Fatal pulmonary hemorrhage in a horse during bronchoalveolar lavage – single case report.
Abstract: Pulmonary hemorrhage is a rare cause of death in horses. Hemorrhage within the respiratory tract has many causes, including mycosis of the guttural pouch, invasive procedures causing serious trauma to nasal conchae, or lung biopsy. We report on a rare case of a fatal pulmonary hemorrhage in a horse after a severe cough during bronchoalveolar lavage. To the best of our knowledge, this is the first report of spontaneous hemorrhage in a horse during bronchoalveolar lavage. Methods: A 21-year-old mare which belonged to the didactic herd of The Faculty of Veterinary Medicine underwent BAL procedure for training purposes. Clinical examination prior to the procedure did not reveal any abnormalities and the horse had been classified as healthy. The horse was sedated with 0.01 mg/kg of detomidine and 0.01 mg/kg of butorphanol. The silicon BAL catheter was passed through the nasal passage into the trachea and then into the bronchus. Before catheter was wedged, the mare began to cough heavily and massive haemorrhage from mouth and nostrils occurred. Despite fluid therapy, shock occurred within 15 min and the mare was euthanized. Upon necropsy, site of hemorrhage was identified in the left lobar caudal bronchi, from a large blood vessel running directly beneath the bronchial wall. Upon histology, a chronic lympho-plasmocytic inflammatory process in left bronchi was identified. Moreover, Masson's trichrome staining revealed severe, perivascular fibrosis. Conclusions: Although BAL is a relatively safe procedure, and such complications should be treated as extremely rare, this case indicates that, in some individuals with specific subclinical problems, even mild physical force such as a cough can lead to rupture of the artery.
Publication Date: 2019-05-24 PubMed ID: 31126342PubMed Central: PMC6534924DOI: 10.1186/s12917-019-1922-9Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Case Reports
- Journal Article
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
This research article discusses a rare case where a horse experienced a fatal pulmonary hemorrhage during a bronchoalveolar lavage procedure. The horse, part of a veterinary school training program, had no prior health issues but encountered a severe cough and massive hemorrhage during the procedure, leading to shock and subsequent euthanasia.
Procedure
- The subject of the case was a 21-year-old mare that was part of an educational herd at a veterinary medicine faculty. Before proceeding with a bronchoalveolar lavage (BAL) procedure, the horse underwent a clinical examination that revealed no abnormalities, classifying it as healthy.
- To perform the BAL, the horse was sedated using detomidine and butorphanol, after which a silicon BAL catheter was inserted through the nasal passage, down the trachea, and into the bronchus.
Pulmonary Hemorrhage
- Before the catheter was fully inserted and wedged into the bronchus, the mare began to cough severely. This was followed by a massive hemorrhage from the horse’s mouth and nostrils. Despite attempts to stabilize the animal through fluid therapy, it went into shock within 15 minutes, which demanded euthanasia.
Necropsy Findings
- After the horse was euthanized, a necropsy was performed to identify the cause of the hemorrhage. The bleeding was traced back to the left lobar caudal bronchus, where a large blood vessel ran directly beneath the bronchial wall.
- Upon further investigation, a chronic lympho-plasmocytic inflammatory process was discovered in the left bronchi. Additionally, severe perivascular fibrosis was found following Masson’s trichrome staining, a technique used to detect collagen and other connective tissue.
Conclusions
- The research concludes by stating that although a BAL is generally regarded as a safe procedure, exceptions exist. In some individuals, especially those with specific, potentially undiagnosed health issues, a mild physical stressor such as a cough can cause an artery rupture. This event emphasizes the need for further study into factors that could help predict risk for such occurrences.
Cite This Article
APA
Varegg MS, Kløverød KM, Austnes MK, Siwinska N, Słowikowska M, Zak A, Madej JA, Kandefer-Gola M, Ciaputa R, Nowak M, Niedzwiedz A.
(2019).
Fatal pulmonary hemorrhage in a horse during bronchoalveolar lavage – single case report.
BMC Vet Res, 15(1), 169.
https://doi.org/10.1186/s12917-019-1922-9 Publication
Researcher Affiliations
- Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
- Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
- Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
- Department of Internal Diseases with Clinic for Horses, Dogs and Cats, Wroclaw University of Environmental and Life Sciences, Grunwaldzki 47, 50-366, Wroclaw, Poland.
- Department of Internal Diseases with Clinic for Horses, Dogs and Cats, Wroclaw University of Environmental and Life Sciences, Grunwaldzki 47, 50-366, Wroclaw, Poland.
- Department of Internal Diseases with Clinic for Horses, Dogs and Cats, Wroclaw University of Environmental and Life Sciences, Grunwaldzki 47, 50-366, Wroclaw, Poland.
- Department of Pathology, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
- Department of Pathology, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
- Department of Pathology, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
- Department of Pathology, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
- Department of Internal Diseases with Clinic for Horses, Dogs and Cats, Wroclaw University of Environmental and Life Sciences, Grunwaldzki 47, 50-366, Wroclaw, Poland. artur.niedzwiedz@upwr.edu.pl.
MeSH Terms
- Animals
- Bronchi / blood supply
- Bronchoalveolar Lavage / adverse effects
- Bronchoalveolar Lavage / mortality
- Bronchoalveolar Lavage / veterinary
- Cough / veterinary
- Female
- Fibrosis / veterinary
- Hemorrhage / mortality
- Hemorrhage / veterinary
- Horse Diseases / mortality
- Horses
- Inflammation / veterinary
- Lung Diseases / veterinary
Conflict of Interest Statement
The authors declare that they have no competing interests.
