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Discussion on Ethmoid Hematoma
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New Member:
Dandy234
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Posted on Friday, Jan 24, 2003 - 11:09 pm:
My 18 year old TB gelding was diagnosed with an Ethmoid Hematoma in Jan 2002. He had a history of a bloody nose that occured every couple months starting on the fall of 2000 and increased over 2001. Endoscopy and x-rays in spring and fall of 2001 were negative. By the end of 2001 the nose bleeds were occuring 4-5 days a week so we took him to UC Davis. Again, endoscopy was negative but the x-rays showed something in the sinuses back behind the ethmoid turbinates. A CAT scan was performed and it clearly showed a mass that originates at the back of the ethmoid turbinates and grew back and down into the sinuses. Since the tumor cannot be visualized through endoscopy, the formalin injection procedure is not an option. They said the bone flap surgery was the best treatment choice.
Unfortunately the horse had problem getting up recovering from anesthesia and damaged his LF medial collateral ligament. So the surgery was posponed to allow his leg to heal. Sadly the knee is now arthritic and the horse can no longer jump or be worked and is now retired.
It's been a year since diagnosis and he appears just fine. We are checking his blood counts every 6 months and he is tolerating the blood loss (his nose drips several times a day now) with Red Cell. His weight, coat and attitude are fine too. The tumor was described as "moderate" in size a year ago. His face has not become deformed, his breathing sounds normal and the tumor has not appeared in his nostril.
My question is, what can you tell me about the prgression of an ethmoid hematoma if left untreated. What signs should I look for to help determine when a decision should be made about euthanasia. Would you expect neurological signs? Do you think he has a headache?
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Moderator:
DrO
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Posted on Saturday, Jan 25, 2003 - 9:51 am:
I am sorry to hear about your horses plight Phyllis and I know the uncertainty of it all is bothering. As long as his attitude is good, I don't think he is suffering. It probably is the best indicator of problems. Untreated they get larger and tend to bleed more as you have seen. What no one can predict is the rate of progress or even which way it will grow. The direction of growth will determine which of the symptoms you have mentioned will develop.
DrO
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Member:
Dandy234
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Posted on Monday, Jan 27, 2003 - 1:42 am:
Dr O
I appreciate your input. Is there any literature describing rate of growth? Statistically speaking do these things grow rapidly, where we might be getting to the end now a year after diagnosis? Or can they live for years and years?
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Moderator:
DrO
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Posted on Monday, Jan 27, 2003 - 6:04 am:
No there are no such statistics Phyllis, as written in my last post, no one can predict the rate of growth.
DrO
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Member:
Dandy234
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Posted on Saturday, May 17, 2003 - 12:59 pm:
Dr O
My horse is now retired in a 20 acre pasture and getting along well. The nose continued to bleed many times a day, (sometimes as much as a few tablespoons at once) but the last 2 weeks the bloody discharge is much less and looks as though it is mixed with serum or puss. His attitude remains good and his temperature is normal. Is it likely that the tumor is infected? Or maybe the lining of the sinus cavity is deteriorating and getting infected?
Thanks
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Moderator:
DrO
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Posted on Sunday, May 18, 2003 - 8:40 am:
Without looking at the horse and probably set of recent radiographs, I cannot answer your questions definatively Phyllis. Certainly the purulence suggests infection, but it may just be irritation or necrosis from the pressure of a space occupying mass.
DrO
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Member:
Dandy234
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Posted on Sunday, May 18, 2003 - 11:54 pm:
Thanks Dr O
Do you think there is anything I should be doing or watching him for to ensure he is comfortable? I assumed a fever would indicate the tumor / infection is getting the best of him and perhaps that might be my decision point. If it is irritation or necrosis do you think a course of antibiotics would help or might it just delay the inevitable? Have you read of a horse bleeding out from this?
Thanks so much for your help
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Moderator:
DrO
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Posted on Monday, May 19, 2003 - 11:35 am:
If you are not seeing any change in behavior I don't think discomfort is likely. I have not heard of a horse bleeding out from a EH.
I do not think antibiotics will cure a Ethmoid Hematoma, but if there is infection present they may help that but without an examination I cannot tell if your horse might benefit.
DrO
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Member:
Dandy234
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Posted on Saturday, Aug 7, 2004 - 5:10 pm:
Dr O
I thought I'd give an update on this horse for the benefit of others who may be dealing with this.
It's been 4 years since the first nosebleed and he's continuing to do well out in pasture. His coat is glossy, his weight is good and his attitude is bright. The nose bleeds occur daily, more when he runs around. We've checked his blood every 6 months and all values are normal. He's having fun being a horse and doesn't seem to have any symptoms of discomfort.
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Moderator:
DrO
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Posted on Sunday, Aug 8, 2004 - 10:49 am:
That is great to hear, Phyllis.
DrO
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Member:
Dandy234
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Posted on Friday, Jan 6, 2006 - 1:30 am:
Hi Dr O
Another update - my horse continues to do well. It's been over 5 years since the first nosebleed and at this point he has no other symptom other than daily nosebleeds. He is not rideable due to his knee injury but is still comfortably pasture-sound.
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Moderator:
DrO
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Posted on Friday, Jan 6, 2006 - 8:38 am:
It remains a truly remarkable story, raise a glass of cheer to the coming great years!
DrO
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Member:
dandy234
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Posted on Tuesday, Feb 26, 2008 - 11:11 am:
Hi Dr O --- He keeps going and going. It's been 7 1/2 years since the first symptoms. Other than the daily nosebleeds he appears fine.
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Moderator:
DrO
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Posted on Tuesday, Feb 26, 2008 - 7:18 pm:
Cheers Phyllis, and thanks for the update. Let us know if you have any change otherwise we will toast in another year of two!
DrO
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Member:
dandy234
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Posted on Friday, Dec 12, 2008 - 12:56 pm:
This is my final post on the story. We euthanized him last month due to age related issues that had nothing to do with the ethmoid hematoma. UC Davis did a necropsy and the biopsy confirmed it was a progressive ethmoid hematoma. It extended into the caudal maxillary and sphenopalatine sinuses. It had grown since the original CAT scan in January 2002 but much slower than they expected. He was comfortable throughout the 8 years and other than a chronic bloody nose he showed no symptoms.
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Member:
erika
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Posted on Friday, Dec 12, 2008 - 9:08 pm:
Sorry for your loss, Phyllis.
Erika
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Moderator:
DrO
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Posted on Saturday, Dec 13, 2008 - 10:09 am:
My condolences Phyllis and thank you for taking the time to update us. I am sure this will be helpful to others who find themselves in a similar situation.
DrO
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Member:
pattyb
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Posted on Saturday, Dec 13, 2008 - 1:14 pm:
 Phyllis, I am new here but wish to extend my condolences as well. Believe me, I know how you feel, I kept a Cushing's horse going to the age of 33, losing her to something totally unrelated just this past August. Hugs to you, you are indeed brave and kind.
(((((((Phyllis)))))))
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Member:
vickiann
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Posted on Saturday, Dec 13, 2008 - 2:56 pm:
Sorry to hear of your loss, Phyllis, but how wonderful it was that he had so many happy years in spite of his problem.
Thank you for sharing this information.
I admire the level of good care that you gave this horse.
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Member:
canter
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Posted on Saturday, Dec 13, 2008 - 4:44 pm:
Thank you, Phyllis for updating the thread, and I am very sorry for your loss.
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Member:
lilo
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Posted on Sunday, Dec 14, 2008 - 10:09 am:
Phyllis, my condolences on the loss of your horse. And thanks for the update.
Take care,
Lilo
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