Outcome
Seven days post-operatively the patient developed a temperature of 38.7 *C (101.6 F) and demonstrated dull behavior and inappetence. The remainder of the physical examination did not reveal any other abnormalities. Complete blood cell count demonstrated marked leukopenia of 5.4 109 g/L (reference range, g/L, increased fibrinogen of 6.5 g/L (0.127-0.224 g/L) and Serum Amyloid A (SSA) of 1305mg/L (<0.5 to 20 mg/L). Upper airway endoscopy and thoracic ultrasonography were performed and reveled severe changes associated with bilateral pleuropneumonia. Thoracic drains (Mila Chest Tube with Sharp Trocar Size 12)7 were placed into the right and left thoracic cavity. Nine liters of turbid orange pleural fluid were evacuated form the right hemithorax and 2 liters from the left hemithorax. Fluid collection from the thoracic cavity demonstrated the growth of S. equi subsp zooepidemicus sensitive to Rifampin (5 mg/Kg bwt p.o q. 12 h )8 and Trimethoprim Sulfamethazine (Sulprim 30mg/kg bwt i.m. q. 12 h) 1
Three months recheck upper endoscopy examination demonstrated a small, 1.0 by 0.7 cm area of discoloration, surrounded by a fungal plaque on the ventral aspect of the rostral maxillary sinus mucosa. The plaque was removed, and the area was lavaged. A tissue sample was submitted for histopathology and confirmed the presence of hematoma like tissue. Findings were discussed with the owner and due to the size and the minimal progression of the hematoma, it was decided to recheck the gelding every three months to monitor the evolution of the hematoma. At the six months recheck no noted changes in size and progression from the previous endoscopic examination were noted. At the twelve-month post-operative recheck, upper airway r endoscopy showed anatomical structural reorganization of the right rostral maxillary sinus (Figure 5).The maxillary sinus opening had narrowed after surgery and the sinus mucosa was clear and no signs of progressive growth or hematoma formations was visualized. At the twenty-five-month post-operative recheck, the owner reported that the horse developed a mild episode of epistaxis, for this reason a CT scan was performed which showed a progressive regrowth of the hematoma. The owner reported that the horse is currently in pasture turned out and in good health.