ways to diagnose HSA before surgery. One promising area is the use of circulating microRNAs (miRNAs).

- A study identified a panel of four circulating microRNAs (miR-126-5p, miR-150-5p, miR-452-5p, and miR-543) that could discriminate dogs with splenic HSA from those with noncancerous splenic masses with an area under the curve of 0.930, a sensitivity of 80%, and a specificity of 90% [<a href="#ref-4">4</a>]. This could potentially help owners make more informed decisions about surgery.
- Another study found that the levels of certain microRNAs (miR-126-5p, miR-150-5p, and miR-214-3p) decreased after splenectomy, suggesting they may also be useful for monitoring response to treatment [<a href="#ref-13">13</a>].
- Additionally, research has shown that specially trained bio-detection dogs can distinguish the odor of hemangiosarcoma in blood serum samples with an accuracy of 70%, suggesting a potential future role for canine scent detection in early diagnosis [<a href="#ref-14">14</a>].

### 5. Definitive Diagnosis: Histopathology

The gold standard for diagnosing hemangiosarcoma is histopathology. After splenectomy, the entire spleen or a sample of the mass is submitted to a veterinary pathologist. The pathologist examines the tissue under a microscope to confirm the diagnosis.

- Traditional markers like CD31 are used, but they have suboptimal sensitivity and specificity.
- Newer immunohistochemical markers, such as ERG (E-26 transformation specific-related gene), a nuclear transcription factor expressed in endothelial cells, have shown superior diagnostic performance. In one study, ERG had a 100% sensitivity for canine splenic vascular tumors compared to 87% for CD31 [<a href="#ref-1">1</a>]. This can be especially helpful in confirming challenging cases.

## Evidence-Based Management and Treatment

The standard of care for splenic hemangiosarcoma involves a two-pronged approach: surgical removal of the primary tumor and systemic chemotherapy to address metastatic disease.

### Surgical Treatment: Splenectomy

Splenectomy, the surgical removal of the spleen, is the primary and most critical treatment for a ruptured splenic tumor [<a href="#ref-2">2</a>][<a href="#ref-6">6</a>]. The goal of this emergency surgery is to control the life-threatening hemorrhage. While the surgery is primarily palliative in the context of HSA, as it does not cure the disease, it is essential for saving the dog's life [<a href="#ref-2">2</a>].

The spleen is a highly vascular organ, and surgery carries risks, especially in an emergency setting with a compromised patient. However, without surgery, the prognosis is grave.

### Adjuvant Chemotherapy

Because HSA is known to metastasize early, surgery alone is rarely curative. Adjuvant chemotherapy is recommended to target microscopic cancer cells that have already spread to other parts of the body [<a href="#ref-2">2</a>].

- **Doxorubicin-Based Protocols:** The most commonly used and studied chemotherapy protocol is doxorubicin, either alone or in combination with other drugs [<a href="#ref-2">2</a>][<a href="#ref-6">6</a>]. A retrospective study of a doxorubicin-cyclophosphamide protocol in dogs with stage II splenic HSA and hemoperitoneum found a median overall survival of 92 days, with longer survival in dogs that completed three or more cycles [<a href="#ref-6">6</a>].
- **Metronomic Chemotherapy:** This involves giving lower doses of chemotherapy drugs (like cyclophosphamide) more frequently. It works by inhibiting the formation of new blood vessels that tumors need to grow (anti-angiogenesis). It is generally well-tolerated and may provide some benefit, particularly when used as a maintenance therapy after a standard protocol [<a href="#ref-6">6</a>]. One case report of a primary vertebral HSA also showed extended survival with metronomic cyclophosphamide and propranolol [<a href="#ref-15">15</a>].
- **Other Therapies:** Immunotherapy and other targeted therapies have been investigated, but they have not yet demonstrated consistent clinical benefit in improving long-term survival [<a href="#ref-2">2</a>].

### Prognosis and Survival Times

The prognosis for dogs with splenic hemangiosarcoma is guarded to poor. The overall median tumor-specific survival time is often short. In one study, the median survival was 132 days [<a href="#ref-7">7</a>].

