Littleton Equine Week 8

This week was a hot one here in CO! On Tuesday, I observed a pleuropneumonia work-up. A 6 y.o Thoroughbred presented for evaluation of pneumonia, previously diagnosed by a referring veterinarian. She was raced in TX approximately a week prior to presentation. She was quiet, tachypnic, and tachycardic on presentation. She had decreased lung sounds with occasional crackles and wheezes. After ultrasound demonstrated significant fluid in the pleural space, it was determined that a chest tube should be placed to drain off the fluid, and that it would remain until it stopped draining. Six liters of serosanguinous fluid drained from the pleural space at the time of tube placement. In some cases, you would worry about having hit an artery when you see blood in the draining fluid, but fluid from an artery would be frank and would clot, where the fluid draining was not and it did not clot. The mare had concerning hyperechoic spots showing up on ultrasound, which could be small abscesses. The tube was placed on the left but the fluid was ultrasonographically determined to be decreasing on the right side as well. A transtracheal wash was performed as well. Fluid from the chest tube and from the transtracheal wash. Culture grew a Strep and Klebsiella (resistant to most things). This case demonstrated the importance of performing a transtracheal wash because the pleural fluid only grew the Strep, where the wash culture grew Klebsiella and Strep. Klebsiella is associated with hemorrhagic pneumonia, explaining the serosanguinous fluid, and a poor prognosis in adult horses. This Klebsiella was only resistant to Chloramphenicol and Amikacin. Her prognosis is very poor as ultrasound is now demonstrating a large abscess in the thoracic cavity. She was placed in ICU for monitoring and to begin her course of antibiotics. After some discussion with the HR/PR team, I've had a few photos approved to share! Below is the chest tube and the fluid drained. (The foam is formed by proteins.) It's fairly common for racehorses to develop pneumonia, due to the nature of racing. These equine athletes are likely to inhale a fair amount of dirt and dust when they run due to the dirt and dust kicked up by any horse running in front and the need for their airways to be as open as possible while racing. 

 

I spent the majority of my day Wednesday in radiology, helping with my first bone scan! It took a number of hours, but it was interesting to see nuclear scintigraphy in action. I pulled my first catheter when we were done!

Thursday and Friday I spent time at the Colorado Horse Park with Dr. Pearson and Dr. Tisher. We had a few clients need shockwave therapy and some that needed joint injections. I jogged for a few lamenesses and a pre-purchase exam. We had one horse come in that landed a little funny after a jump and tore its deep digital flexor tendon. The photo demonstrates the lesion visualized on ultrasound.

On Friday, we saw two colic cases immediately after arriving to the horse park. One was sent directly to the clinic after we worked it up. It was soon thereafter sent to surgery, and is now recovering in ICU. When we work up a horse for colic, we take vital signs, listen to borborygmi, pass a nasogastric tube to check for reflux, and do a rectal exam. In this particular case, Dr. Tisher decided that a trip to the clinic would be necessary after completing the rectal exam. He felt tight bands and gas distension, and suspected there was a nephrosplenic entrapment. In surgery, it was confirmed that there was, in fact a nephrosplenic entrapment.

To wrap up, I'll leave you with a quote that I've heard before, but have found so much truth in during my time here at Littleton: "More is missed by not looking than not knowing."