Suspected retropharyngeal haemorrhage as a complication of guttural pouch mycosis

An 11-year-old Thoroughbred mare presented for evaluation of severe, acute bilateral epistaxis of several hours’ duration. Endoscopic evaluation revealed active haemorrhage from the right guttural pouch and significant dorsal compression of the nasopharynx. Rapid and severe retropharyngeal swelling developed, prompting placement of a temporary tracheostomy. Guttural pouch mycosis was suspected and transarterial coil embolisation of the right internal carotid, external carotid and maxillary arteries was successfully performed. It was suspected that haemorrhage from the vasculature of the guttural pouch tracked caudally into the retropharyngeal region resulting in significant swelling, pharyngeal collapse and a severely compromised airway. Clinicians should be aware of this rare complication of guttural pouch epistaxis.