Oral hemorrhage is an uncommon clinical finding when it occurs spontaneously without a history of trauma. Nontraumatic oral
bleeding can be due to neoplasia, periodontal disease and, in the case discussed below, what appears to be several factors.
Frank and significant hemorrhage as seen in this case is particularly unusual.
A curious case
A white domestic shorthaired cat was presented to a local emergency facility for evaluation of spontaneous oral bleeding.
No abnormalities other than frank oral hemorrhage were noted on presentation. The patient was sedated, and an oral examination
revealed arterial hemorrhage associated with a diffuse palatal defect 3 mm palatal to the right maxillary canine tooth. A
suture was placed into the palatal tissue and successfully stopped the hemorrhage. The patient was kept for observation and
then discharged some time later.
Less than 48 hours later, the patient was presented again to the emergency facility with the same complaint. Sedation and
suturing were repeated at the same site, although this time a horizontal mattress suture was placed. A recommendation was
made for referral the next morning to determine a cause for the recurrent spontaneous hemorrhage.
Photo 1: Three palatal lesions are evident. The lesion adjacent to the canine tooth was the origin of the bleeding. (Photos:
Courtesy of Dr. Brett Beckman)
On physical examination at the referral clinic, numerous fleas, pink staining of the coat in multiple locations about the
torso and limbs and dried blood within and about the oral cavity were noted. The owners were queried and confirmed that the
cat groomed excessively, but they were not aware of the flea infestation. The results of a complete blood count, serum chemistry
profile, T4 concentration measurement and feline leukemia virus and feline immunodeficiency virus testing revealed a slight anemia (PCV
= 23.7%), mild hypoglobulinemia and a mild decrease in the T4 concentration. While awaiting sedation and a complete oral examination, the patient's oral hemorrhage returned, with arterial
blood dripping freely from the oral cavity.
Photo 2: A palatal mucosal flap was used to visualize the bone adjacent to the defect, ligate the major palatine artery and
obtain biopsy samples of the lesion.
The patient was sedated, and an oral examination revealed bleeding associated with the palatal lesion. The tissue associated
with the lesion was dark-red and lacked palatal ruggae (Photo 1). Two additional smooth darkened lesions were present in the
caudal palatal mucosa.
Photo 3: The major palatine artery is seen here after surgical exposure.
Because of the recurrence and severity of the hemorrhage, ligation of the major palatine artery was indicated to eliminate
the major arterial supply to the tissue. A full-thickness palatal flap was used to expose the bone adjacent to the lesion
for visualization and to isolate the artery for ligation (Photos 2 and 3). The bone and adjacent palatal tissue appeared normal.
Biopsy samples were then taken of the bleeding lesion and one of the caudal palatal mucosal lesions. The flap was closed by
using a simple interrupted suture technique (Photo 4). Eosinophilic granuloma and neoplasia were considered the most likely
rule-outs. Histopathology was nonspecific and revealed well-differentiated hyperplastic epithelial cells. Pruritic dermatitis
secondary to flea infestation was diagnosed based on the clinical signs and was resolved with flea treatment and an anti-inflammatory
dose of prednisone given every other day.
Photo 4: The flap is sutured after ligation.
The patient returned in six weeks for a recheck. No additional bleeding was observed, and external parasites were absent.
Evidence of all three lesions was still present, but the lesions appeared to be resolving and not clinically active (Photo
Photo 5: The patient at a recheck showing the resolving lesions.