A Large Frontonasal Bone Flap for Sinus Surgery in the Horse

A large frontonasal bone flap was created to treat diseases of the paranasal sinuses in 14 horses. The bone flap was made as wide as possible within the confines of the nasolacrimal duct so the floor of the frontal sinus and the dorsal and ventral conchae could be opened. These openings exposed the nasal passages, maxillary sinuses, and ventral conchal sinus thereby facilitating removal of diffuse and localized lesions from these sites. Diseases treated were ethmoid hematomas (4 horses), sinus cysts (5 horses), cryptococcal granuloma, osteoma, hemangiosarcoma, pus in the ventral conchal sinus, and periapical infection of a second molar. Four horses were euthanatized during or after surgery, one because of postsurgical pleuritis and pneumonia (horse with osteoma) and three because of their primary problems (cryptococcal granuloma, hemangiosarcoma, pus in the ventral conchal sinus). Skin suture abscesses that responded to treatment developed in four horses. Ten horses returned to their intended uses, the sinus flaps healed without blemish, and the original problems did not recur. The frontonasal flap technique provided greater access to all paranasal sinuses than methods described previously.     

Sperm granuloma in a stallion

A 7-year-old stallion with a history of abdominal pain after it fell was examined and found to have a swelling of the right testis and epididymis. Semen evaluation revealed an increase in secondary sperm abnormalities. The stallion was unilaterally castrated. The histologic diagnosis was sperm granuloma, with no evidence of infection. Periductal fibrosis was observed and appeared to have developed before the trauma occurred. The changes seen could be compatible with chronic blockade of efferent ductules, resulting in extravasation of spermatozoa.     

Bovine nasal granuloma: nasal eosinophilia

SUMMARY A prospective study of nasal eosinophil counts was made in Jersey and Friesian dairy cattle at Leongatha, and of Hereford, Aberdeen Angus and Shorthorn cattle at Kilmore, Victoria. Mean nasal eosinophil counts in subgroups of cattle were found to correlate with the known susceptability, of Jerseys and Friesians to develop bovine nasal granuloma, and to reflect the known seasonal activity of the disease, thus confirming the validity of nasal eosinophil counts as an index of clinical activity of nasal granuloma. Peaks in mean nasal eosinophil counts in cattle which developed lesions of bovine nasal granuloma during study correlated with periods of warm moist environmental conditions. This finding suggests microbial spores may be the allergen(s) in bovine nasal granuloma, and indicates that the allergen(s) might be identified by simultaneously monitoring the pasture particle content and assessing nasal eosinophilia in cattle with the disease. The detection of nasal eosinophila in some cattle by 6 to 9 months of age also suggests early sensitisation to allergen(s); if the allergen(s) were identified they might be used to detect cattle prone to nasal granuloma at this early age. Early detection of predisposed animals would open the possibility of control of the disease by genetic selection.     

ECHOCARDIOGRAPHIC DETECTION OF A DISSECTING AORTIC ROOT ANEURYSM IN A THOROUGHBRED STALLION

A 12-year-old Thoroughbred stallion was referred with a history of acute pain and tachycardia immediately after breeding a mare. On presentation, the horse showed no evidence of pain and routine examination of the abdomen failed to yield any abnormalities, however, a persistent tachycardia remained. A base-apex ECG examination revealed sustained ventricular tachycardia which resolved spontaneously within 12 hours of hospitalization. During this period, the stallion developed a grade 4/6 heart murmur. An aortic root aneurysm in the right sinus of Valsalva was diagnosed using two-dimensional echocardiography. Pulsed-wave Doppler evaluation revealed turbulent flow within the aneurysm. Repeat echocardiographic examination 10 months after the onset of signs revealed no change and the horse continues to perform as a breeding stallion.     

Chylothorax associated with cryptococcal mediastinal granuloma in a cat

A 10-year-old neutered female cat had chylothorax, precaval syndrome, and a mediastinal granuloma resulting from infection with Cryptococcus neoformans. Diagnosis of a chylous effusion was made by cytologic examination of pleural fluid and by finding higher triglyceride levels in the effusion than in serum (825 vs. 64 mg/dl, respectively). Postmortem examination revealed cryptococcal organisms in the mediastinal granuloma, lungs, cerebral meninges, and connective tissues adjacent to the thyroid gland. Chylous effusion in a cat associated with cryptococcosis has not been reported previously. Cryptococcosis should be included in the differential diagnosis in chylous effusions in cats.     

