The effects of signalment, diet, geographic location, season, and colitis associated with antimicrobial use or Salmonella infection on the fecal microbiome of horses.

BACKGROUND: The fecal microbiome of healthy horses may be influenced by signalment, diet, environmental factors, and disease. OBJECTIVES: To assess the effects of age, breed, sex, geographic location, season, diet, and colitis caused by antibiotic use (antimicrobial-associated diarrhea [AAD]) and Salmonella infection on fecal microbiota. ANIMALS: Healthy horses (n = 80) were sampled from nonhospital environments across multiple geographical locations in the United States. Horses with AAD (n = 14) were defined as those that developed diarrhea secondary to antimicrobial use. Horses with Salmonella infection (n = 12) were presented with spontaneous onset of colitis and subsequently tested positive on Salmonella quantitative polymerase chain reaction. All horses were >1 year of age and stratified by a dietary scale that included forages (pasture and hay) and concentrates grouped by percentage of fiber and amount. METHODS: Illumina sequencing of 16S rRNA genes was performed on fecal DNA. RESULTS: Healthy horses fed higher amounts of grain clustered separately from those fed lower amounts of grain (analysis of similarities [ANOSIM], R = 0.356-0.385, Q = 0.002). Horses with AAD and Salmonella had decreased richness and evenness compared to healthy horses (P < .05). Univariable analysis of the 3 groups identified increases in Bacteroidetes (Q = 0.002) and Protebacteria (Q = 0.001) and decreases in Verrucomicrobia (Q = 0.001) in AAD horses whereas Salmonella horses had less Firmicutes (Q = 0.001) when compared to healthy horses. CONCLUSIONS AND CLINICAL IMPORTANCE: Although the amount of grain in the diet had some impact on the fecal microbiome, colitis had a significantly larger influence. Horses with ADD have a more severe dysbiosis than do horses with Salmonella.

Immersion Foot Syndrome in 6 Equids Exposed to Hurricane Floodwaters.

Prolonged exposure to water, known as immersion foot syndrome in humans, is a phenomenon first described in soldiers during World War I and characterized by dermal ischemic necrosis. In this report, we describe the pathologic findings of a condition resembling immersion foot syndrome in 5 horses and 1 donkey with prolonged floodwater exposure during Hurricane Harvey. At necropsy, all animals had dermal defects ventral to a sharply demarcated "water line" along the lateral trunk. In 5 animals, histologic examination revealed moderate to severe perivascular dermatitis with vasculitis and coagulative necrosis consistent with ischemia. The severity of the lesions progressed from ventral trunk to distal limbs and became more pronounced in the chronic cases. The pathophysiology of immersion foot syndrome is multifactorial and results from changes in the dermal microvasculature leading to thrombosis and ischemia. Prompt recognition of this disease may lead to appropriate patient management and decreased morbidity.

Signalment, clinical features, and outcome for male horses with urethral rents following perineal urethrotomy or corpus spongiotomy: 33 cases (1989-2013).

OBJECTIVE To describe the signalment, clinical features, and outcome for male horses with urethral rents following perineal urethrotomy (PU) or corpus spongiotomy (CS). DESIGN Retrospective case series. ANIMALS 33 horses. PROCEDURES Medical records of male horses examined because of hematuria or hemospermia caused by urethral rents that underwent PU or CS at a referral hospital between 1989 and 2013 were reviewed. Data regarding signalment, clinical features, urethroscopic findings, surgical treatment, and outcome were recorded. Long-term follow-up information was obtained by telephone interviews. RESULTS Age of the study population ranged from 3 to 18 years. Nineteen geldings and 1 stallion were examined because of hematuria, of which 13 and 7 underwent PU and CS, respectively, at a mean of 56 days after onset of clinical signs. Thirteen stallions were examined because of hemospermia, of which 7 and 6 underwent PU and CS, respectively, at a mean of 193 days after onset of clinical signs. Hematuria resolved following 1 surgical procedure in all 17 horses for which long-term information was available. Of the 12 stallions for which long-term information was available, 7 had resolution of hemospermia after 1 PU or CS and 5 developed recurrent hemospermia that required additional PUs or CSs (n = 3) or primary closure of the urethral rent (2). CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that PU and CS were reliable treatments for resolution of hematuria in male horses with urethral rents; stallions with urethral rents may require multiple PUs or CSs or primary closure of the rent for resolution of hemospermia.

Composition and Diversity of the Fecal Microbiome and Inferred Fecal Metagenome Does Not Predict Subsequent Pneumonia Caused by Rhodococcus equi in Foals.

