Thoracic trauma and post operative lung injury in a neonatal foal

A 24‐hour‐old Standardbred filly was referred with an acute history of weakness, respiratory distress and subcutaneous emphysema. Radiographic evaluation revealed left sided rib fractures, unilateral pneumothorax and pneumomediastinum. Serial arterial blood gas measurements pre‐ and post rib repair showed pulmonary dysfunction. Post operative radiographs revealed the presence of air bronchograms and a bronchointerstitial pattern, suggestive of alveolar parenchymal pathology consistent with pulmonary contusion, pulmonary oedema or ALI/ARDS. The filly was treated with intranasal oxygen and an active chest draining unit and recovered uneventfully.     

Bronchointerstitial Pneumonia and Respiratory Distress in Young Horses: Clinical, Clinicopathologic, Radiographic, and Pathological Findings in 23 Cases (1984–1989)

Twenty-three foals, between 1 and 7 months old, with signs of acute respiratory distress, were examined at the Veterinary Medical Teaching Hospital (VMTH), University of California, Davis, between 1984 and 1989. Characteristic features included sudden onset of severe respiratory distress and tachypnea, cyanosis unresponsive to nasal oxygen, pyrexia, hypoxemia, hypercapneic respiratory acidosis, poor response to treatment, and histopathologic lesions of bronchiolitis and bronchointerstitial pneumonia. Seven of the 23 foals were normal before the onset of respiratory distress, 3 foals were found dead, aqd 13 foals were being treated for respiratory tract infections at the time of presentation. Laboratory data obtained for 13 horses showed increased plasma fibrinogen concentration (630.7 ±193 mg/dL), leukocy-tosis (18,607 ± 7,784/μL), and neutrophilia (13,737 ± 8,211/μL). Thoracic radiographs showed a diffuse increase in interstitial and bronchointerstitial pulmonary opacity and, in 5 foals, an alveolar pulmonary pattern of increased density was also seen. In 3 foals heavy interstitial infiltration proceeded to a coalescing nodular radiographic appearance. Microbiological culture of tracheobronchial aspirates (TBA) from 9 foals yielded bacterial growth, but no one bacterial species was consistently isolated. Microbiological culture of postmortem specimens of the lung from 6 foals yielded growth of bacteria that included Escherichia coli, Enterobacter spp., Proteus mirabilis, Klebsiella pneumonias, Rhodococcus equi, or β-hemolytic Streptococcus spp. Tracheobronchial aspirates from 4 foals and lung samples collected from a further 4 foals at necropsy yielded no bacterial growth. Cultures were not taken from two foals premortem or postmortem. Virologic examination of TBA, lung tissue, or pooled organ tissue from 12 foals was negative. Viral culture of TBA from 1 foal showed cytopathic effects and positive immunoflu-orescence for equine herpes virus type II (EHV-II). In addition to the 3 foals that were found dead, 11 foals died or were euthanatized. Pathologic lesions were limited to the lungs in 50% of the foals; the remainder also had bowel lesions suggestive of hypoxic injury. The predominant histopathologic pulmonary lesions included bronchiolitis, bronchiolar and alveolar epithelial hyperplasia, and necrosis. Many bronchioles were filled with mucoid and fibrinocellular exudate. The peribronchiolar interstitium and adjacent alveolar spaces were also infiltrated with inflammatory cells and contained proteinaceous edema fluid. Type II cell hyperplasia and hyaline membrane formation were observed in the majority of foals and in 2 foals alveolar multinucleate giant cells were also present. Nine of 13 foals (69%) on which treatment was attempted at the VMTH survived after aggressive medical care that included external thermoregulatory control, oxygen by nasal insufflation, antimicrobial drugs, bronchodilating agents, nonsteroidal anti-inflammatory drugs, and corticosteroids. Persistent radiographic evidence of increased interstitial density was noted up to 24 months after initial presentation, and one horse remained exercise intolerant for at least 15 months after discharge. The exact etiopathogenesis of this disorder and long-term sequalae in the survivors have yet to be fully determined. However, it is likely that a number of different insults rather than a single agent may initiate the pulmonary damage that leads to severe interstitial pneumonia and subsequent acute respiratory distress or apparent sudden death in foals. (Journal of Veterinary Internal Medicine 1993; 7:277–288. Copyright © 1993 by the American College of Veterinary Internal Medicine.)     

