Percutaneous retrieval of a jugular catheter fragment from the pulmonary artery of a foal

A 49-kg (107.8-lb) sexually intact male Arabian foal was evaluated at 3 days of age because of profuse watery diarrhea, anorexia, and signs of abdominal pain. Physical examination findings were unremarkable except for evidence of diarrhea. A catheter was placed in the right jugular vein for administration of antimicrobials and lactated Ringer's solution. The foal was discharged with instructions to the owner to continue antimicrobial administration and fluid therapy; at home, the owner inadvertently cut the catheter at the level of the hub during attempted removal, and the catheter fragment migrated distally in the jugular vein and subsequently lodged in the pulmonary artery. The foal was readmitted to the hospital for retrieval of the fragment, using a percutaneous retrieval technique. Catheter fragmentation is a well-recognized risk of catheterization in horses. Catheter fragments can be retrieved somewhat easily from the jugular vein; however, if the fragment migrates to the heart or pulmonary artery, imaging the fragment to locate and retrieve it can be difficult. Complications associated with catheter fragmentation include septicemia, endocarditis, lung abscesses, pulmonary embolism, dysrhythmias, cardiac perforation, pulmonary or caval thrombosis, and death. To our knowledge, this is the first report of successful retrieval of a catheter fragment from the pulmonary artery in a horse.     

An unusual pulmonary embolism after a fatal traumatic missile injury

Extract

While embolism following detachment of thrombi in veins of the pelvis and legs is not unusual. particularly in human medicine, other tissue and foreign body emboli in the lungs are much less common. Pulmonary embolism in man, for example. has been caused by the release of fat from traumatic injury sites, amniotic fluid into the maternal circulation following strong uterine contractions. air during intravenous fluid therapy. bone marrow after skeletal trauma, brain after severe head injury, liver following hepatic trauma or severe parenchymal necrosis. trophoblastic tissue during pregnancy, atheromatous material from severe arteriosclerosis, tumour metastases. cotton wool fibres by insertion of a needle into a vein and also. rarely. by vascular embolisation of a bullet(1)(2). In animals, pulmonary emboli are essentially derived from either thrombi, neoplasms or fat(3). Although skeletal muscle emboli have been experimentally induced in pulmonary arteries by parenteral injection of muscle tissue(4), this form of pulmonary embolism in clinical material has apparently not been described. This paper reports the finding of multiple skeletal muscle emboli in the lungs of a kangaroo after a fatal gunshot wound to the chest.     

A case of interstitial pneumonia associated with Pneumocystis carinii in a foal

Subacute interstitial pneumonia with diffuse alveolar damage, marked macrophage infiltration, and intracellular Pneumocystis carinii cysts is described in a 3-month-old Swiss warmblood foal. Clinically, the disease was characterized by sudden onset of respiratory distress with fatal outcome. Based on serum immunoglobulin G (IgG), IgA, and IgM values, no humoral immunosuppression was detected. Spleen, thymus, and bronchial lymph nodes did not reveal lymphoid depletion, as assessed by immunohistochemical staining of CD-3-positive cells. Immunopathogenesis of pulmonary infections with intracellular agents in foals is discussed.     

Use of Renal Replacement Therapy in a Neonatal Foal with Postresuscitation Acute Renal Failure

A newborn foal was presented because it was unresponsive and in cardiopulmonary arrest. Aggressive cardiopulmonary cerebral resuscitation was administered to the foal, which revived the foal; however, acute renal failure developed. Fluid retention and azotemia occurred although the foal was alert and able to suckle. A 6‐hour renal replacement therapy session using hemodiafiltration and a continuous renal replacement therapy machine was administered to the foal at 3 days of age which lowered the foal's azotemia and facilitated removal of some of the excess body fluid. Despite therapy, the foal developed pulmonary edema and was euthanized. Although the foal in this case did not survive, this report highlights the possibility of developing postresuscitation complications such as acute renal failure and describes the use of renal replacement therapy using hemodiafiltration as a viable option in neonatal foals with acute kidney injury.     

Clinical Leptospira interrogans serogroup Australis serovar lora infection in a stud farm in The Netherlands

A Leptospira interrogans serogroup australis serovar lora infection in a stud farm is reported. During three successive years (1984-1986) clinical leptospirosis with a severe often rapid, fatal course was seen in 12 foals. Clinical examination revealed severe respiratory distress, depression and pyrexia. Other symptoms were diarrhea (2), jaundice (1), and an unsteady gait (1). Morphological characteristics of the disease were massive pulmonary haemorrhage and haemorrhagic-thrombotic or extracapillary glomerulonephritis with tubulonephrosis and interstitial oedema. In most foals high or increasing MAT titres to serovar bratislava were found; from one foal Leptospira interrogans serovar lora was isolated. Serological examination of all 56 mares at the farm (August 1986) revealed antibodies to serovar bratislava in 64 per cent of the animals. These findings support the idea that Leptospira interrogans serovar bratislava and closely related strains (in this study serovar lora) may be adapted to and maintained by the horse population.     

