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  Discussion on Infected Jugular Vein
Author Message
Member:
katie4

Posted on Saturday, Apr 30, 2011 - 5:52 am:

Hi DrO,

A few months ago my 5yo horse developed sinusitis which persisted despite 6 weeks of antibiotics. She went in for surgery just over 2 weeks ago and had an infected tooth removed as well as 2 of her sinuses opened and drains left in them for twice daily flushing for a week. All of that went well except she developed an infection around the site of the IV cannula that was in her jugular vein for a week.

She came home 10 days ago and was very listless and unwell. Her neck became severely indurated along the entire length of the jugular vein (jaw to shoulder) and blood stained fluid and small amounts of pus drained out of the insertion site of the cannula on a daily basis. She was on oral doxycycline.

In the past week the induration from cannula site to shoulder has gone away but the jugular vein is rock hard up to her jaw as well as the tissues extending 2" in all directions from it. What looks like an abscess the size of a golfball has developed over the site of insertion of the cannula although when it was lanced this morning nothing came out of it. She is now on IV Penicillin (I don't know which one)

My concern is the risk of Bacterial Endocarditis. I've asked the vet to listen for murmurs today and she has got a murmur although he says he thinks it is physiological. She didn't have a murmur when she was vetted before purchase 3 years ago. She has got a low grade temperature of 102-104 degrees. She has no oedema but she does have an occasional cough which is new.

In herself she is still depressed but not as ill as she was. She is now eating her hard feed and has had a little bounce around her field this morning. Last week she just stood there, head DrOoping, too ill to bother to eat grass.

I have no knowledge of the incidence and prognosis of bacterial endocarditis in horses but the infection in this horse's jugular extended to within inches of her heart. In a human that would be a massive risk. Is there anything I can ask the vet to do to investigate this or decrease the risk of it happening (if it hasn't happened already)? Her sinus surgery is healing up beautifully but her neck is a mess and I think her jugular is full of infected blood clot which will take a while to liquefy and come out and probably poses a risk of throwing off septic emboli. Obviously I'm feeling very worried at the moment.
Member:
katie4

Posted on Saturday, Apr 30, 2011 - 6:03 am:

Here's a photo of her from 5 days ago. I think you can see the start of the abscess formation round the site of the cannula insertion and also that it is draining bloodstained fluid. At that stage the entire side of her neck was hard and the jugular along its length was rock hard.

Since then her neck has become softer on the shoulder side of the cannula site but worse on the head side. I will take a photo this afternoon and post it.

[IMG]https://i253.photobucket.com/albums/hh71/pirie/IMG_0186.jpg[/IMG]
Member:
katie4

Posted on Saturday, Apr 30, 2011 - 6:16 am:

Quick update: just spoken to my vet who says he has changed the antibiotics to Penicillin and Gentamycin. He's going to continue her on IV antibiotics until her temperature is normal and the wound is dry. He's confident that the murmur is not that of endocarditis. I do hope he's right!
Member:
katie4

Posted on Saturday, Apr 30, 2011 - 3:51 pm:

As promised here are photos of her neck. The abscess is about 2 1/2" across but the surrounding area is also hard and infected although the extent of this is slightly smaller than it was. Poor mare!

[IMG]https://i253.photobucket.com/albums/hh71/pirie/IMG_0194.jpg[/IMG]

[IMG]https://i253.photobucket.com/albums/hh71/pirie/IMG_0195.jpg[/IMG]

I poulticed it today with Animalintex and some bloodstained pus came out of it. I was planning on doing the same again tomorrow. My feeling is that there is a significant amount of infected blood clot in the jugular vein that will have to liquefy before it can drain. Does that sound reasonable and do you have any suggestions how to help this resolve as fast as possible?
Moderator:
DrO

Posted on Sunday, May 1, 2011 - 11:08 am:

Hello Michelle,
The next step diagnostically would be an ultrasound of the vein and heart to identify the extent of the lesions. Also under consideration would be bllod cultures to identify the sensitivity of any circulating bacteria. As to the prognosis this review suggests the prognosis for recovery is good:

J Am Vet Med Assoc. 2009 Nov 1;235(9):1073-8.
Evaluation of athletic performance in horses with jugular vein thrombophlebitis: 91 cases (1988-2005).
Moreau P, Lavoie JP.
SourceDépartement de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Saint-Hyacinthe, QC, Canada.