IMAGING DIAGNOSIS: ACUTE LUNG INJURY FOLLOWING MASSIVE BEE ENVENOMATION IN A DOG

A 5-year-old neutered male mixed breed dog presented for increased respiratory effort after being stung by over 100 bees and developing anaphylactic shock. Given the history, clinical signs and thoracic radiographic findings of a mild bilateral interstitial pattern, acute lung injury/acute respiratory distress syndrome (ALI/ARDS) was suspected. Further testing was performed to support this diagnosis. On computed tomographic images, there was a diffuse bilateral opacification of the lungs, with preservation of bronchial and vascular margins. Pulmonary function testing indicated decreased pulmonary compliance, decreased diffusion capacity and decreased functional residual capacity. These results supported the diagnosis of ALI/ARDS secondary to bee sting envenomation and development of anaphylactic shock. After 8 days of treatment with oxygen, steroids, antibiotics, and bronchodilators the dog improved. This case demonstrates the usefulness of computed tomography and pulmonary function testing in the diagnosis of ALI/ARDS.     

Acute lung injury and acute respiratory distress syndromes in veterinary medicine: consensus definitions: The Dorothy Russell Havemeyer Working Group on ALI and ARDS in Veterinary Medicine

Background: As veterinary medicine has become more sophisticated, with greater numbers of veterinary patients receiving intensive care, more patients with an acute respiratory distress (ARDS)‐like syndrome have been recognized. Methods: A consensus definition meeting was held for the purpose of developing veterinary‐specific definitions for acute lung injury (ALI) and ARDS. Results/conclusions: Three clinically based definitions for acute lung injury and acute respiratory distress‐like syndromes occurring in veterinary patients were described. Neonatal equine respiratory distress syndrome (NERDS) was defined separately due to the specific requirement for primary developmental surfactant dysfunction and lack of an inflammatory component. Five diagnostic criteria categories were established for Veterinary ALI/ARDS (Vet ALI/ARDS) with 4 required and a fifth highly recommended criteria. A strong consensus was reached that onset of respiratory distress must have been acute and that known risk factors must be present. Additional criteria included evidence of pulmonary capillary leak with no evidence of increased pulmonary capillary pressure, evidence of inefficient gas exchange and, finally, evidence of inflammation. Some features of ALI/ARDS in the neonatal horse were recognized as unique, therefore, equine neonatal ALI/ARDS (EqNALI/EqNARDS) was similarly defined but with a graded gas exchange inefficiency table to allow for normal developmental changes in gas exchange. Use of these definitions in planning prospective studies of these problems in veterinary patients should allow for more direct comparisons of studies and clinical trials, with a larger goal of improving outcome in veterinary patients.     

Respiratory disease in foals and the epizootiology of equine herpesvirus type 2 infection

The epizootiology of equine herpesvirus type 2 (EHV-2) infection was investigated in Thoroughbred foals on a stud farm which in previous years had suffered economic loss due to respiratory disease. Sixteen pairs of foals and their dams were selected for this study and all of the foals became infected with EHV-2 by two to four months of age. These animals responded serologically to the virus infection as detected by an enzyme-linked immunosorbent assay (ELISA). EHV-2 infection persisted in these foals for two to six months with constant or intermittent virus recovery. This persistent infection stimulated continuous production of antibodies against EHV-2. As soon as the antibody levels reached their peak at five to six months, the isolation rate of EHV-2 from the nasal cavity of these animals decreased, and eventually by nine months of age virus could no longer be recovered. Respiratory disease was observed in ten of the 16 foals; and two severely affected animals died at two months of age. EHV-2 was isolated from both foals at ante and/or post mortem examination. It is postulated that EHV-2, either as an initiating agent or by means of immnunosuppression, caused the respiratory disease observed in these foals.     

Rhodococcus equi foal pneumonia: protective effects of immune plasma in experimentally infected foals