- **Stage of Disease:** The most significant prognostic factor is the clinical stage at diagnosis. Dogs with stage I (tumor confined to the spleen) have a better prognosis than those with stage II (tumor ruptured) or stage III (metastasis present) [<a href="#ref-7">7</a>].
- **Metastasis:** The presence of metastasis, especially to the liver, is associated with a significantly decreased survival time [<a href="#ref-7">7</a>].
- **Treatment:** Dogs that receive adjuvant chemotherapy generally survive longer than those that do not. For example, in dogs with liver metastasis, those receiving anthracycline-based chemotherapy had a longer survival (255 days) compared to those receiving metronomic therapy alone (65 days) [<a href="#ref-7">7</a>].

## Recovery Support and Aftercare

Supporting your dog through recovery after a splenectomy and chemotherapy requires careful attention and a strong partnership with your veterinary team.

### Post-Surgical Care

The immediate post-operative period is critical. Your dog will be hospitalized for monitoring of vital signs, pain control, and to ensure they are recovering from anesthesia and surgery. Once home, you will need to:

- **Restrict Activity:** Strict rest is essential for the surgical incision to heal. This means no running, jumping, or playing for several weeks. Short, leash-walks for bathroom breaks only.
- **Manage the Incision:** Check the surgical site daily for signs of redness, swelling, discharge, or if your dog is licking or chewing at it. An Elizabethan collar (cone) is often necessary to protect the incision.
- **Administer Medications:** Give all prescribed medications, including pain relievers and antibiotics, exactly as directed by your veterinarian.
- **Provide a Quiet Environment:** Create a calm, comfortable space for your dog to recover without stress.

### Supporting Your Dog Through Chemotherapy

Chemotherapy in dogs is generally better tolerated than in humans, with fewer severe side effects. However, you should be prepared for potential issues.

- **Gastrointestinal Upset:** Some dogs may experience nausea, vomiting, or diarrhea (also spelled diarrhoea). Your veterinarian can prescribe anti-nausea medications to help manage these signs.
- **Lethargy:** It is common for dogs to be tired for a few days after a chemotherapy treatment.
- **Low Blood Cell Counts:** Chemotherapy can temporarily lower white blood cell counts, making your dog more susceptible to infection. Monitor for any signs of fever or illness and keep them away from other unvaccinated or sick animals.

### Nutrition and Hydration

A high-quality, palatable diet is important to help your dog maintain their strength. You may need to warm their food or offer small, frequent meals to encourage eating. Ensure fresh water is always available. Some dogs may require appetite stimulants if their appetite is poor.

## Unsafe Home Remedies and What to Avoid

When faced with a cancer diagnosis, it is natural to want to try everything. However, some unproven or unsafe "remedies" can be harmful.

- **Do Not Give Human Medications:** Never give your dog human pain relievers like ibuprofen, naproxen, or acetaminophen. These are toxic to dogs and can cause severe liver or kidney damage.
- **Avoid Unproven Supplements:** Many supplements are marketed for cancer in pets, but few have been proven to be effective. Some can interfere with chemotherapy drugs. Always discuss any supplement with your veterinary oncologist before giving it to your dog.
- **Do Not Delay Surgery:** Some owners may seek alternative therapies instead of surgery. For a ruptured splenic tumor, surgery is the only life-saving option. Delaying it can be fatal.
- **Do Not Ignore Bleeding Signs:** If you notice any signs of internal bleeding, do not wait. Seek emergency veterinary care immediately.

## Prevention and Early Detection

Because the cause of hemangiosarcoma is not fully understood, there is no known way to prevent it. The focus is on early detection.