Identification of degenerative germ cells in semen from a quarter horse stallion

A 3-year-old Quarter Horse stallion was presented for evaluation of potential fertility. An impairment in spermatogenesis was suspected as the stallion produced semen with reduced percentages of progressively motile and morphologically normal spermatozoa. In addition, when semen was collected daily from the stallion, daily spermatozoal output (DSO) was found to be below normal. Semen from this stallion also contained spherical cells of unknown origin. The following report describes the identification of these cells as degenerating spermatids by the use of light and electron microscopy.     

Severe cryptococcal granulomas of the nasopharynx in a horse treated with standing endoscopic laser surgery and oral fluconazole

An Arabian mare was referred due to a 4-month history of bilateral mucopurulent nasal discharge, which was unresponsive to multiple courses of antimicrobials and intravenous sodium iodide. Digital radiographs revealed multiple variably sized nodular opacities within the nasopharynx. Upper airway endoscopy showed multiple, ulcerated granulomatous masses originating from the walls of the nasopharynx. Repeat culture of the exudate and from endoscopic biopsies grew only a mixed bacterial population. Standing endoscopic guided laser excision of two granulomas was performed and histopathology and culture from the center of a surgically excised granuloma identified Cryptococcus terrestris. Treatment with fluconazole (14 mg/kg bwt per os once then 5 mg/kg bwt per os q. 12 h) was administered for a total of 11 weeks. Follow-up endoscopic examination was used to guide therapy duration, and the horse has since returned to competition and remained free of infection for >1.5 years. Establishing a diagnosis of cryptococcal infection was difficult in this horse despite multiple culture attempts. This is the first report of Cryptococcus terrestris infection in a horse and treatment with oral fluconazole after surgical de-bulking was successful.     

Cranial vena cava syndrome secondary to cryptococcal mediastinal granuloma in a cat

The successful management of cranial vena cava syndrome with suspected secondary chylothorax due to mediastinal cryptococcal granuloma in a 4-year-old male domestic shorthair cat is described. Treatment included long-term antifungal medication, short-term corticosteroids, intermittent thoracocentesis, rutin, octreotide, and enalapril.     

Bovine nasal eosinophilic, granuloma with blood eosinophilia caused by Nocardia species.

OBJECTIVE: To describe a case of nocardial nasal granuloma in a Holstein heifer. CLINICAL FEATURES: The heifer showed laboured respiration and occasional coughing with granulomatous excrescences on the bilateral nasal mucosa, and a marked leucocytosis with eosinophilia. NECROPSY: Severe granulomatous inflammation with eosinophils, epithelioid cells, giant cells and Nocardia sp obstructed both nasal passages completely. CONCLUSION: This lesion resulted from chronic infection with Nocardia sp and is distinct from other forms of bovine nasal granuloma, also called atopic rhinitis or chronic granular rhinitis, which we propose should be classified as bovine allergic granular rhinitis. The most appropriate name for the present disease is bovine nasal eosinophilic granuloma.     

Disseminated cryptococcosis including osteomyelitis in a horse

A 4-year-old Arab mare was diagnosed with disseminated cryptococcosis, including osteomyelitis of the proximal phalanx of the left hind limb, osteomyelitis with associated soft tissue granuloma of a rib and disseminated, large cryptococcal nodules in the lungs. The lesion in the dorsoproximal aspect of the proximal phalanx had a large area of cortical lysis with spiculated periosteal new bone and extensive soft tissue swelling. The affected rib had a pathological fracture. Cryptococcal osteomyelitis has not been previously reported in horses but should be considered as a differential diagnosis, particularly in endemic regions.     

BACTERIAL ENDOCARDITIS WITH THROMBUS FORMATION AND ABSCESSATION IN A HORSE

A 2.5 year old Appaloosa stallion with progressive weight loss and a heart murmur was diagnosed as having vegetative endocarditis of the right atrioventricular valves with a mass in the right atrium. The ultrasonographic appearance of the lesion was characterized by extreme reverberation. On postmortem examination, a 9 cm diameter thrombus was found within the right atrium and auricle, occupying approximately 80% of the chamber volume. Additionally, a lenticular abscess extended throughout the parietal cusp of the right atrioventricular valve. Histologic examination revealed that the lesions were septic with numerous gram positive cocci in short chains, suggestive of Streptococcus equi , and gram negative rods.     