The immunoprophylactic capacity of specific immune plasma was evaluated in pony foals infected experimentally with Rhodococcus equi. Immune plasma, produced by repeated parenteral administration of viable R. equi to adult horses, was harvested and frozen. Group I (six control foals) and Group II (six principal foals) received lactated Ringers solution and immune plasma respectively at three and five days of age. R. equi were aerosolised into a caudal lung lobe of all foals at seven days of age. Clinical signs, haematological alterations, immune responses, thoracic radiographs and technetium99m pulmonary perfusion scans were monitored. All foals were destroyed and complete post mortem examinations performed. All foals developed pneumonia as evidenced by clinical, radiographic and perfusion alterations, but the survival rate of principal foals was significantly (P less than 0.01) greater than that of control foals. Five control foals developed terminal disease, whereas all principal foals recovered. There was no significant (P greater than 0.05) difference in temperature response, or peripheral blood leucocyte, neutrophil or fibrinogen concentrations between groups. ELISA values for R. equi antibody were significantly (P less than 0.001) greater in principal foals following treatment, but there was no significant (P greater than 0.05) difference in IgG or IgM concentrations between groups. Results of the haemolysis inhibition assay indicated that equi factor neutralising antibodies were transferred by immune plasma to the principal foals. Post mortem examinations of five control foals destroyed at approximately three weeks post infection because of terminal disease, revealed severe pyogranulomatous pneumonia. One control and all principal foals were either free of lesions or had resolving lesions and/or minimal scar formation at three months post infection.(ABSTRACT TRUNCATED AT 250 WORDS)     

Neonatal respiratory distress syndrome in the calf

Thirty-five calves were delivered by caesarean section near to term. During the operation amniotic fluid was collected for determination of the lecithin/sphingomyelin (L/S) ratio. Clinical examination of the calves and analysis of blood gas concentration (venous blood) were carried out within the first hour of life. Fifteen out of 35 calves under examination did not show clinical or blood gas disorders in the course of the first hour of life. In these calves, the L/S ratio, which represents a measure for the maturity of the surfactant system, averaged 2.6. The other 20 calves, however, developed a respiratory distress syndrome together with a progressive respiratory and metabolic acidosis within the first hour of life. The L/S ratio in the animals affected with respiratory distress syndrome reached an average value of 1.5 which was significantly below that of the calves not suffering from respiratory distress. Eleven of the 20 calves which developed respiratory distress syndrome died within the first 60 hours of life. The most striking findings in the post mortem examinations of these animals were intracranial haemorrhages and pulmonary lesions (hyaline membranes, interstitial and alveolar oedema). On the basis of the significantly lower L/S ratio and the post mortem findings, it is to be assumed that the respiratory distress syndrome in calves, equally with that in infants, is attributable to a surfactant deficiency.     

Risk of adverse effects in pneumonic foals treated with erythromycin versus other antibiotics: 143 cases (1986-1996)

OBJECTIVE: To determine whether foals with pneumonia that were treated with erythromycin, alone or in combination with rifampin or gentamicin, had a higher risk of developing adverse effects, compared with foals treated with trimethoprim-sulfamethoxazole (TMS), penicillin G procaine (PGP), or a combination of TMS and PGP (control foals). DESIGN: Retrospective study. ANIMALS: 143 foals < 240 days old. PROCEDURE: Information on age, sex, breed, primary drug treatment, total days of treatment with the primary drug, and whether the foal developed diarrhea, hyperthermia, or respiratory distress was obtained from the medical records. Relative risk (RR) and attributable risk (AR) were calculated to compare risk of adverse reactions between foals treated with erythromycin and control foals. RESULTS: Only 3 (4.3%) control foals developed diarrhea; none developed hyperthermia or respiratory distress. Foals treated with erythromycin had an 8-fold risk (RR, 8.3) of developing diarrhea, compared with control foals, and increased risks of hyperthermia (AR, 25%) and respiratory distress (AR, 15%). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that use of erythromycin to treat foals with pneumonia was associated with an increased risk of diarrhea, hyperthermia, and respiratory distress, compared with use of TMS or PGP.     

Acute respiratory distress in cattle.

The term "fog fever" was originally used identify a disease of adult cattle grazing lush pastures in the autumn. Unfortunately, the name has subsequently been applied to other respiratory disorders which occurred under different epidemiological circumstances, so that the name "fog fever" has lost much of its original specificity and become almost synonymous with "acute respiratory distress". The pulmonary lesions in 151 cattle, of all ages, with acute respiratory distress are described in this report. While most of the animals were referred as examples of "fog fever", in only 43 of the 151 cases were the clinical signs, epidemiology and post mortem findings consistent with that disease. Twelve other pulmonary disturbances were encountered in the other animals and the pathology of these conditions has bee described.     