Abstract
OBJECTIVE: To evaluate effects of thrombophlebitis of 1 or both jugular veins on athletic performance of horses.

DESIGN: Retrospective case series.

ANIMALS: 91 horses with jugular vein thrombophlebitis.

PROCEDURES: Medical records of horses with jugular vein thrombophlebitis examined between 1988 and 2005 were reviewed for signalment, history, clinical signs, diagnosis, and treatment. Performance was evaluated in 2 ways. A questionnaire was used to obtain a subjective assessment from the owner or trainer of the horse's performance after thrombophlebitis, compared with the performance before thrombophlebitis. Racing records from before and after thrombophlebitis were also evaluated.

RESULTS: Thrombophlebitis was diagnosed in 37 horses at the time of admission (group 1), and 54 horses developed thrombophlebitis during hospitalization for an unrelated medical condition (group 2). Twenty-seven of 81 (33%) owners answered the questionnaire, and racing records were available for 31 horses. Performance data were available for 48 horses. Owners reported that all nonracing horses, except 1, had equivalent or better performances after discharge. Twenty-six of 31 (84%) Standardbreds resumed racing; in these horses, there was no significant difference between racing times before and after thrombophlebitis. No significant difference in performance was detected regardless of the primary disease, whether a horse had unilateral or bilateral thrombophlebitis, or the treatment administered.

CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that the athletic performance of horses used for nonracing events was not affected by thrombophlebitis. Thrombophlebitis in racing Standardbreds was associated with a decreased chance of return to racing; however, performance was not impaired in those that resumed racing.

DrO
Member:
katie4

Posted on Tuesday, May 3, 2011 - 4:50 pm:

Hi DrO, thanks for finding that reference. My horse had her neck ultrasounded today and her jugular is occluded for 4" above the abscess and 6" below it. Her heart was not ultrasounded probably because the mobile unit was not powerful enough but her temperature is now normal. Thank goodness!

The vet debrided the middle of the abscess and it has been draining more pus since he did that. He also saw a large, walled off abscess in her neck on the ultrasound and the tissues of her neck are still rock hard and painful. The abscess is having Fuciderm applied to it twice a day and I'm poulticing it with Animalintex once a day for a couple of hours. She is also still on Penicillin and Gentamycin via injection once a day.

In herself she is not as ill as she was but she's still unwell. I think she's stopped losing weight but she isn't eating as much forage as usual.

Do you think the occlusion of her jugular (which I'm assuming is infected blood clot) will have to drain out of her abscess too or will it organise and eventually recanalise?

I hope she picks up soon. She looks so down and depressed and has done for 3 weeks. All this to try to cure a snotty nose!!!
Moderator:
DrO

Posted on Thursday, May 5, 2011 - 8:33 am:

Though a better question for the ultrasonographer, I am betting on the clot breaking down resulting in a patent vein.
DrO
Member:
katie4

Posted on Monday, May 9, 2011 - 3:08 pm:

Well the abscess on her neck is still dripping pus. The area around it is still rock hard but is getting smaller, its about 10" x 4" now. Her occluded jugular can be felt for a good 4" beyond the area of induration.

In herself she is getting better but still a long way from being normal. It looks like this is going to be a long, slow recovery. :-(
Moderator:
DrO

Posted on Wednesday, May 11, 2011 - 6:03 am:

As long as the direction of change is positive take heart and know one day there is a good chance this will be OK.
DrO
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