Epistaxes: um desafio para o clínico na busca do prognóstico / Epistaxis: a challenge for clinicians in the search for prognosis

Background: Ailments that affect guttural pouches (GPs) include congenital malformations, tumors, and, especially, infections. Clinical signs of disorders of the GPs are not always specific, and include nasal secretion, epistaxis, and enlargement of regional lymph nodes. Deficient diagnosis and treatment tend to limit life expectancy. Some cases can lead to terminal exsanguination due to progression of the disorder if not diagnosed or if treatment fails. Unusual presentations may occur, and these cases require knowledge for prompt action and determination of the prognosis. The objective of this work is to report one of these unusual cases: epistaxis caused by rupture of the GP by a pharyngeal abscess.Case: A 6-year-old mare was presented for examination exhibiting purulent nasal secretion that had been ongoing for approximately 45 days (which had been treated as strangles for 7 days) and intermittent epistaxis for the past 20 days. When the mare was taken to the Veterinary Hospital, it also exhibited dysphagia with purulent nasal secretion mixed with the ingested food, a body condition score of 3/9, wheezing, mild ataxia, anemia (2.8 million RBCs/mm3 ; hematocrit = 14%), leukopenia (4,600 WBCs/mm3), and hyperfibrinogenemia (600 mg/dL). Upper airway endoscopy revealed presence of blood in the anterior third of the trachea, a blood clot in the left GP, and absence of bacterial of fungal plaques. Analysis of the bloody material collected from the GP showed presence of cocci bacteria and neutrophils. The treatment initially implemented was antibiotic therapy with enrofloxacin. Epistaxis worsened on the day following admission. Blood transfusion was carried out, but this procedure was not effective as profuse acute hemorrhage took place and led to death of the patient 48 h after admission. At necropsy, the left GP was laden with blood clots and serous/bloody content, and exhibited a circular/cylindrical lesion in its retropharyngeal portion.[...](AU)

Epistaxes: um desafio para o clínico na busca do prognóstico / Epistaxis: a challenge for clinicians in the search for prognosis

Background: Ailments that affect guttural pouches (GPs) include congenital malformations, tumors, and, especially, infections. Clinical signs of disorders of the GPs are not always specific, and include nasal secretion, epistaxis, and enlargement of regional lymph nodes. Deficient diagnosis and treatment tend to limit life expectancy. Some cases can lead to terminal exsanguination due to progression of the disorder if not diagnosed or if treatment fails. Unusual presentations may occur, and these cases require knowledge for prompt action and determination of the prognosis. The objective of this work is to report one of these unusual cases: epistaxis caused by rupture of the GP by a pharyngeal abscess.Case: A 6-year-old mare was presented for examination exhibiting purulent nasal secretion that had been ongoing for approximately 45 days (which had been treated as strangles for 7 days) and intermittent epistaxis for the past 20 days. When the mare was taken to the Veterinary Hospital, it also exhibited dysphagia with purulent nasal secretion mixed with the ingested food, a body condition score of 3/9, wheezing, mild ataxia, anemia (2.8 million RBCs/mm3 ; hematocrit = 14%), leukopenia (4,600 WBCs/mm3), and hyperfibrinogenemia (600 mg/dL). Upper airway endoscopy revealed presence of blood in the anterior third of the trachea, a blood clot in the left GP, and absence of bacterial of fungal plaques. Analysis of the bloody material collected from the GP showed presence of cocci bacteria and neutrophils. The treatment initially implemented was antibiotic therapy with enrofloxacin. Epistaxis worsened on the day following admission. Blood transfusion was carried out, but this procedure was not effective as profuse acute hemorrhage took place and led to death of the patient 48 h after admission. At necropsy, the left GP was laden with blood clots and serous/bloody content, and exhibited a circular/cylindrical lesion in its retropharyngeal portion.[...]