Lung Injury Leading to Respiratory Distress Syndrome in Young Dalmatian Dogs

A progressive pulmonary disease resulting in severe respiratory failure and death in an average of 3 weeks was diagnosed in 11 young Dalmatian dogs. The dogs were from 4 litters, all genetically related by a common ancestor. The initial clinical signs were tachypnea and noisy respiration. Respiratory distress developed shortly before death and was characterized by strenuous and rapid respirations, along with cyanosis and vomiting. On blood gas analysis, there were severe arterial hypoxemia, hypercapma, and marked alveolar-arterial oxygen difference. Radiographically, a diffuse pattern of alveolar, interstitial, and peribronchial densities was observed in the lungs. Most dogs developed pneumomediastinum and gastroesophageal intussusception in the terminal phase of the disease. There was no response to treatment with antibiotics, corticosteroids, diuretics, or oxygen. At necropsy, the lungs were wet, heavy, and relatively airless. Absence of 1 kidney in 2 dogs and severe internal hydrocephalus in 2 dogs were additional necropsy findings. Pulmonary histopathology included metaplasia and atypia of the alveolar and bronchiolar epithelium, a nonpurulent inflammatory reaction characterized mainly by mononuclear cells and macrophages, eosinophilic hyaline membrane formation, and focal pulmonary fibrosis. The histological manifestations were typical of acute lung injury. Clinically, the findings were consistent with adult respiratory distress syndrome (ARDS), except for the relatively long course. No known risk factors for ARDS, such as trauma, toxin exposure, infection, or endotoxemia could be identified. The relationship of the other abnormalities (ie, renal aplasia, hydrocephalus) to the pulmonary disease also remains obscure. An inherited defect is suspected, because segregation analysis of the 4 litters suggests autosomal recessive inheritance.     

Right to left patent ductus arteriosus,acute bronchointerstitial pneumonia,pulmonary hypertension and cor pulmonale in a foal

Patent ductus arteriosus (PDA) is a rare congenital cardiac defect in foals causing left to right shunting from the aorta to pulmonary artery. In extremely rare conditions, complications with pulmonary hypertension can result in right to left shunting (Eisenmenger's physiology); however, reversed or right to left shunting has not yet been precisely described in PDA-affected equids. This report describes a unique and unusual case of right to left PDA associated with acute respiratory distress syndrome in a 20-day-old male foal. A holosystolic murmur over the tricuspid valve area and adventitious pulmonary sounds respectively on cardiac and thoracic auscultations, caudodorsally interstitial and bronchointerstitial pulmonary opacities on thoracic radiography, right atrial and ventricular dilatations with paradoxical ventricular septal motion, increased ratio of pulmonary artery internal diameter to the aorta and tricuspid valve regurgitation on echocardiography were detected. Post-mortem and histopathological examinations revealed consolidated, dark red and diffusely enlarged lungs with granular appearance, marked enlargement of the right atrium and ventricle, pulmonary artery thickening and enlargement, patency of the ductus arteriosus, hyaline membrane formation, type II pneumocyte proliferation, hypertrophy and thickening of the pulmonary arteries medial layers and right ventricular myocardial cells distortion and hypertrophy. The findings suggest a right to left shunting through the persistent patency of the ductus arteriosus, pulmonary hypertension and cor pulmonale. We proposed pulmonary hypertension associated with bronchointerstitial pneumonia as a cause of this unusual case of PDA with reversed shunt direction.     

Effect of intranasal oxygen administration on arterial blood gas and acid base parameters in spontaneously delivered, term induced and induced premature foals

The effect of intranasal administration of oxygen at a flow rate of 10 litres per minute for 10 minutes, was studied in a total of 19 foals (thoroughbred and pony) aged between 0.5 and 12 hours. Arterial blood samples were collected before and after oxygen administration for the determination of paO2, paCO2, pHa and base excess. The foals were divided into three groups: five spontaneously delivered thoroughbred and pony foals (group 1), seven term induced thoroughbred foals (group 2) and seven induced premature pony foals (group 3). To examine the effect of duration of oxygen administration on blood gas values, three foals aged five to seven days received intranasal oxygen for 40 minutes and serial arterial blood samples were collected. Significant increases in paO2 values were found in group 1 and group 2 foals in response to intranasal oxygen. When the groups were compared, groups 1 and 2 had significantly higher paO2 values than group 3 foals, whether breathing air or oxygen. The duration of administration of intranasal oxygen had no significant effect on blood gas values.     