- **Regular Veterinary Check-ups:** Routine physical exams are important, especially for senior dogs. Your veterinarian may be able to palpate an enlarged spleen during a wellness exam.
- **Screening Bloodwork:** Annual bloodwork may not specifically detect HSA, but it can identify anemia or other abnormalities that warrant further investigation.
- **Proactive Imaging:** For breeds at high risk, some veterinarians may recommend periodic abdominal ultrasounds to screen for splenic masses. However, this is not yet a standard recommendation, and its cost-effectiveness is debated.
- **Incidental Findings:** Splenic masses are sometimes found incidentally during surgery for other conditions, such as gastric dilatation-volvulus (GDV). One study found that if a solitary splenic mass is identified during GDV surgery, it is associated with a 19.1% chance of being malignant [<a href="#ref-16">16</a>]. This highlights the importance of histopathology on any splenic tissue removed, even if it appears normal.

## Limitations and When to Contact a Veterinarian

This article provides a comprehensive overview of hemangiosarcoma, but it cannot replace professional veterinary advice. The information presented here is educational and is not a substitute for veterinary diagnosis or treatment. Every dog is an individual, and the specifics of your dog's case, including the stage of disease, overall health, and response to treatment, will significantly influence their prognosis.

**When to contact a veterinarian immediately:**

- **Any sign of acute weakness, collapse, or lethargy.**
- **Pale or white gums.**
- **A swollen or distended abdomen.**
- **Difficulty breathing.**
- **Vomiting or diarrhea that persists for more than 24 hours.**
- **Any signs of pain or distress.**
- **If your dog is not eating or drinking.**

Your veterinary team is your best resource for personalized guidance and support. They can help you understand the diagnosis, treatment options, and what to expect, allowing you to make the best possible decisions for your beloved companion.

## Frequently Asked Questions

### 1. What are the first signs of a splenic rupture in a dog?
The first signs are often sudden collapse, severe weakness, pale gums, and a rapidly distending abdomen, all due to internal bleeding.

### 2. Is a splenic mass in a dog always cancer?
No, not all splenic masses are cancerous. Non-cancerous lesions like nodular hyperplasia and hematomas are common. However, hemangiosarcoma is the most common malignant splenic tumor, so a biopsy is essential for diagnosis [<a href="#ref-8">8</a>].

### 3. Can a dog survive a ruptured splenic tumor?
Yes, a dog can survive the immediate crisis of a ruptured splenic tumor, but it requires emergency surgery (splenectomy) to stop the bleeding. Survival long-term depends on the tumor type and whether it has spread [<a href="#ref-2">2</a>][<a href="#ref-6">6</a>].

### 4. How long can a dog live with splenic hemangiosarcoma without treatment?
Without treatment, the prognosis is very poor, and survival is often measured in days to weeks, primarily due to the high risk of fatal hemorrhage from tumor rupture.

### 5. What is the survival time for a dog with splenic hemangiosarcoma after surgery and chemotherapy?
With surgery and adjuvant doxorubicin-based chemotherapy, the median survival time is typically around 3 to 6 months, though some dogs may live longer [<a href="#ref-2">2</a>][<a href="#ref-7">7</a>][<a href="#ref-6">6</a>].

### 6. Is hemangiosarcoma painful for dogs?
A slow-growing tumor may not be painful initially. However, a splenic rupture causing internal bleeding is acutely painful and causes severe distress. Metastasis to bone can also cause significant pain [<a href="#ref-15">15</a>].

### 7. Are there any new tests for diagnosing hemangiosarcoma in dogs?
Yes, research is exploring new biomarkers. A panel of four circulating microRNAs has shown promise in distinguishing HSA from non-cancerous masses, and trained dogs have been able to detect HSA odor in blood samples [<a href="#ref-14">14</a>][<a href="#ref-4">4</a>].

### 8. What are the treatment options if the cancer has already spread?
If the cancer has metastasized, treatment is still focused on controlling the primary tumor (splenectomy) and using chemotherapy to slow the growth of secondary tumors. The goal is to maintain a good quality of life for as long as possible, but the prognosis is more guarded [<a href="#ref-7">7</a>].

