TREAT­MENT CHAL­LENGES

EQUUS - - Eq Casereport -

Pleu­rop­neu­mo­nia can re­quire in­ten­sive and ex­pen­sive treat­ment. Once it de­vel­ops–and the horse is ac­cu­mu­lat­ing flu­ids be­tween his lungs and his chest wall–the flu­ids will need to be drained via tubes in­serted through the rib cage. This pro­ce­dure is likely to be re­peated mul­ti­ple times over the course of the ill­ness.

And it may dif­fi­cult to drain the fluid. “The in­flamed pleu­ral mem­brane forms fib­rin, a type of stringy tis­sue that can trap bac­te­ria and also make it hard to re­move the fluid in the chest,” says Vir­ginia Buech­ner-Maxwell, DVM, DACVIM, of the Vir­ginia– Mary­land Re­gional Col­lege of Vet­eri­nary Medicine in Blacksburg, Vir­ginia. “It be­comes a cob­web of fi­brous ma­te­rial be­tween the lung and chest wall, like a hon­ey­comb of tis­sue. This is a very se­ri­ous con­di­tion.”

In these cases, the vet­eri­nar­ian may sug­gest a tho­ra­coscopy: “We put a scope into the pleu­ral cav­ity the same way that a la­paroscopy is done into the ab­domen. The scope goes into the chest cav­ity, in be­tween the ribs,” says Amy John­son, DVM, DACVIM, of the Univer­sity of Penn­syl­va­nia. “With the scope we can pos­si­bly see what we are do­ing as we try to drain the pleu­ral cav­ity.”

The tho­ra­coscopy may also be used to drain fluid from an­other po­ten­tial com­pli­ca­tion: ab­scesses. “As time goes on the horse may de­velop necro­tiz­ing pneu­mo­nia, in which parts of the lung tis­sue die, or he may de­velop ab­scesses within the pleu­ral cav­ity or within the lung,” John­son says. “Since those ab­scesses be­come walled off very quickly, they can be re­ally hard to treat. Once the in­fec­tion is walled off, it’s harder for an­tibi­otics to pen­e­trate into the in­fected area.”

In this sit­u­a­tion, the horse may need to con­tinue with an­tibi­otic treat­ment for many months, or if the area is sur­gi­cally ac­ces­si­ble the vet­eri­nar­ian may do sur­gi­cal pro­ce­dures to ei­ther drain the ab­scess or re­duce its size. Some ab­scesses that are mainly fluid can also be drained without surgery. “We can put a tube into the ab­scess and drain most of the pus out of the mid­dle of it,” John­son says.

The most se­vere cases might re­quire a tho­ra­co­tomy, a sur­gi­cal in­ci­sion through the chest wall. “Some­times the sur­geon will reach a hand in through the ribs to try to scoop out as much of the pu­ru­lent de­bris as pos­si­ble,” John­son says. “In some cases, in or­der to ac­cess the in­fected area, the sur­geon has to do a rib re­sec­tion, which in­volves re­mov­ing part of a rib. This al­lows the sur­geon to get to the site and drain an ab­scess or an in­fected area within the chest cav­ity.”

Even with treat­ment this ex­ten­sive, the prog­no­sis can be good. “We are able to save a lot of these horses, even if they do need rib re­sec­tions or sur­gi­cal pro­ce­dures to drain ab­scesses. We aren’t able to save all of them, but the horse has a fair chance of sur­vival,” says John­son. “The cost, how­ever, can be high—tens of thou­sands—

MAN­AGE­MENT: When a horse de­vel­ops pleu­rop­neu­mo­nia, the flu­ids that ac­cu­mu­late be­tween his lungs and the chest wall must be drained.

by the time you pay for the months of an­tibi­otics re­quired, the re­peated chest tubes and drainage, and the sur­gi­cal pro­ce­dure. Most own­ers don’t have the abil­ity to pur­sue this ex­ten­sive treat­ment.”

But, John­son adds, “Most cases, if de­tected rel­a­tively early, can be man­aged just with an­tibi­otics, plus or minus chest tubes, without do­ing the more in­va­sive tho­ra­coscopy or a tho­ra­co­tomy and rib re­sec­tion.”

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