Efficacy of a live equine herpesvirus-1 (EHV-1) strain C147 vaccine in foals with maternally-derived antibody: protection against EHV-1 infection

REASONS FOR PERFORMING STUDY: Currently, there is no recommended immunoprophylaxis against febrile respiratory diseases due to equine herpesvirus-1 (EHV-1) and -4 (EHV-4) in horses below age 5-6 months. This is because of interference by maternally-derived antibody (MDA) of vaccines. OBJECTIVE: Unweaned equine foals are an important reservoir of EHV-1 transmission; therefore, we experimentally assessed the efficacy of a live EHV-1 vaccine in foals age 1.4-3.5 months with MDA. METHODS: Following vaccination and challenge, parameters assessed were virus shedding in nasal mucus, leucocyte-associated viraemia, circulating virus neutralising antibody activity and clinical reactions. RESULTS: Controlled challenge showed that a single intranasal dose of the vaccine afforded partial but significant protection against febrile respiratory disease, virus shedding and viraemia due to EHV-1 infection, despite virus-neutralising MDA. CONCLUSIONS AND POTENTIAL RELEVANCE: The prospective vaccine would be a significant step forward in reducing the incidence of the disease caused by EHV-1 infection.     

Acute respiratory distress syndrome in dogs and cats: a review of clinical findings and pathophysiology

Objective: To review the clinical and pathophysiologic aspects of acute respiratory distress syndrome (ARDS) in dogs and cats. Data sources: Data from human and veterinary literature were reviewed through Medline and CAB as well as manual search of references listed in articles pertaining to acute lung injury (ALI)/ARDS. Human data synthesis: Since the term ARDS was first coined in 1967, there has been a abundance of literature pertaining to this devastating syndrome in human medicine. More complete understanding of the complex interactions between inflammatory cells, soluble mediators (e.g., tumor necrosis factor, interleukin (IL)‐6, IL‐8, platelet activating factor) and the clinical patient has provided for timely recognition and mechanistically based protective strategies decreasing morbidity and mortality in human patients with ARDS. Veterinary data synthesis: Although little is known, ARDS is becoming a more commonly recognized sequela in small animals. Initial case reports and retrospective studies have provided basic clinical characterization of ARDS in dogs and cats. Additionally, information from experimental models has expanded our understanding of the inflammatory mechanisms involved. It appears that the inflammatory processes and pathologic changes associated with ARDS are similar in dogs, cats, and humans. Conclusions: Unfortunately, current mortality rates for ARDS in small animals are close to 100%. As our capability to treat patients with advanced life‐threatening disease increases, it is vital that we develop a familiarity with the pathogenesis of ARDS. Understanding the complex inflammatory interactions is essential for determining effective preventative and management strategies as well as designing novel therapies for veterinary patients.     

Presumed immune‐mediated hemolytic anemia in two foals with Rhodococcus equi infection

Objective – To describe the clinical presentation, case management, and outcome in 2 foals with Rhodococcus equi infection associated with presumptive severe immune‐mediated hemolytic anemia. Series Summary – Two foals diagnosed with R. equi pneumonia on the basis of tracheal wash cultures, thoracic radiographs, and thoracic ultrasonography were concurrently diagnosed with hemolytic anemia. Both foals required whole blood transfusions, and were treated with the antimicrobial combination of rifampin and a macrolide (eg, clarithromycin, erythromycin, or azithromycin). Dexamethasone was used to prevent further hemolysis in both foals, and to treat acute lung injury/acute respiratory distress syndrome in 1 of the foals. Both foals survived, and required prolonged antimicrobial therapy. New or Unique Information Provided – Although extra‐pulmonary disorders are commonly diagnosed in foals infected with R. equi, hemolytic anemia is rarely described. Dexamethasone is considered the treatment of choice for immune‐mediated hemolytic anemia, but may be contra‐indicated in foals with severe bacterial infections. In these foals, a relatively low dose and short duration of dexamethasone was utilized in an attempt to minimize immune suppression, although early discontinuation in 1 foal precipitated a second hemolytic crisis.     

Acute respiratory distress syndrome.