Verminous arteritis in a 3-month-old thoroughbred foal

Strongylus vulgaris migration and cranial mesenteric arterial thrombus formation resulted in fatal colic in a 3-month-old Thoroughbred foal. Vascular damage associated with S. vulgaris occurs early in the course of infection and, despite widespread use of broad-spectrum anthelmintics, appropriate management is still essential to minimize exposure of young animals to this parasite.     

Tricuspid atresia in a foal

An Arabian crossbred foal was examined because of a suspected congenital cardiac anomaly. There was a grade V/V crescendo-decresendo holosystolic murmur and thrill in the left 4th intercostal space. The foal was slightly cyanotic and polycythemic. Electrocardiography suggested left ventricular hypertrophy. Angiography and cardiac and vascular pressure recordings led to a diagnosis of pulmonic stenosis. The foal died after cardiac bypass and corrective surgery. Postmortem examination revealed an enlarged right atrium, atresia of the tricuspid orifice, a large, fenestrated patent foramen ovale, eccentric left ventricular hypertrophy, and a large interventricular septal defect. The right ventricle had a small lumen and a relatively thick wall. There was valvular and supravalvular pulmonic stenosis, with poststenotic dilatation of the pulmonary artery. A single coronary artery originated from the anterior sinus of the aorta.     

Pulmonary embolism and cor pulmonale in a cat

A 14-year-old male neutered cat experienced pulmonary embolism 15 days following surgical debridement of a recurrent dorsolumbar abscess. Clinical signs were dominated by respiratory distress. Pulmonary embolism was suggested from the lateral thoracic radiograph by the presence of an abruptly attenuated lobar artery and a contiguous oligaemic area in the caudal lung lobe. Pulmonary hypertension was demonstrated on Doppler echocardiography by right pulmonary artery dilation and tricuspid regurgitation raising the pulmonary arterial pressure to 56 mmHg. Chronic pulmonary hypertension, assumed from right ventricular wall hypertrophy, and hypokinesia, indicating chronic cor pulmonale, was suggestive of chronic rather than acute pulmonary embolism. Postmortem histological evidence of pulmonary arteriolar occlusion confirmed the diagnosis of pulmonary embolism.     

Kernicterus in a neonatal foal.

A 5-day-old Thoroughbred foal was submitted to the necropsy service at the University of Kentucky Livestock Disease Diagnostic Center. The foal had a clinical history of seizure activity and severe icterus. A complete blood count and serum chemistry analysis indicated that the foal was anemic (hematocrit, 16%), hyperbilirubinemic (45 mg/dl), and hypoglycemic. At necropsy, all tissues were discolored various shades of yellow. Microscopically, there was degeneration and necrosis of cerebral neurons and cerebellar Purkinje cells; severe hepatocellular degeneration and necrosis; and deposition of amorphous golden-yellow material in the cerebellar granular cell layer, pulmonary alveoli, renal tubular epithelium, splenic trabecula, and the lamina propria of the small and large intestine. The golden-yellow material in the brain, lung, spleen, and small intestine was identified as bilirubin by histochemistry. Based on the macroscopic and microscopic findings, a diagnosis of kernicterus (bilirubin encephalopathy) was made. This report describes a rare case of equine neonatal kernicterus.     

Use of ultrasonography to detect pulmonary lesions in Thoroughbred foals in Argentina

Rhodococcus equi is an important cause of pulmonary disease in foals often related to economic losses and death. A study was performed on a Thoroughbred farm (Buenos Aires Province, Argentina) where this disease was enzootic causing 1–2% of foal deaths every year. One hundred foals were monitored by thoracic ultrasonography at ages 1–5 months to detect pulmonary lesions in order to initiate an early treatment. This strategy allowed reducing the number of foal deaths almost totally. In our experience, thoracic ultrasonography was proved to be very efficient in detection of early cases of pneumonia on a farm with high density of horses and intensive management.     