Successful treatment of invasive nasal cryptococcosis in a ferret

Invasive cryptococcal rhinitis due to Cryptococcus neoformans var gattii was diagnosed in a castrated, 5-year-old, albino ferret with subcutaneous swelling of the nasal bridge. The diagnosis was based on histology, needle aspirate cytology and positive culture on Sabouraud's dextrose agar and birdseed agar. The ferret was successfully treated using a long course of itraconazole (25 to 33 mg orally once daily with food) subsequent to surgical debulking of the lesion, using sequential cryptococcal antigen titre determinations to guide therapy.     

Extensive and invasive guttural pouch granuloma in a 2-year-old gelding

This report describes a case of an unusually extensive and invasive fungal granuloma within the right guttural pouch and its surrounding area of a 2-year-old Noriker gelding, causing diverse neurogenic deficits and tissue destruction. The gelding was initially presented with cachexia, unilateral nasal discharge, intermittent fever, swelling of the right side of the head, facial nerve paralysis and dysphagia. The right guttural pouch was not accessible to endoscopic examination initially, but after anti-inflammatory medical management, empyema and an extensive, solid mass appeared within the guttural pouch. Surgical exploration and excision were attempted but were unsuccessful. Histopathological examination identified Aspergillus fumigatus as the causative infective agent of the extensive fungal granuloma, and the consequent invasion and destruction of surrounding bone and soft tissue structures.     

Triangulated Flap Technique for Nasofrontal Surgery Results in Five Horses

A modified bone-flap technique was used to expose space occupying lesions that involved the conchofrontal sinus, ethmoturbinates, and caudal nasal cavity in five horses. The most common clinical findings were chronic nasal discharge and upper airway obstruction. Surgical intervention was based on endoscopic and radiographic interpretation. The triangulated bone-flap technique increased surgical exposure to the conchofrontal sinus by almost twice the area observed in previously described surgical techniques. The major advantages were that this technique allowed excellent visualization, thorough palpation, and surgical manipulation within the sinus and associated structures. Complications were minimal. One horse was euthanized 1 month postoperatively with recurrence and spread of a mycotic granuloma. The technique extended the usefulness of the other four horses in a 9 to 24 month follow-up period, although the obstructing lesion recurred after 2 years in one of the four horses.     

Use of manual stimulation for collection of semen from an atactic stallion unable to mount

A 9-year-old atactic breeding stallion was trained to ejaculate, with only manual stimulation, while standing on the ground. Ejaculates obtained yielded fertile semen with morphologic and motility characteristics within the range for normal stallions. This method extended the breeding life of a stallion unable to mount a live or dummy mare or to ejaculate into an artificial vagina while standing on the ground.     

Isolation of equine coital exanthema virus (equine herpesvirus 3) from the nostril of a foal

The virus causing equine coital exanthema (equine herpesvirus 3) was isolated from a lesion on the nostril of a 2-month-old foal. One week after the mare had returned from a stallion station, vesicular lesions developed on her vulva. They were diagnosed clinically as coital exanthema, and 5 days later a lesion developed on the nostril of her foal. This case is an example of horse-to-horse transmission of coital exanthema virus without coitus. A laboratory diagnosis is necessary to differentiate viruses that cause vesicular lesions about the oral and nasal cavities of horses.     

Cryptococcosis in seven horses

The clinical, radiographic and post-mortem findings in 6 horses with cryptococcal pneumonia and one horse with an abdominal cryptococcal granuloma are described. In pulmonary cryptococcosis, the lesions were either diffuse and multiple, with bilateral lung involvement, or localised mainly to the dorsocaudal region of one lung. The cases of diffuse multiple cryptococcosis were thought to be associated with haematogenous spread of the fungus after gastrointestinal infection and dissemination from regional lymph nodes. The localised form of the disease was thought to have been associated with inhalation of cryptococci. In all cases of pulmonary cryptococcosis, encapsulated yeast-like organisms were demonstrated in Wright's-stained sediment of tracheal washes. In the horse with the abdominal granuloma, cryptococci were present in a fine needle aspirate sample. Isolates of Cryptococcus neoformans var gattii were recovered from 2 of the 5 horses in which cultures were attempted. In addition to a history of previous illness that may have predisposed to infection, most horses in this report had been in areas in which Eucalyptus camaldulensis, or the closely related E rudis, were growing. In humans, an epidemiological relationship between E camaldulensis and infection with C neoformans var gattii has been suggested. Cases of equine cryptococcosis carry a poor prognosis and treatment was not attempted in any of these cases.