In equids, susceptibility to disease caused by Rhodococcus equi occurs almost exclusively in foals. This distribution might be attributable to the age-dependent maturation of immunity following birth undergone by mammalian neonates that renders them especially susceptible to infectious diseases. Expansion and diversification of the neonatal microbiome contribute to development of immunity in the gut. Moreover, diminished diversity of the gastrointestinal microbiome has been associated with risk of infections and immune dysregulation. We thus hypothesized that varying composition or reduced diversity of the intestinal microbiome of neonatal foals would contribute to increased susceptibility of their developing R. equi pneumonia. The composition and diversity indices of the fecal microbiota at 3 and 5 weeks of age were compared among 3 groups of foals: 1) foals that subsequently developed R. equi pneumonia after sampling; 2) foals that subsequently developed ultrasonographic evidence of pulmonary abscess formation or consolidation but not clinical signs (subclinical group); and, 3) foals that developed neither clinical signs nor ultrasonographic evidence of pulmonary abscess formation or consolidation. No significant differences were found among groups at either sampling time, indicating absence of evidence of an influence of composition or diversity of the fecal microbiome, or predicted fecal metagenome, on susceptibility to subsequent R. equi pneumonia. A marked and significant difference identified between a relatively short interval of time appeared to reflect ongoing adaptation to transition from a milk diet to a diet including available forage (including hay) and access to concentrate fed to the mare.

Gallium maltolate as an alternative to macrolides for treatment of presumed Rhodococcus equi pneumonia in foals.

BACKGROUND: Macrolide-resistant isolates of Rhodococcus equi are emerging, prompting the search for clinically effective alternative antimicrobials. HYPOTHESIS: The proportion of foals with ultrasonographic evidence of pneumonia presumed to be caused by R. equi that had a successful outcome when administered gallium maltolate (GaM) PO would not be more than 10% inferior (ie, lower) than that of foals receiving standard treatment. ANIMALS: Fifty-four foals with subclinical pulmonary abscesses among 509 foals at 6 breeding farms in Kentucky. METHODS: Controlled, randomized, prospective noninferiority study. Foals with ultrasonographic lesions >1 cm in diameter (n = 54) were randomly allocated to receive per os either clarithromycin combined with rifampin (CLR+R) or GaM, and followed up for 28 days by daily physical inspections and weekly (n = 1 farm) or biweekly (n = 4 farms) thoracic ultrasound examinations by individuals unaware of treatment-group assignments. Treatment success was defined as resolution of ultrasonographically identified pulmonary abscesses within 28 days of initiating treatment. Noninferiority was defined as a 90% confidence interval for the observed difference in CLR+R minus GaM that was ≤10%. RESULTS: The proportion of GaM-treated foals that resolved (70%; 14/20) was similar to that of foals treated with CLR+R (74%; 25/34), but we failed to demonstrate noninferiority for GaM relative to CLR+R; however, GaM was noninferior to CLR+R treatment when results from a noncompliant farm were excluded. CONCLUSIONS AND CLINICAL IMPORTANCE: Gallium maltolate is not inferior to macrolides for treating foals with subclinical pneumonia. Use of GaM might reduce pressure for macrolide-resistance in R. equi.

Ultrasonographic visualization of the liver in sites recommended for blind percutaneous liver biopsy in horses.

OBJECTIVE: To ascertain the frequency of ultrasonographic identification of liver at sites recommended for blind percutaneous liver biopsy in middle-aged horses and to determine whether the liver is obscured by other organs or too thin for safe sample collection at recommended locations. DESIGN: Prospective case series. ANIMALS: 36 healthy middle-aged (between 3 and 18 years old) Quarter Horses or Quarter Horse crosses [Corrected]. PROCEDURES: Blood samples were collected from each horse and submitted for evaluation of liver function. Horses with any indication of liver dysfunction on serum biochemical analysis were excluded. The region just below a line drawn between the dorsal aspect of the tuber coxae and the point of the elbow joint in the right 11th, 12th, 13th, and 14th intercostal spaces (ICSs) was imaged by ultrasonography for the presence of liver. In each ICS, liver thickness and whether there was partial obstruction in viewing the liver caused by other abdominal or thoracic organs were recorded. RESULTS: 39% (14/36) of horses had liver imaged on ultrasonographic examination in all of the 11th to 14th ICSs. None of the 36 horses had liver of adequate thickness (ie, liver thickness ≥ 3.5 cm) for biopsy in all of the imaged ICSs. For 22 horses in which the liver was not visible on ultrasonographic examination of an ICS, lung was imaged instead in 12 (55%) horses, intestine in 8 (36%), and both intestine and lung in 2 (9%). CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of the results of this study, the practice of blind percutaneous liver biopsy in horses is not recommended because of the risk of serious complications.

