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Compendium April 2013 (Vol 35, No 4)

Clinical Snapshot: A Tennessee Walking Horse With Acute Dyspnea and Epistaxis

by Sharon Tirosh-Levy, DVM, Amir Steinman, DVM, PhD, MHA, Gal Kelmer, DVM, MS, DACVS, DECVS

    Case Presentation

    A 3-week-old Tennessee walking horse filly was referred for acute dyspnea and epistaxis to the Veterinary Teaching Hospital at The Hebrew University of Jerusalem. At presentation, the filly was quiet and had hyperthermia (102.7°F [39.3°C]; normal range: 100°F to 102°F [37.8°C to 38.9°C]), tachycardia (100 bpm; normal range: 70 to 90 bpm), and tachypnea (76 breaths/min; normal range: 20 to 40 breaths/min). The patient’s breathing pattern was strenuous, with a notable abdominal phase, difficult expiration, harsh wheezes in the upper airways, occasional coughing, and signs of epistaxis. Rhinoscopic imaging of the upper airways was performed (FIGURE A); no sedation was needed.

    1. What is your diagnosis?

    2. What are the immediate treatment options?

    3. What complications may accompany this finding?

    4. What additional diagnostic tests should be performed?

    Answers and Explanations

    1. Rhinoscopic imaging of the upper airways revealed foreign plant material (a stalk of grain) blocking the larynx and the entrance to the trachea (FIGURE B).

    2. Because of the severity of the clinical signs, an emergency tracheotomy should be considered. Foreign material may be surgically removed by a laryngotomy or through either the nasal passages or the mouth using endoscopic guidance. In this case, all the foreign material was removed in stages through the endoscope, using an alligator (FIGURE B) and basket probes. The main stalk was finally removed in one piece.

    3. Inhaled or swallowed foreign bodies are primarily associated with clinical signs of dysphagia or dyspnea. Inhaled foreign bodies usually lead to the development of pneumonia, whereas swallowed material may result in choking or in trauma to the alimentary tract. Foreign material may also (1) penetrate surrounding tissues, causing focal disturbance or injury, or (2) migrate, creating fistulas to other structures (e.g., guttural pouches, ear canals).

    4. Chest radiography and blood work (complete blood count) are important to rule out aspiration pneumonia caused by fragments of plant material. A thorough endoscopic examination of the upper respiratory system, the guttural pouches, and the esophagus is important to rule out the presence of additional foreign particles and to evaluate tissue damage due to foreign material.

    In this case, chest radiography revealed a multifocal alveolar pattern (FIGURE C), leading to a diagnosis of aspiration pneumonia. The filly responded well to antimicrobial therapy (cefquinome), and 2 months after discharge from the hospital, the owner reported that the filly was healthy and had no respiratory abnormalities.

    Suggested Reading

    Chiavaccini L, Hassel DM. Clinical features and prognostic variables in 109 horses with esophageal obstruction (1992–2009). J Vet Intern Med 2010;24:1147-1152.

    Farr AC, Hawkins JF, Baird DK, Moore GE. Wooden, metallic, hair, bone, and plant foreign bodies in horses: 37 cases (1990–2005). J Am Vet Med Assoc 2010;237(10):1173-1179.

    Ferrucci F, Croci C, Zucca E, et al. Use of a transendoscopic technique to remove a bronchial foreign body in a Standardbred colt. Equine Vet Educ 2003;15(5):228-232.

    NEXT: Dental Care for Senior Pets

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