Several combination therapies have been described throughout this article: in all likelihood, it is combination therapy that will allow improved survival of ARDS patients. As medicine moves into the future, clinical trials evaluating the efficacy of therapies for ARDS will be performed. In human critical care medicine, a large forward step was taken when ALI and ARDS were clearly defined. Unfortunately. as good as the definition is, ALI and ARDS occur secondary to many different underlying pathologic processes,perhaps obscuring the benefits of certain therapies for ARDS based on the underlying condition, for example, trauma versus sepsis. Selection of patients entering any ARDS trial is crucial: not only must those patients meet the strict definition of ARDS but the underlying disease process should be clearly identified. Identification of patients suffering from different disease processes before the onset of ARDS will allow for stratification of outcomes according to the intervention and the underlying pathology--comparing apples to apples and not to oranges. We are in a unique position in veterinary medicine. Although frequently financially limited by our clients, we have the opportunity to achieve several goals. First, we need to clearly define what constitutes ALI and ARDS in veterinary medicine. Do we want to rely on the human definitions? Probably not; however, as a group, we need to determine what we will accept as definitions. For example, we may not be able perform right heart catheterizations on all our patients to meet the wedge pressure requirement of human beings of less than 18 mm Hg. Do we agree that a PAOP of less than 18 mmHg is appropriate for animals, and is it appropriate for all animals? Will we accept another measure, for example, pulmonary artery diameter increases with echocardiographic evidence of acceptable left heart function? What is acceptable left heart function? As veterinarians, what do we consider to be hypoxemia? Is it the same in all species that we work with? What do we define as acute onset? Most human ARDS cases occur while patients are in hospital being treated for other problems, whereas many of our patients present already in respiratory distress. If we are unable to ventilate patients for economic or practical reasons, what do we use as the equivalent of the Pao2/Flo, ratio'? Reliance on the pathologist is not reasonable, because many disease processes can look similar to ARDS under the microscope. If anything, ALI and ARDS are clinical diagnoses. It is time for veterinarians to reach a consensus on the definition for ALI and ARDS in our patients.Only when we have a consensus of definition can rational prospective clinical trials of therapies be designed.     

Natural infection with Dictyocaulus arnfieldi in pony and donkey foals

From June to October 1978 four pony mares and foals and two donkey mares and foals grazed a paddock contaminated with Dictyocaulus arnfieldi larvae. No signs of respiratory disease were seen in the foals but within 11 weeks of exposure to the paddock all six developed patent lungworm infections. In October 1978 one donkey and two pony foals were killed. At post mortem examination parasites in various stages of development and measuring up to 8 cm in length were found in the lungs. At this time the three surviving foals were stabled for the remainder of the experiment. Two of these ceased passing D arnfieldi larvae during the winter months but in one pony foal patency persisted until the study ended in August 1979. Patent lungworm infections were not seen in the pony mares, although two started to cough four to six weeks after starting to graze the infected paddock. One of the affected mares was killed in October 1978 when seven small (less than 7 mm) D arnfieldi were recovered. The other continued to cough until the end of the study over a year later.     

Equine laryngeal dysplasia as a cause of acute respiratory distress in a neonatal foal

Equine laryngeal dysplasia (ELD) is a congenital disorder caused by hypoplasia or aplasia of the structures derived from the fourth and possibly sixth branchial arches. The severity of the clinical signs varies widely, and depends on which structures are involved and the extent of the defect. In most cases, affected horses present with abnormal respiratory noise during exercise and poor performance. Manifestation of the disease in foals is very rare. This case report describes an unusual presentation of ELD in a neonatal foal. The foal presented with severe respiratory distress and weakness. Equine laryngeal dysplasia was suspected on endoscopy and later confirmed on post mortem examination of the larynx. To the best of our knowledge, this is the first report describing ELD as a cause of respiratory distress in a neonatal foal.     

THORACIC RADIOGRAPHY IN THE NEONATAL FOAL: A PRELIMINARY REPORT

Thoracic radiographs from 22 neonatal foals were reviewed to investigate the radiographic appearance of the thorax in normal, immature, and septicemic foals, and in foals with neonatal respiratory distress syndrome. The size and radiographic appearance of intrathoracic structures and abnormal lung opacities were evaluated. The craniocaudal and apicobasilar dimensions of the heart were 5.6–6.3 and 6.7–7.8 times the length of a midthoracic vetebral body, respectively, in normal, immature and septicemic foals. Apicobasilar measurements were greater (8.0–8.7) in the foals with respiratory distress syndrome. Normal foals had clear lung fields within 12 hours of birth. A more marked interstitial pattern was observed in immature and septicemic foals compared to normals. Diffuse air–space (alveolar) pattern with air bronchograms was seen in foals with respiratory distress syndrome. It was concluded from this series that thoracic radiographs taken 24–48 hours after birth may aid differentiation of normal foals, septicemic or immature foals, and foals with respiratory distress syndrome.