In-hospital development of an aorto-cardiac fistula in a Warmblood gelding with chronic renal disease

A 20-year-old Warmblood gelding presented for evaluation and treatment of ventral oedema and azotaemia of unknown aetiology. On presentation, a diastolic heart murmur was appreciated and echocardiography revealed moderate aortic insufficiency due to chronic degenerative valve disease. The horse was hospitalised and failed to respond to oral and i.v. fluids and diuretics. Following discontinuation of all fluid and diuretic therapy, the horse became acutely agitated and developed monomorphic ventricular tachycardia. The ventricular tachycardia spontaneously converted to normal sinus rhythm, however the heart murmur changed in timing to a right basilar continuous murmur and bounding jugular pulses were noted. Repeat echocardiogram revealed an aorto-cardiac fistula with dissection into the basilar interventricular septum and left-sided chamber volume overload that was not previously present. Attempts at stabilisation were unsuccessful and euthanasia was elected. Post-mortem examination confirmed chronic renal disease of unknown aetiology in addition to an aorto-cardiac fistula originating from the right sinus of Valsalva with subsequent dissection into the basilar interventricular septum.     

Removal of a fragmented nasogastric tube from the transverse colon of a horse undergoing exploratory celiotomy for colic

This report describes the clinical course and surgical findings of a 5-year-old Warmblood gelding referred for colic with a previous history of intermittent colic episodes, and gastric ulcers diagnosed by gastroscopy in the preceding months. The horse underwent medical treatment but remained painful and surgery was elected. The horse underwent an exploratory laparotomy during which an impaction was identified in the transverse colon that was associated with an approximately 1 metre segment of nasogastric tube. The foreign body was removed via an enterotomy in the left dorsal colon, and the horse recovered well from surgery. No complications were encountered post-operatively.     

Computed tomographic (CT) arthrogram contributes to the diagnosis of an osteochondroma of the distal calcaneus in a horse

Osteochondromas in the horse are most commonly found as a solitary lesion affecting the distal radial metaphysis. In this location, diagnosis is reliant on radiographic and ultrasonographic examination and confirmed with post-operative histopathology. This case report describes the additional benefit of performing a CT arthrogram to aid the diagnosis of an osteochondroma in an atypical location.     

Diagnosis and treatment of mastitis in mares

Infection and inflammation of the udder (mastitis) is a common condition affecting all domestic mammals, but it appears to be less prevalent in mares than in dairy cows and dairy goats. The seemingly reduced incidence of mastitis in mares can be partially explained by the smaller size and relatively concealed location of the mare’s udder, coupled with a smaller storage capacity than cows and goats. Mastitis can affect lactating, peripartum, dry mares, mares at dry-off or prepubertal foals. Common clinical signs include swollen mammary tissue, abnormal mammary gland secretion, fever and anorexia; less common signs are hindlimb lameness and a swollen mammary vein. On rare occasions, mastitis pathogens can severely affect the nursing foal and mares may develop fibrotic tissue and consequent agalactia in the side(s) or quarter(s) affected. Based on the clinical presentation, mastitis can be classified as acute or chronic, and clinical or subclinical. Diagnosis is based on the clinical signs aided with aerobic culture and cytological evaluation of the gland secretion. In addition, these ancillary tests can also be used to assess prognosis and duration of treatment. Mares suffering from mastitis may present neutrophilia and hyperfibrinogenaemia. Treatment for mastitis includes antimicrobial therapy (systemic and/or locally), nonsteroidal anti-inflammatory drugs, frequent milking and cold hosing with/without hot-packing applied on the gland. While the frequent monitoring of mares after weaning and reducing food intake should be part of common practices at weaning, cleaning of the udder, control of insect populations and frequent milking of mares with a foal unable to nurse can also aid in preventing mastitis.     

The clinical features and short-term treatment outcomes of scirrhous cord: A retrospective study of 32 cases

Scirrhous cord (SC) is an uncommon complication of castration, characterised by chronic infection of the spermatic cord remnant. It is reported that surgical excision of the infected tissue is the most effective means of treatment, but there are few published studies assessing the outcomes of horses treated for SC. The aims of this retrospective study were to describe the clinical features and short-term outcomes in horses treated for SC at two equine hospitals in the UK. The clinical records of horses diagnosed with SC over a 10-year period were reviewed. A diagnosis of SC was made if the gelding presented with typical clinical signs with confirmation at surgery. Thirty-two cases of SC were identified at the two equine hospitals. The mean age at presentation was 6 years (range 2–14 years, n = 22), and the median time from castration to presentation was 29.5 days (range 20–2500 days). Mean age at castration was 4.3 years (range 6 months to 10 years, n = 10). Clinical signs included scrotal swelling, discharging wounds, hindlimb lameness and pyrexia. Five horses demonstrated hyperfibrinogenaemia (n = 8). Microbial culture isolated various bacterial species. All 32 cases were treated with surgical excision of the infected tissue and discharged from the hospitals between 1 and 10 days post-operatively. A limitation of this study is that it was a retrospective study with no long-term follow-up available. It was concluded that the results of this study confirm that SC can present at variable time points following castration, even many years later, and that a variety of bacterial species may be involved. Surgical excision of infected tissue is a successful treatment with a good short-term prognosis for survival.     

Medical management of Rhodococcus equi infections: A clinical epidemiology perspective

Rhodococcus equi infections cause severe pulmonary disease in foals, affecting animal welfare and increasing production costs in horse-breeding farms. Extra-pulmonary disorders (EPD) are relatively common and can occur independently of pulmonary disease; foals with EPD have a more guarded prognosis. The accompanying paper by Shaw et al. (2021) reports the successful diagnosis and medical treatment of a large abdominal abscess caused by R. equi infection. The authors report on the benefits of using gallium maltolate, a semimetal compound with antimicrobial activity, in combination with traditional R. equi infection antimicrobial treatment (combination of a macrolide and rifampicin). Experimental studies are needed to understand further the benefits of this combined therapy, to evaluate the synergistic effects and if it improves the concentration of antimicrobial drugs into infected tissues. The publication of this case report in Equine Veterinary Education is of clinical importance to equine practitioners when diagnosing and treating R. equi infected foals with or without EPD.