Diagnosis
Upper airway endoscopy revealed a severe narrowing of the right nasal
passage, dynamic nasal collapse observed in the left nostril and mild to
moderate thick dark sanguineous discharge was also noted. Computer
tomography (CT) was performed under general anesthesia. The gelding was
sedated with xylazine (Xylazil 100 0.5 mg/kg bwt
i.v.)1 and Butorphanol (Butorgesic 0.1 mg/kg bwt
i.v.)1. General anesthesia was induced with ketamine
(Ketamil 2.2 mg/kg bwt i.v.)1 and midazolam (Midazolam
Alphafarma 0.05 mg/kg bwt i.v.)2 and maintained on
isoflurane (Isorane)3 and medical oxygen delivered
through a circle breathing system. The examination disclosed a large
infiltrative, heterogeneous, and partially hyperattenuating,
non-contrast enhancing mass extending throughout most of the right
paranasal sinuses (Figure 1 and 2).
The mass was effacing the right
ethmoid turbinate and was expansile caudally, impinging upon the axial
margin of the right orbit. The mass extended dorsally into the rostral
aspect of the right frontal sinus and caudoventrally into the rostral
aspect of the right sphenopalatine sinus and was causing moderate
leftward displacement of the nasal septum with subsequent collapse of
the left nasal passages. There was complete obliteration of the right
infraorbital canal and nasolacrimal duct at the level of the mass. A
lobular soft tissue attenuating structure is present throughout the left
sphenopalatine sinus. An emergency tracheostomy was performed during
recovery from general anesthesia. A metal 22 mm diameter tracheostomy
tube was placed and remained in position until the surgical procedure
was completed.