Primary bilateral guttural pouch empyema in a two-month-old foal / Empiema de bolsa gutural primário bilateral em potro de dois meses

The present report describes a 2-month-old foal which signs of respiratory infectious disease, bilateral retropharyngeal swelling and nasal mucopurulent discharge, suggesting guttural pouch empyema. The owners reported that the foal lived in a herd that experienced an outbreak of strangles. Foals younger than 3 months are usually protected against infectious diseases, however in this case, the foal was exposed to an environment heavily populated by Streptococcus equi equi during the outbreak of strangles. Although uncommon in such young animals, the foal was infected and developed a primary bilateral guttural pouch empyema, without signs of lymph nodes alteration.(AU)

O presente trabalho descreve o caso de um potro de dois meses de idade com sinais de infecção respiratória, distensão bilateral da região retrofaríngea e secreção nasal mucopurulenta, sugerindo empiema de bolsa gutural. Os proprietários relataram que o potro pertencia a uma tropa que havia sido acometida por garrotilho recentemente. Potros com menos de 3 meses de idade são normalmente protegidos contra as doenças infecciosas, no entanto, este potro foi exposto a um ambiente altamente contaminado por Streptococcus equi equi durante o surto de garrotilho. Embora incomum em animais tão jovens, o potro foi infectado e desenvolveu um empiema primário de bolsa gutural, não havendo sinais de acometimento dos linfonodos.(AU)

Primary bilateral guttural pouch empyema in a two-month-old foal / Empiema de bolsa gutural primário bilateral em potro de dois meses

The present report describes a 2-month-old foal which signs of respiratory infectious disease, bilateral retropharyngeal swelling and nasal mucopurulent discharge, suggesting guttural pouch empyema. The owners reported that the foal lived in a herd that experienced an outbreak of strangles. Foals younger than 3 months are usually protected against infectious diseases, however in this case, the foal was exposed to an environment heavily populated by Streptococcus equi equi during the outbreak of strangles. Although uncommon in such young animals, the foal was infected and developed a primary bilateral guttural pouch empyema, without signs of lymph nodes alteration.

O presente trabalho descreve o caso de um potro de dois meses de idade com sinais de infecção respiratória, distensão bilateral da região retrofaríngea e secreção nasal mucopurulenta, sugerindo empiema de bolsa gutural. Os proprietários relataram que o potro pertencia a uma tropa que havia sido acometida por garrotilho recentemente. Potros com menos de 3 meses de idade são normalmente protegidos contra as doenças infecciosas, no entanto, este potro foi exposto a um ambiente altamente contaminado por Streptococcus equi equi durante o surto de garrotilho. Embora incomum em animais tão jovens, o potro foi infectado e desenvolveu um empiema primário de bolsa gutural, não havendo sinais de acometimento dos linfonodos.

Timpanismo bilateral de bolsa gutural em potro

A 2-month old Quarter Horse filly presented, since few hours after birth, increased bilateral volume in the parotid gland region, with progressive enlargement. The radiographic examination revealed bilateral tympany of guttural pouch. Surgery was performed by medial septal fenestration. In addition, partial ressection of mucous membrane of the pharingeal orifice was performed. The disease was healed without recurrences.

Uma potra da raça Quarto de Milha com dois meses de idade apresentava aumento de volume bilateral na região da parótida desde algumas horas após o nascimento. Por exame radiográfico diagnosticou-se timpanismo bilateral de bolsa gutural. Realizou-se a abertura cirúrgica da bolsa gutural esquerda e fenestrou-se o septo medial das bolsas guturais. Adicionalmente, procedeu-se à ressecção parcial da mucosa na abertura do orifício guturo-faríngeo. A afecção foi debelada, sem recidivas.

Timpanismo bilateral de bolsa gutural em potro

A 2-month old Quarter Horse filly presented, since few hours after birth, increased bilateral volume in the parotid gland region, with progressive enlargement. The radiographic examination revealed bilateral tympany of guttural pouch. Surgery was performed by medial septal fenestration. In addition, partial ressection of mucous membrane of the pharingeal orifice was performed. The disease was healed without recurrences.

Uma potra da raça Quarto de Milha com dois meses de idade apresentava aumento de volume bilateral na região da parótida desde algumas horas após o nascimento. Por exame radiográfico diagnosticou-se timpanismo bilateral de bolsa gutural. Realizou-se a abertura cirúrgica da bolsa gutural esquerda e fenestrou-se o septo medial das bolsas guturais. Adicionalmente, procedeu-se à ressecção parcial da mucosa na abertura do orifício guturo-faríngeo. A afecção foi debelada, sem recidivas.

Doença vestibular periférica decorrente de osteoartropatia temporoioídea em um eqüino

A 22-year-old gelding showed vestibular syndrome associated with left facial nerve paralysis due to temporohyoid osteoarthropathy and the diagnostic was confirmed by guttural pouch endoscopic examination. The exam revealed abnormal contour of the left tympanic bulla and an enlargement of the proximal part of the left stylohyoid bone.