Polymerized Hemoglobin Therapy in a Foal with Neonatal Isoerythrolysis

Objective: To present the successful management of a foal with severe neonatal isoerythrolysis (NI) given polymerized (bovine) hemoglobin while awaiting appropriate red blood cells for transfusion.
Case Summary: A foal with peracute neonatal isoerythrolysis, anemia and low venous oxygen tension was stabilized with intravenous polymerized hemoglobin. Polymerized hemoglobin treatment maintained the foal's oxygen requirement for up to 18 hours permitting adequate time for preparation of the donor's washed red blood cells for transfusion. The clinical findings and venous oxygen tension improved following the hemoglobin administration. No adverse effects were noted from the polymerized hemoglobin administration.
Unique information provided: This paper presents a foal with an uncommon cause of NI due to anti-Pa antibodies and the short term management of NI using polymerized hemoglobin while awaiting a washed and packed RBC transfusion. Clinical and laboratory findings (trigger factors), which can be used to determine the need for a blood transfusion, are discussed. These "trigger factors" include weakness, tachypnea and tachycardia, increased anion gap and decrease in hematocrit, hemoglobin concentration and mixed venous (pulmonary artery) oxygen tension (approximated using jugular venous samples). ( J Vet Emerg Crit Care 2001; 11(2): 141–146 )     

Toxigenic characteristics of Clostridium perfringens type C in enterotoxemia of domestic animals.

Eleven Clostridium perfringens type C strains isolated from fatal cases of hemorrhagic enterotoxemia of Canadian calves, a piglet, and a foal were studied for the production of soluble antigens. All the isolates from calves and a foal failed to produce delta toxin, but were capable of producing large amounts of lethal beta toxin. A strain isolated from a piglet produced delta, but very little beta toxin. Other differences were relatively minor. The results indicated that young domestic animals may be susceptible to all subtypes of C. perfringens type C. A simple method of using blood agar plates coated with type A antiserum for demonstration of hemolytic patterns was found advantageous in differentiation of C. perfringens strains.     

Fatal venous air embolism in a cat undergoing dental extractions

A five‐year‐old domestic shorthair cat underwent general anaesthesia and tooth extractions. Immediately after use of a high‐speed, air‐driven, water‐cooled dental drill, the cat suffered cardiac arrest and attempted resuscitation was unsuccessful. Post‐mortem radiographs showed air in the vena cava, right atrium, right auricle and right ventricle, hepatic and renal veins. These findings were confirmed at post‐mortem examination. The cause of death was massive air embolism. There are reports of fatal venous air embolism in the human literature from the use of high‐speed, air‐driven, water‐cooled dental drills. In this case, we believe that the air jet from the cooling system provided an enormous pressure gradient allowing air entry through an alveolar bone fracture or the inflamed gingival tissues. This is the first report of fatal venous air embolism associated with the use of a high‐speed dental drill in the veterinary literature.     

An unusual cause of colic in a neonatal foal

A case of a neonatal foal with acute colic and respiratory distress is described. The foal presented with signs of acute colic and was treated medically. The foal did not respond to treatment and 2 h after admission the foal began to demonstrate signs of respiratory distress. Thoracic and abdominal radiographs were obtained and a diagnosis of a diaphragmatic hernia was made. Surgical repair of the hernia was recommended but the owner declined and the foal was subjected to euthanasia. Post mortem findings confirmed the diagnosis and revealed that the defect was of congenital origin. Congenital diaphragmatic hernia is an unusual cause of colic in a neonatal foal.     

A case of spontaneous venous embolism with carbon dioxide during laparoscopic surgery in a pig

BACKGROUND: Carbon dioxide (CO2) embolism is a possible complication of capnoperitoneum during laparoscopic surgery. Experimentally induced venous CO2 embolism has been studied in pigs. In this paper we report a case of spontaneous CO2 embolism. OBSERVATIONS: A 4-month-old Large White pig weighing 20 kg underwent experimental laparoscopic surgery under general anaesthesia. Monitoring consisted of pulse oximetry, capnography, airway pressure, electrocardiography, invasive arterial and central venous blood pressures, and arterial blood-gas analysis. Shortly after the start of laparoscopy and onset of CO2 insufflation, sudden decreases in end-tidal CO2 (Pe'CO2), haemoglobin saturation of oxygen (SpO2), systolic arterial blood pressure and heart rate were observed. Airway pressure increased and pulmonary compliance decreased simultaneously. Insufflation was immediately discontinued and epinephrine (2 mg IV), atropine (0.5 mg IV) and a 50 mL bolus of a polygeline solution were administered without effect. At this time arterial blood-gas analysis revealed a pH of 7.29 and a PaCO2 of 6.8 kPa (51.2 mmHg); PaO2 was 26.6 kPa (199.5 mmHg). After 4 minutes asystole occurred. CONCLUSIONS: The sudden decrease of Pe'CO2 and lung compliance combined with the sudden decrease in systolic blood pressure, heart rate and a poor response to resuscitation suggest a case of fatal gaseous venous embolism.     