Identification of genomic loci associated with Rhodococcus equi susceptibility in foals.

Pneumonia caused by Rhodococcus equi is a common cause of disease and death in foals. Although agent and environmental factors contribute to the incidence of this disease, the genetic factors influencing the clinical outcomes of R. equi pneumonia are ill-defined. Here, we performed independent single nucleotide polymorphism (SNP)- and copy number variant (CNV)-based genome-wide association studies to identify genomic loci associated with R. equi pneumonia in foals. Foals at a large Quarter Horse breeding farm were categorized into 3 groups: 1) foals with R. equi pneumonia (clinical group [N = 43]); 2) foals with ultrasonographic evidence of pulmonary lesions that never developed clinical signs of pneumonia (subclinical group [N = 156]); and, 3) foals without clinical signs or ultrasonographic evidence of pneumonia (unaffected group [N = 49]). From each group, 24 foals were randomly selected and used for independent SNP- and CNV-based genome-wide association studies (GWAS). The SNP-based GWAS identified a region on chromosome 26 that had moderate evidence of association with R. equi pneumonia when comparing clinical and subclinical foals. A joint analysis including all study foals revealed a 3- to 4-fold increase in odds of disease for a homozygous SNP within the associated region when comparing the clinical group with either of the other 2 groups of foals or their combination. The region contains the transient receptor potential cation channel, subfamily M, member 2 (TRPM2) gene, which is involved in neutrophil function. No associations were identified in the CNV-based GWAS. Collectively, these data identify a region on chromosome 26 associated with R. equi pneumonia in foals, providing evidence that genetic factors may indeed contribute to this important disease of foals.

Risk factors associated with nasopharyngeal cicatrix syndrome in horses.

OBJECTIVE: To determine risk factors associated with the development of nasopharyngeal cicatrix syndrome (NCS) in horses. DESIGN: Retrospective case-control study. ANIMALS: 242 horses referred for endoscopic evaluation of the upper portion of the respiratory tract (121 horses with NCS and 121 control horses). PROCEDURES: Medical records of horses that had an endoscopic evaluation of the upper airway performed between January 2003 and December 2008 were reviewed. Signalment, housing management, and season of evaluation were recorded and reviewed for each horse. The associations between clinical signs and endoscopic findings were evaluated by the use of a prospective logistic model that included a Bayesian method for inference. Results-Breed and sex had no significant effect on the risk of having NCS. The risk that a horse had NCS increased significantly with age. Exclusive housing in a stall was protective against the development of NCS. In addition, the amount of pasture turnout had a dose-related effect, with exclusive pasture turnout positively correlated with increased risk of developing NCS, compared with a mixture of pasture turnout and stall confinement. Horses were significantly more likely to be evaluated because of clinical signs of the syndrome during the warm months of the year. CONCLUSIONS AND CLINICAL RELEVANCE: The risk factors for NCS identified in this study may support chronic environmental exposure to an irritant or infectious agent as the cause of NCS. Information gained from this study should be useful for investigating the cause of NCS.

Enthesopathy and desmitis of the medial collateral ligament of the cubital joint in 4 horses.

CASE DESCRIPTION: 4 horses with enthesopathy and desmitis of the medial collateral ligament of the cubital joint were examined. CLINICAL FINDINGS: All 4 horses had a history of acute, severe, unilateral forelimb lameness and had signs of pain during manipulation of the affected upper forelimb; 2 also had swelling in the axillary region. There was no improvement in lameness after diagnostic local analgesia below the carpal region, and 1 of 4 horses had mild improvement after cubital joint analgesia. Radiography revealed enthesophyte formation on the radial tuberosity and linear mineralization of the medial collateral ligament in 2 horses and periosteal reaction on the humeral condyle in all 4 horses. One horse had mild osteoarthritis of the cubital joint, and 3 had osteophytosis of the cranial aspect of the radius. Although all horses were initially examined because of an acute onset of lameness, all had chronic abnormalities visible on imaging. Ultrasonography revealed an irregular boney contour and enthesopathy at the insertion of the short medial collateral ligament to the radial tuberosity and desmitis of the short medial collateral ligament. Two horses had radiographic evidence of similar but less severe lesions of the contralateral cubital joint. TREATMENT AND OUTCOME: All horses received phenylbutazone and rest. All horses were free of lameness after a median of 3 months (range, 2 to 4 months) and returned to previous use after a median of 6 months (range, 3 to 8 months). CONCLUSIONS AND CLINICAL RELEVANCE: The results of the present report suggested that performance horses with enthesopathy and desmitis of the medial collateral ligament of the cubital joint may have a good prognosis for return to previous use following appropriate treatment.

