This week has involved some very interesting cases! A pony
has been in the ICU for four days with a hemothorax. She presented with a fever
of four days duration, and we drained frank blood from both sides of her chest
and ran it through the CBC. A thoracic ultrasound revealed large amounts of
fluid in the chest and what appeared to be large, thickened vessels. The
decision was made not to place chest tubes, as she was likely actively bleeding
into her chest, and a more in-depth ultrasound was performed the next morning.
The diaphragm was thickened and there appeared to be an abnormal mass very near
the heart, supporting the clinicians’ suspicions of a possible hemangiosarcoma.
Diaphragmatic hernia was also suspected, but no evidence of a diaphragm tear or
abdominal organs in the thorax was noted on the ultrasound. Thoracic
radiographs were also taken but provided little additional information because
of all the fluid blocking detail.
The pony’s heart and respiration rates were consistently
high, but did decrease to near normal after the first night when she received
coagulant drugs that the vets normally used for EIPH horses on the racetrack.
At this point the owners have given permission to euthanize when ready, but as
long as she remains stable we are waiting. Beginning today (day 4) we have
noted that she has become polyuric polydipsic, but continues to have a strong
appetite.
Another emergency, this time treated on the farm, was a
fractured sinus. The horse either hit its head or was kicked while in the
pasture and had a wound between the eyes and a steady, bilateral nose bleed.
Due to extensive swelling, an endoscopic exam was not performed, as significant
results would have likely been obscured by blood and edema. Radiographs revealed
a depression fracture. While it could be surgically repaired, the fracture did
not appear to impede breathing, and the owners opted to let the fracture heal
on it own, pending any significant changes in the horse’s mentation or ability
to breath. Dexamethasone, bute, banamine and DMSO were all given to reduce
swelling that was near the brain along with vasoconstrictors and
pro-coagulants.
One of the weeks most satisfying calls was a “lump check.”
The owners had recently moved from California and wanted to establish a
relationship with a vet and also have us check a 5 year old lump behind the
point of the elbow that had recently tripled in size. The vet did not recommend
removing it because it was not currently painful or impeding movement (it was about
the size of a golf ball) and the location would require suturing in an area of
high tension. The cytology sample was chunky looking, not oily like would
expect from a lipoma. The cytology results plus a soft spot lead to an
ultrasounded of the lump under the suspicion that it could be an abscess.
Although the ultrasound did not show fluid the doctor decided to puncture the
soft spot with a needle and sure enough it was an abscess! The discharge was
old pus that had been walled off. Because there was such a thick capsule, the
drained sac was flushed with saline and betadine to keep it open until the
owner returned from a vacation the were leaving for and could necrose the
capsule by flushing with formalin.
This weekend I have been giving treatments via a subpalpebral
lavage that was placed Saturday afternoon. The horse has a corneal ulcer which
is at risk of melting. We are waiting to hear back on culture results, but
started treatments of ofloxacin, cefazolin and serum on day 1 and added IV banamine and acetylcysteine today.
Those were my favorite cases of the week; the variety of
cases that I have gotten to see is great!
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