Transplacental infection of a foal with Anaplasma phagocytophilum

This is the first report to document transplacental transmission of Anaplasma phagocytophillum in the horse. A 4-year-old late-term pregnant mare presented for a recent onset of pyrexia due to equine granulocytic anaplasmosis (EGA). She was hospitalised for treatment with oxytetracycline and monitoring of high-risk foaling due to significant thrombocytopenia. Parturition occurred overnight, and the foal was PCR positive for A. phagocytophilum at birth. The foal was slow to stand and nurse, with signs of neonatal encephalopathy and anaplasmosis (thrombocytopenia). Therapy with oxytetracycline resulted in complete clinical recovery of the mare and foal within 5 days. Congenital anaplasmosis should be considered in any foal delivered to a mare suffering from EGA during late-term pregnancy and guide appropriate antimicrobial therapy.     

Parascaris in foals

Extract

Sir, — We wish to report the death of a foal due to a parasitic lesion caused by Parascaris equorum..P equorum is reported to cause periodic colic, enterilis, obstructive colic with occasional rupture of the small intestine. However, personal communications with other veterinarians and our experience indicate fatal cases are not as common as indictaed in the literature.     

Cervical Vertebral Osteomyelitis With Secondary Septic Arthritis of the Atlantoaxial Joint in a Foal: A Case Report

A 36-day-old, 100-kg Thoroughbred colt was presented with a sudden onset of abnormal head carriage and pyrexia. Radiography revealed an osteomyelitis of the vertebral body of the second cervical vertebra. Ultrasonography revealed abscessation in the region of the atlantoaxial articulation on the left side, and fluid aspirated from the abscess confirmed suppurative inflammation. Surgical management was not feasible on economic grounds, and therefore this case was managed with aggressive medical therapy based on the most likely pathogens involved. To provide prolonged antibiotic therapy within the client’s budget, the antibiotic flucloxacillin (Staphlex, 500 mg) was used at a dose of 10 mg/kg by mouth, three times daily. Thirty-eight days after first presentation, the foal was euthanized because of chronic pain and deterioration in neurologic signs. A diagnosis of chronic osteomyelitis of the body of the second cervical vertebra (axis) was made with concurrent septic arthritis of the atlantoaxial joint involving the articular surface of the first cervical vertebra (atlas) and cervical myelopathy of the spinal cord within the first two vertebrae. No pathogens were isolated post mortem. This is the first report to describe the use of flucloxacillin in a foal. Although the outcome was fatal, the medical therapy provided could be considered successful at sterilizing the bony lesion.     

Fecal Isolation of Corynebacterium equi from a Foal with Chronic Diarrhea

Corynebacterium equi was isolated from the feces of a foal with chronic diarrhea. The foal had multiple walnut-sized masses associated with the intestine on rectal examination. These were thought to be enlarged lymph nodes and/or abscesses. The foal also had an elevated plasma fibrinogen. The diarrhea was controlled with antibiotics but recurred when the treatment was stopped.     

Diagnostic contribution of thoracic ultrasonography in 17 foals with Rhodococcus equi pneumonia

The aim of this retrospective study was to determine the clinical usefulness of thoracic ultrasonography compared to thoracic radiography in evaluation of Rhodococcus equi pneumonia. Criteria for patient inclusion in this study were: (1) isolation of R. equi from transtracheal aspirate, (2) radiographic evaluation of the pulmonary parenchyma, and (3) sonographic evaluation of the pulmonary parenchyma. Seventeen foals met this criteria and their medical records were reviewed. Pyogranulomatous pneumonia was identified radiographically in 13 foals. Severe consolidative pneumonia with no detectable abscessation was identified radiographically in three others. Both consolidation and abscessation were identified radiographically in one. In this foal only consolidation was ultrasonographically identified. Ultrasonographically, pulmonary abscessation was identified in 12 foals and pulmonary consolidation with no detectable abscessation was identified in three others. Sonographic examination allowed detection of only pleural irregularities in one foal, which was subsequently found to have pyogranulomatous pneumonia radiographically. Results indicate that ultrasonography may be an accurate alternative imaging modality for detection of pulmonary pathology attributed to R. equi pneumonia in foals when thoracic radiography is not available.