Nephrectomy via ventral median celiotomy in equids.

OBJECTIVE: To report technique for, and outcome after, nephrectomy through a ventral median celiotomy in equids. STUDY DESIGN: Case series. ANIMALS: Equids with unilateral renal disease (n = 6), aged 2 months to 18 years, weighing 90-434 kg. METHODS: A ventral median celiotomy was used to access the left or right kidney. To facilitate surgical exposure, the small intestine was reflected towards the diaphragm using laparotomy sponges and the ascending colon was exteriorized and in some cases evacuated. The peritoneum over the affected kidney was incised and blunt dissection used to free the kidney from the retroperitoneal fat, then the renal artery, vein, and ureter were isolated and ligated. Abdominal lavage with sterile saline solution was performed before abdominal closure. RESULTS: Four horses, 1 donkey, and 1 mule had unilateral nephrectomy to treat verminous nephritis (1), idiopathic hematuria (1), and ectopic ureter (4). A ventral median approach provided adequate access to the kidney in all 6 cases. Two horses had postoperative complications (peritonitis, chylous abdominal effusion) that resolved with medical therapy. No complications attributable to nephrectomy were reported by the owners upon follow-up 1-8 years after surgery. CONCLUSIONS: A ventral median approach for nephrectomy can be used for unilateral nephrectomy in equids weighing up to 434 kg.

Association of perinatal exposure to airborne Rhodococcus equi with risk of pneumonia caused by R equi in foals.

OBJECTIVE: To determine whether the concentrations of airborne virulent Rhodococcus equi in stalls housing foals during the first 2 weeks after birth are associated with subsequent development of R equi pneumonia in those foals. SAMPLE: Air samples collected from foaling stalls and holding pens in which foals were housed during the first 2 weeks after birth. PROCEDURES: At a breeding farm in Texas, air samples (500 L each) were collected (January through May 2011) from stalls and pens in which 121 foals were housed on day 1 and on days 4, 7, and 14 after birth. For each sample, the concentration of airborne virulent R equi was determined with an immunoblot technique. The association between development of pneumonia and airborne R equi concentration was evaluated via random-effects Poisson regression analysis. RESULTS: Some air samples were not available for analysis. Of the 471 air samples collected from stalls that housed 121 foals, 90 (19%) contained virulent R equi. Twenty-four of 121 (20%) foals developed R equi pneumonia. Concentrations of virulent R equi in air samples from stalls housing foals that developed R equi pneumonia were significantly higher than those in samples from stalls housing foals that did not develop pneumonia. Accounting for disease effects, air sample concentrations of virulent R equi did not differ significantly by day after birth or by month of birth. CONCLUSIONS AND CLINICAL RELEVANCE: Exposure of foals to airborne virulent R equi during the first 2 weeks after birth was significantly (and likely causally) associated with development of R equi pneumonia.

Abdominal abscesses in adult horses: 61 cases (1993-2008).

OBJECTIVE: To determine clinical signs, diagnostic methods, treatment, and outcome for a series of adult horses with abdominal abscesses. DESIGN: Retrospective case series. ANIMALS: 61 adult horses. PROCEDURES: Medical records of adult horses with abdominal abscesses treated at Texas A&M Veterinary Medical Teaching Hospital (1993 to 2008) were reviewed. Information was recorded regarding signalment, history, clinical signs, diagnosis, treatment, and short- and long-term outcomes. Risk factors for survival were determined. RESULTS: 61 horses met the criteria for inclusion. Clinical signs included colic (67%), fever (46%), anorexia (51%), signs of depression (57%), tachycardia (46%), and weight loss (30%). The diagnosis was made on the basis of abdominal ultrasonography, exploratory celiotomy, palpation per rectum, and necropsy. Abscesses were variable in size, location, and number. Only 15 (24.6%) horses survived to discharge. Multiple bacterial isolates were identified from aspirates of abscesses, and subsequent abdominal adhesion formation limited survival, affecting outcome. Risk factors for survival included age and heart rate at admission. CONCLUSIONS AND CLINICAL RELEVANCE: Adult horses with abdominal abscesses often have severe adhesion formation. Multiple bacterial isolates are frequently identified from the abscess. Prognosis for survival is guarded.

