Weeks 4-5 Cleveland Equine

I have been quite busy here in Ohio.  We have had a few colics come through the clinic, and have been busy going to different farms and the race track.  I was able to accompany Dr.Berthold to Thistledown's track.  It was a great experience to see behind the scenes and assess some lamenesses.  I was able to shoot hock radiographs of one of the horses.  Each time we review radiographs I pick up on one more subtlety I didn't previously see. The case load and volume of radiographs that I have had a chance to view has helped me immensely in being able to determine different abnormalities.

One very interesting case that came into the clinic was a 3 year old Thoroughbred gelding.  He was presented to us with a 30 day history of pleural pneumonia.  He was being treated off and on with antibiotics--compounded chloramphenicol, but was not improving.

We ultrasounded his lungs, and found consolidation, fluid, and fibrin.  

Cranial is to the left of the US, and Caudal to the right. The hyperechoic triangular portion on the left of the image is the tip of the left lung. Fluid surrounds it, with clumps of fibrin along the diaphragm.  The liver can be seen as the hypoechoic wedge on the right of the image.

He was hospitalized in our ICU, and a bilateral thoracentesis was performed. Approximately 2-3 gallons of pleural fluid was drained off. The tubes were sutured and bandaged in place to allow for further drainage at later times during his stay.  A three way stop-cock was placed at the ends of the tubes to close them, in order to prevent a pneumothorax.
He was also being treated with systemic antibiotics until culture and sensitivity results were obtained based on the pleural fluid.  Upon admission blood work was also done on him.  His Serum Amyloid A (SAA) was very high, this is an acute phase protein that indicates inflammation- it has a shorter half life than fibrin and can therefore be monitored daily to see if any improvements are being made. Globulins were high (antibodies trying to fight infection). Albumin was low (because it is leaking out of the vasculature into pleural space). Slight decrease in hematocrit (anemia of chronic infection), and also decreased lymphocytes (due to infection).  
Unfortunately after about a 48 hour stay he began to deteriorate quickly.  His breathing became extremely labored, and his mucus membranes began to look toxic.  Another ultrasound was done at this time and portions of the lung were not moving at all.  At that time the owner made the decision to euthanize.  A basic necropsy of his chest cavity was done, and it was found that portions of his lung lobes had formed adhesions to the thorax wall, and other portions showed signs of necrosis.
As a part of my time at CEC I check on our inpatients, after only a couple of nights this horse became a favorite. It was sad to see him go, but harder to watch him suffer. I am glad to have been able to learn from his case and help as I could.

-Roya Oliai