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.