Um eqüino com 22 anos de idade apresentou síndrome vestibular periférica associada à paralisia de nervo facial esquerdo devido à osteoartropatia temporoioídea. O exame endoscópico das bolsas guturais mostrou alteração de contorno da bula timpânica esquerda e aumento de volume da extremidade proximal do osso estiloióide do mesmo lado.

Doença vestibular periférica decorrente de osteoartropatia temporoioídea em um eqüino

A 22-year-old gelding showed vestibular syndrome associated with left facial nerve paralysis due to temporohyoid osteoarthropathy and the diagnostic was confirmed by guttural pouch endoscopic examination. The exam revealed abnormal contour of the left tympanic bulla and an enlargement of the proximal part of the left stylohyoid bone.

Um eqüino com 22 anos de idade apresentou síndrome vestibular periférica associada à paralisia de nervo facial esquerdo devido à osteoartropatia temporoioídea. O exame endoscópico das bolsas guturais mostrou alteração de contorno da bula timpânica esquerda e aumento de volume da extremidade proximal do osso estiloióide do mesmo lado.

Evaluation of the healing process in medial septum fenestration of the guttural pouch in the horse / Avaliação dos processos de cicatrização da fenestração do septo-medial da bolsa gutural em eqüinos

The guttural pouch tympany is characterized by a painless distension of the parotid region, frequently severe enough to displace the pharynx and trachea and to compress the contralateral guttural pouch. In timpanites of the guttural pouches, surgical access is achieved through Viborg"s triangle, an attempt to establish a communication between the affected and the normal guttural pouches through a fenestration in the medium wall between them. The objective of this study was to observe the time necessary from the incision to produce the fenestration until the complete healing, as well as the post-surgical scarring phenomena such as evolution of local reactions, formation of granulation tissue, neovascularization, scarring degree along time, and to observe the formation or not of interguttural stoma.

O timpanismo de bolsa gutural caracteriza-se por uma distensão indolor da região parotídea, frequentemente severa o bastante para deslocar a faringe e a traquéia, e comprimir a bolsa gutural contralateral. A bolsa gutural pode ser acessada cirurgicamente, em casos de timpanismo, através do triângulo de Viborg. Essa cirurgia consiste em se estabelecer uma comunicação entre a bolsa gutural afetada e a bolsa gutural normal, criando-se uma fenestração no septo-medial entre elas. Pretendeu-se, com este trabalho, observar-se o tempo dispendido desde a incisão para produzir a fenestração, até sua completa cicatrização incluindo fenômenos cicatriciais pós-operatórios como a evolução das reações locais, a formação de tecido de granulação, a ocorrência de neovascularização, o grau de cicatrização de acordo com o tempo transcorrido, assim como a verificação de formação ou não de estoma intergutural.

Evaluation of the healing process in medial septum fenestration of the guttural pouch in the horse / Avaliação dos processos de cicatrização da fenestração do septo-medial da bolsa gutural em eqüinos

The guttural pouch tympany is characterized by a painless distension of the parotid region, frequently severe enough to displace the pharynx and trachea and to compress the contralateral guttural pouch. In timpanites of the guttural pouches, surgical access is achieved through Viborg"s triangle, an attempt to establish a communication between the affected and the normal guttural pouches through a fenestration in the medium wall between them. The objective of this study was to observe the time necessary from the incision to produce the fenestration until the complete healing, as well as the post-surgical scarring phenomena such as evolution of local reactions, formation of granulation tissue, neovascularization, scarring degree along time, and to observe the formation or not of interguttural stoma.

O timpanismo de bolsa gutural caracteriza-se por uma distensão indolor da região parotídea, frequentemente severa o bastante para deslocar a faringe e a traquéia, e comprimir a bolsa gutural contralateral. A bolsa gutural pode ser acessada cirurgicamente, em casos de timpanismo, através do triângulo de Viborg. Essa cirurgia consiste em se estabelecer uma comunicação entre a bolsa gutural afetada e a bolsa gutural normal, criando-se uma fenestração no septo-medial entre elas. Pretendeu-se, com este trabalho, observar-se o tempo dispendido desde a incisão para produzir a fenestração, até sua completa cicatrização incluindo fenômenos cicatriciais pós-operatórios como a evolução das reações locais, a formação de tecido de granulação, a ocorrência de neovascularização, o grau de cicatrização de acordo com o tempo transcorrido, assim como a verificação de formação ou não de estoma intergutural.