Association of airborne concentration of virulent Rhodococcus equi with location (stall versus paddock) and month (January through June) on 30 horse breeding farms in central Kentucky.

OBJECTIVE: To determine whether the concentration of airborne virulent Rhodococcus equi varied by location (stall vs paddock) and month on horse farms. SAMPLE: Air samples from stalls and paddocks used to house mares and foals on 30 horse breeding farms in central Kentucky. PROCEDURES: Air samples from 1 stall and 1 paddock were obtained monthly from each farm from January through June 2009. Concentrations of airborne virulent R equi were determined via a modified colony immunoblot assay. Random-effects logistic regression was used to determine the association of the presence of airborne virulent R equi with location from which air samples were obtained and month during which samples were collected. RESULTS: Of 180 air samples, virulent R equi was identified in 49 (27%) and 13 (7%) obtained from stalls and paddocks, respectively. The OR of detecting virulent R equi in air samples from stalls versus paddocks was 5.2 (95% confidence interval, 2.1 to 13.1). Of 60 air samples, virulent R equi was identified in 25 (42%), 18 (30%), and 6 (10%) obtained from stalls during January and February, March and April, and May and June, respectively. The OR of detecting virulent R equi from stall air samples collected during May and June versus January and February was 0.22 (95% confidence interval, 0.08 to 0.63). CONCLUSIONS AND CLINICAL RELEVANCE: Foals were more likely to be exposed to airborne virulent R equi when housed in stalls versus paddocks and earlier (January and February) versus later (May and June) during the foaling season.

Association of clinical signs with endoscopic findings in horses with nasopharyngeal cicatrix syndrome: 118 cases (2003-2008).

OBJECTIVE: To characterize the associations between clinical signs of nasopharyngeal cicatrix syndrome (NCS) and endoscopic findings in horses. DESIGN: Retrospective, case-control study. ANIMALS: 239 horses (118 case horses and 121 control horses). PROCEDURES: Medical records of horses that had an endoscopic evaluation of the upper airway performed between January 2003 and December 2008 were reviewed. Clinical signs and the appearance and anatomic locations of lesions identified during endoscopic evaluation were reviewed and recorded for each horse. The associations between clinical signs and endoscopic findings were evaluated by the use of a prospective logistic model that used a Bayesian method for inference and was implemented by a Markov chain Monte Carlo method. RESULTS: Nasal discharge was associated with acute inflammation of the pharynx and larynx. Exercise intolerance was associated with circumferential pharyngeal lesions. Respiratory noise was associated with chronic scarring of the pharynx, a combination of pharyngeal and laryngeal scarring, and circumferential scarring of the pharynx. Respiratory distress was associated with acute inflammation of all portions of the airway, especially when there was preexisting scarring and narrowing of the airway by ≥ 50%. Cough did not have any significant association with NCS, compared with results in control horses. CONCLUSIONS AND CLINICAL RELEVANCE: Associations between the endoscopic appearance of NCS lesions and relevant clinical signs will help practitioners identify horses with NCS and allow them to select appropriate treatment.

Diagnosis, treatment, control, and prevention of infections caused by Rhodococcus equi in foals.

Rhodococcus equi, a gram-positive facultative intracellular pathogen, is one of the most common causes of pneumonia in foals. Although R. equi can be cultured from the environment of virtually all horse farms, the clinical disease in foals is endemic at some farms, sporadic at others, and unrecognized at many. On farms where the disease is endemic, costs associated with morbidity and mortality attributable to R. equi may be very high. The purpose of this consensus statement is to provide recommendations regarding the diagnosis, treatment, control, and prevention of infections caused by R. equi in foals.

Rhodococcus equi: clinical manifestations, virulence, and immunity.

Pneumonia is a major cause of disease and death in foals. Rhodococcus equi, a gram-positive facultative intracellular pathogen, is a common cause of pneumonia in foals. This article reviews the clinical manifestations of infection caused by R. equi in foals and summarizes current knowledge regarding mechanisms of virulence of, and immunity to, R. equi. A complementary consensus statement providing recommendations for the diagnosis, treatment, control, and prevention of infections caused by R. equi in foals can be found in the same issue of the Journal.

Heterobilharzia americana infection as a cause of hepatic parasitic granulomas in a horse.