References
This article includes 22 references
- Hinchcliff KW, Couetil LL, Knight PK, Morley PS, Robinson NE, Sweeney CR, van Erck E. Exercise induced pulmonary hemorrhage in horses: American College of Veterinary Internal Medicine consensus statement.. J Vet Intern Med 2015 May-Jun;29(3):743-58.
- Relave F, David F, Leclère M, Alexander K, Hélie P, Meulyzer M, Lavoie JP, Marcoux M. Thoracoscopic lung biopsies in heaves-affected horses using a bipolar tissue sealing system.. Vet Surg 2010 Oct;39(7):839-46.
- Versnaeyen H, Saey V, Vermeiren D, Chiers K, Ducatelle R. Intermittent Haemoptysis due to an Aortobronchial Fistula in a Warmblood Mare.. J Comp Pathol 2016 Aug-Oct;155(2-3):213-217.
- Pusterla N, Jones ME, Mohr FC, Higgins JK, Mapes S, Jang SS, Samitz EM, Byrne BA. Fatal pulmonary hemorrhage associated with RTX toxin producing Actinobacillus equuli subspecies haemolyticus infection in an adult horse.. J Vet Diagn Invest 2008 Jan;20(1):118-21.
- Couëtil LL, Cardwell JM, Gerber V, Lavoie JP, Léguillette R, Richard EA. Inflammatory Airway Disease of Horses--Revised Consensus Statement.. J Vet Intern Med 2016 Mar-Apr;30(2):503-15.
- Hoffman AM, Viel L. Techniques for sampling the respiratory tract of horses.. Vet Clin North Am Equine Pract 1997 Dec;13(3):463-75.
- Hoffman AM. Bronchoalveolar lavage: sampling technique and guidelines for cytologic preparation and interpretation.. Vet Clin North Am Equine Pract 2008 Aug;24(2):423-35, vii-viii.
- Niedźwiedź A, Borowicz H, Kubiak K, Nicpoń J, Skrzypczak P, Jaworski Z, Cegielski M, Nicpoń J. Evaluation of serum cytokine levels in recurrent airway obstruction.. Pol J Vet Sci 2016 Dec 1;19(4):785-791.
- Westermann CM, Laan TT, van Nieuwstadt RA, Bull S, Fink-Gremmels J. Effects of antitussive agents administered before bronchoalveolar lavage in horses.. Am J Vet Res 2005 Aug;66(8):1420-4.
- Couetil L, Hawkins JF. Respiratory diseases of the horse: a problem-oriented approach to diagnosis and management. CRC Press; 2013.
- Mathew R, Abdullah S, Renfrew I. Massive abdominal wall haematoma and haemothorax due to spontaneous rupture of an intercostal artery.. Emerg Med J 2008 Sep;25(9):608.
- Sundram-Novelend SY, Appleton DS, Screaton NJ, Davies RJ, Chilvers ER. Spontaneous rupture of an intercostal artery aneurysm during air flight.. Thorax 2008 Mar;63(3):294.
- Salmi R, Gaudenzi P, Ricci F, Gnani MC, Morandi P, Di Todaro F, Galeotti R, Manfredini R. Sudden acute thoracic pain and hypovolemic shock as a presentation of spontaneous rupture of intercostal artery: a case report.. J Am Geriatr Soc 2012 Feb;60(2):371-3.
- Lindbeck GH. Abdominal wall hematoma in an elderly man.. Acad Emerg Med 1995 Feb;2(2):134-8.
- Thurman JD, Johnson BJ, Lichtenfels JR. Dirofilariasis with arteriosclerosis in a horse.. J Am Vet Med Assoc 1984 Sep 1;185(5):532-3.
- Hislop AA. Airway and blood vessel interaction during lung development.. J Anat 2002 Oct;201(4):325-34.
- Dua A, Dua A, Jechow S, Desai SS, Kuy S. Idiopathic spontaneous rupture of an intercostal artery.. WMJ 2014 Jun;113(3):116-8.
- Moon JM, Lee SC, Chun BJ. Spontaneous intercostal artery bleeding.. Emerg Med J 2008 Jan;25(1):53-4.
- Saboo SS, Chamarthy M, Bhalla S, Park H, Sutphin P, Kay F, Battaile J, Kalva SP. Pulmonary arteriovenous malformations: diagnosis.. Cardiovasc Diagn Ther 2018 Jun;8(3):325-337.
- Robinson C, Miller D, Will M, Dhaun N, Walker W. Hughes-Stovin syndrome: the diagnostic and therapeutic challenges of peripheral pulmonary artery aneurysms.. QJM 2018 Oct 1;111(10):729-730.
- Allen DA, Schertel ER. Pathogenic aspects of circulatory shock.. Vet Clin North Am Equine Pract 1994 Dec;10(3):495-501.
- Magdesian KG. Therapeutics in practice: acute blood loss. Emerg Med 2008;3(2).
Citations
This article has been cited 2 times.- Lee GKC, Beeler-Marfisi J, Viel L, Piché É, Kang H, Sears W, Bienzle D. Bronchial brush cytology, endobronchial biopsy, and SALSA immunohistochemistry in severe equine asthma. Vet Pathol 2022 Jan;59(1):100-111.
- Tharwat M, Al-Sobayil F, Ali H. Changes in the hematobiochemical, acid-base and blood gas elements as well as biomarkers of inflammation and bone metabolism in donkeys (Equus asinus) with acute bleeding. Open Vet J 2024 May;14(5):1146-1153.
Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists