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<a id="ref-4"></a>[<a href="#ref-4">4</a>] [A panel of 4 circulating microRNAs (126-5p, 150-5p, 452-5p, and 543) discriminates dogs with splenic hemangiosarcoma from those with noncancerous splenic masses.](https://pubmed.ncbi.nlm.nih.gov/41248605/)

<a id="ref-5"></a>[<a href="#ref-5">5</a>] [MicroRNA differential expression analysis in canine visceral hemangiosarcoma formalin-fixed, paraffin-embedded tissues.](https://pubmed.ncbi.nlm.nih.gov/41924723/)

<a id="ref-6"></a>[<a href="#ref-6">6</a>] [Doxorubicin-Cyclophosphamide Protocol in Dogs with Splenic Haemangiosarcoma and Haemoabdomen: A Retrospective Case Series.](https://pubmed.ncbi.nlm.nih.gov/41295691/)

<a id="ref-7"></a>[<a href="#ref-7">7</a>] [Frequency, distribution, and prognostic impact of metastatic site in dogs with splenic hemangiosarcoma.](https://pubmed.ncbi.nlm.nih.gov/41742582/)

<a id="ref-8"></a>[<a href="#ref-8">8</a>] [Epidemiology of Splenic Lesions in Dogs Undergoing Splenectomy-Pathological Characterization and Risk Factors.](https://pubmed.ncbi.nlm.nih.gov/41600720/)

<a id="ref-9"></a>[<a href="#ref-9">9</a>] [Neoplasms with splenic involvement in dogs at necropsy: Macroscopic presentation patterns in 262 cases.](https://pubmed.ncbi.nlm.nih.gov/41218305/)

<a id="ref-10"></a>[<a href="#ref-10">10</a>] [MRI and CT Findings of a Rare Extradural-Extramedullary Lumbar Hemangiosarcoma in a Dog: A Case Report.](https://pubmed.ncbi.nlm.nih.gov/42007628/)

<a id="ref-11"></a>[<a href="#ref-11">11</a>] [Magnetic resonance imaging features of primary appendicular bone sarcomas in 20 dogs.](https://pubmed.ncbi.nlm.nih.gov/41387098/)

<a id="ref-12"></a>[<a href="#ref-12">12</a>] [Thromboembolic disease and hemostatic alterations in tumor-bearing dogs - A narrative review.](https://pubmed.ncbi.nlm.nih.gov/42328058/)

<a id="ref-13"></a>[<a href="#ref-13">13</a>] [Circulating levels of microRNAs 126-5p, 150-5p, 214-3p, and 452-5p decrease following splenectomy in dogs with hemangiosarcoma.](https://pubmed.ncbi.nlm.nih.gov/41289681/)

<a id="ref-14"></a>[<a href="#ref-14">14</a>] [Trained dogs can detect the odor of hemangiosarcoma in canine blood samples.](https://pubmed.ncbi.nlm.nih.gov/41319895/)

<a id="ref-15"></a>[<a href="#ref-15">15</a>] [Vertebral hemangiosarcoma as a cause of spinal cord compression in a dog.](https://pubmed.ncbi.nlm.nih.gov/41695824/)

<a id="ref-16"></a>[<a href="#ref-16">16</a>] [Identification of a solitary splenic mass during surgery for gastric dilatation-volvulus is associated with diagnosis of splenic neoplasia in dogs.](https://pubmed.ncbi.nlm.nih.gov/41919143/)

<a id="ref-17"></a>[<a href="#ref-17">17</a>] [Surgical treatment and outcome of intracranial hemangiosarcoma in two dogs: case series.](https://pubmed.ncbi.nlm.nih.gov/42038052/)

<a id="ref-18"></a>[<a href="#ref-18">18</a>] [Clinical features and imaging findings for a mediastinal hemangiosarcoma in a dog.](https://pubmed.ncbi.nlm.nih.gov/41586149/)

<a id="ref-19"></a>[<a href="#ref-19">19</a>] [Hemangiosarcoma involving the interventricular and interatrial septum, atrioventricular node, and right ventricle, causing atrioventricular block and ventricular arrhythmias in a dog.](https://pubmed.ncbi.nlm.nih.gov/41380581/)

<a id="ref-20"></a>[<a href="#ref-20">20</a>] [Sternal wound reconstruction with transverse locking plate fixation in two dogs.](https://pubmed.ncbi.nlm.nih.gov/41220190/)

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