CASE DESCRIPTION-A 22-year-old American Paint Horse gelding from the Gulf Coast region of Texas was evaluated for regrowth of a perirectal squamous cell carcinoma that had been surgically removed 11 months previously. CLINICAL FINDINGS-A necrotic and ulcerated mass was present below the anus. The horse had paraphimosis and was having difficulty with urination. Histologic examination of the mass revealed that it was squamous cell carcinoma, and the horse was euthanized because of the unlikelihood that the mass could be adequately resected and its close proximity to the urethra. OUTCOME-At necropsy, in addition to the squamous cell carcinoma, hundreds of round, white to pale yellow nodules were disseminated throughout the liver, resulting in a so-called starry-sky appearance. Similar granulomas were seen in the right caudal lung lobe and small intestinal serosa. A single granuloma in the liver, which differed from the others by its larger size, contained a pair of adult schistosomes. Several hepatic granuloma specimens were used for PCR amplification and sequencing. Use of primers specific for a portion of the Heterobilharzia americana small subunit rRNA gene resulted in amplification of a 487-base pair product that had 100% sequence identity with H americana. CLINICAL RELEVANCE-Severe cases of disseminated granulomas in the liver of horses may result in a liver with a grossly abnormal starry-sky pattern. To our knowledge, this is the first report documenting the association of granulomas with H americana infection along with adult schistosomes in the liver of a horse.

Evaluation of the efficacy of gallium maltolate for chemoprophylaxis against pneumonia caused by Rhodococcus equi infection in foals.

OBJECTIVE: To determine the chemoprophylactic effect of gallium maltolate on the cumulative incidence of pneumonia caused by Rhodococcus equi infection in foals. ANIMALS: 483 foals born and raised on 12 equine breeding farms with a history of endemic R equi infections. PROCEDURES: Group 1 foals were treated with a placebo and group 2 foals were treated with gallium maltolate (approx 30 mg/kg, PO, q 24 h) during the first 2 weeks after birth. Foals were monitored for development of pneumonia attributable to R equi infection and for adverse effects of gallium maltolate. RESULTS: There were no significant differences in the cumulative incidence of R equi pneumonia among the 2 groups. CONCLUSIONS AND CLINICAL RELEVANCE: Chemoprophylaxis via gallium maltolate administered orally at approximately 30 mg/kg daily for the first 2 weeks after birth failed to reduce the cumulative incidence of pneumonia attributable to R equi infection among foals on breeding farms with endemic R equi infections. Further investigation is needed to identify strategies for control of R equi infections.

Starry sky hepatic ultrasonographic pattern in horses.

The starry sky hepatic pattern is an unusual ultrasonographic appearance of equine liver characterized by numerous small, hyperechoic foci, some of which cast an acoustic shadow, distributed randomly throughout the hepatic parenchyma. Our objectives were to describe the signalment, clinical signs, clinicopathological findings, primary disease process, and ultrasonographic findings of horses with this ultrasonographic pattern, as well as determine the associated gross and histologic changes. The starry sky pattern was identified in 18 adult horses of mixed gender and breed. The horses had various clinical signs, with weight loss and anorexia reported most commonly. Liver size and parenchymal echogenicity were normal in most horses. The hyperechoic foci frequently caused acoustic shadowing. Biliary dilation was noted rarely. The ultrasonographic pattern was the result of numerous fibrosing hepatic granulomas in all horses evaluated histologically. γ-Glutamyltransferase was the most commonly elevated hepatic enzyme, though it was increased in fewer than half the horses. Fifteen horses had an additional disease that was identified as the apparent cause of clinical signs. Three horses had primary hepatic disease while 12 had diseases of other body systems. Therefore, the starry sky ultrasonographic pattern is likely incidental in most horses and not clinically significant. Improved recognition of this pattern and further investigation of affected horses may help refine the etiology and clinical significance of the granulomas.

Sonographic characteristics of intraabdominal abscessation and lymphadenopathy attributable to Rhodococcus equi infections in foals.

The sonographic characteristics of intraabdominal abscesses in 11 foals and intraabdominal lymphadenitis in five foals with Rhodococcus equi infections are presented. Intraabdominal abscesses were usually present in the ventral abdomen adjacent to the ventral body wall, well-marginated, and contained a mixed or complex echo pattern. Lymphadenitis appeared as singular or multiple clusters of lymph nodes of mixed echogenicity adjacent to any portion of the gastrointestinal tract or body wall. Sonographic findings were supported by necropsy examinations, but sonographic measurements consistently underestimated the size of abscess.