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Discussion on Pnemonia caused by a BAL Lavage
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New Member:
jennbk12
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Posted on Sunday, Nov 4, 2018 - 8:30 pm:
My horse came down with summer pasture asthma in July. It was finally diagnosed after 2 vet visits. We had her on antibiotics for a month to be sure there was not an underlying cause for her coughing at exercise and some at rest and her exercise intolerance. We had her allergy tested and started her on a variety of supplements. Her respiratory rate was generally around 20 breaths per minute. Once allergy shots were started, we purchased a nebulizer and nebulized her once a day. Her respiratory rate went to 16 and she coughed less, but it never went away-- especially during exercise. Last week we decided to have the vet (a new one) perform a BAL Lavage. He did a scope of her airway and found a mucus score of about a 2D. He thought she should have a BAL Lavage. She did and after two attempts (two different sets of tubings) he was able to have 2.5 syringes filled of fluid to send off for a diagnosis. Two days later, I notice she is not eating and feels hot. I take her temperature and it is 103.7. I give her bannermine and she seems fine and is eating in the morning. The next day, she has a fever and I take her to the vet who performed the lavage. He takes a blood sample and she has a slight elevated white blood count and after an ultrasound he determines she has pneumonia. The interesting thing is the BAL came back normal. He said that all we were doing to control the allergies was working, but that somehow the scope caused the pneumonia. Tomorrow after 2 days being on IV antibiotics (she is in the hospital there) we will find out a prognosis. I am scared to death. I went and saw her today, and she was eating. She had a temperature of 100.9 and her respiratory rate was 22 breaths per minute. The vet tech said she had no fever the past 48 hours since the antibiotics. I am desperate to have some answers. Recovery? permanent damage? questions to ask the vet? thank you so much. I love this horse completely.
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New Member:
jennbk12
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Posted on Monday, Nov 5, 2018 - 10:13 am:
The vet said the mass was down. He is taking her off IV antibiotics and putting her on oral for 2 more days. Penicilin and gentocin. Her respitatory rate over weekend was as high as 28. It was 16 this morning. No fevers. She is coming home on Wednesday. The vet does not want to give any more antibiotics after Wednesday. My husband is a physician and thinks that she should be on oral antibiotics longer. Please advise.
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Moderator:
DrO
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Posted on Tuesday, Nov 6, 2018 - 7:28 am:
Hello Jennbk12,
It would be unusual for me to keep a bacterial pneumonia on antibiotics for less than a week to 10 days but this is a clinical decision requiring an exam. Reading your earlier questions there really is not much I can offer other than the observation that a rapid turn around is a very good sign.
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New Member:
jennbk12
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Posted on Saturday, Nov 10, 2018 - 11:42 pm:
Recent development. The mass was not responding to treatment. The vet xrayed her lungs and found a large mass and several other masses in her lung. He took a biopsy from the largest mass--measuring around 8.92 x 8 cm. It doesn't look good. She is home now. No fever and appetite is good. She only has occasional cough, but will cough 6 or 7 at a time. We get results on Monday. I am guessing cancer. The mass was cream colored, solid and soft mass. Vet said it was unlikely to be melanoma. (She is grey) Nothing grew on the slide for 48 hours, so all antibiotics were stopped.
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New Member:
jennbk12
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Posted on Sunday, Nov 11, 2018 - 8:27 am:
I have the xrays if you are interested
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New Member:
jennbk12
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Posted on Monday, Nov 12, 2018 - 1:01 pm:
I just got test results back. The mass was her liver. She has a diaphramatic hernia. Some of her liver is in her lung, and guessing the other 'growths' are her intestines. They are sending the case to Texas A&M for further evaluation.
Thoughts?
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Moderator:
DrO
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Posted on Monday, Nov 12, 2018 - 3:08 pm:
Diaphramatic hernia is rare in the horse and often associated with trauma or general anesthesia recovery. Here is an interesting paper from a few years ago:
Vet Surg. 2013 Jun;42(5):591-4. Epub 2013 Apr 25.
Thoracoscopic diaphragmatic hernia repair in a warmblood mare.
Röcken M1, Mosel G, Barske K, Witte TS.
Author information
Abstract
OBJECTIVE:
To describe successful repair of a diaphragmatic hernia in a standing sedated horse using a minimally invasive thoracoscopic technique.
STUDY DESIGN:
Clinical report.
ANIMALS:
Warmblood mare with a diaphragmatic hernia.
RESULTS:
An 18-year-old Warmblood mare with severe colic was referred for surgical treatment of small intestinal strangulation in a diaphragmatic defect. Twelve days after initial conventional colic surgery, left-sided laparoscopy in the standing sedated mare for diaphragmatic herniorrhaphy failed because the spleen obscured the hernia. One week later, a left-sided thoracoscopy was performed in the standing sedated horse and the hernia repaired by an intrathoracic suture technique. No long-term complications occurred (up to 4 years) and the mare returned to her previous athletic activity, followed by use as a broodmare.
CONCLUSIONS:
To avoid the high risks associated with general anesthesia, and to reduce surgical trauma and postoperative recovery, central diaphragmatic hernias are amenable to repair using a minimally invasive thoracoscopic technique in the standing sedated horse.
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Member:
jennbk12
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Posted on Tuesday, Nov 13, 2018 - 11:05 am:
So the vet called last night and said the lab got the results wrong. IT wasn't her liver in the biopsy, but indeed was a pulmonary granular cell tumor. She has several smaller ones in her lung, but the big mass was 8 x 8 cm.
The vet felt very bad and is consulting with other vets for anything to prolong her life.
Any suggestions? Thank you.
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Moderator:
DrO
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Posted on Monday, Nov 19, 2018 - 10:46 am:
Could you post the whole lab report? How is the horse clinically.
DrO
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Member:
jennbk12
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Posted on Monday, Nov 19, 2018 - 11:25 am:
The horse is doing great clinically. Great appetite, respiratory rate 14- 16, outside and up at night in run. She coughs sometimes when letting out in the morning-- only if she runs. If she runs across pasture she will cough 4-6 times. She coughs at exercise, although I haven't ridden her since all of this. Three weeks ago she took 4 blue ribbons at a horse show with 4 jumps. She coughed before during warm up, but managed to subdue them during show. I have complete xrays and sonogram if you would like to see them. Vet is looking into removing right lung. She has several other tumors in her lungs that are smaller--looks to be golf ball size??? I am guessing. I am leaning toward just managing the symptoms and then eventually having to put her down when breathing gets difficult. Vet tells me there are no tumors in left lung.
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Member:
jennbk12
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Posted on Saturday, Nov 24, 2018 - 9:03 am:
Would it be possible to put an endoscope down and see if we could possibly cut out the part of the tumor that was in her airway? I realize it will grow back, but maybe it could give her a few more years of less blockage? I am thinking about taking her to A&M next week and seeing if they would think that was a possibility.
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Moderator:
DrO
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Posted on Sunday, Nov 25, 2018 - 8:51 am:
Hello jenn,
I do not have much to add to the diagnostic information in the report. As to treatment yes removal by endoscope is possible and in the case referenced in the report removal was followed up by laser and recurrence did not occur. The size may be prohibitive but there is a case where the effected lung lobe was removed and the horse did well but details of exercise levels are not readily available.
DrO
J Am Vet Med Assoc. 2000 Nov 15;217(10):1522-5.
Treatment of granular cell tumor via complete right lung resection in a horse.
Facemire PR1, Chilcoat CD, Sojka JE, Adams SB, Irizarry AR, Weirich WE, Morisset SS, Dutweiler VA.
Author information
Abstract
A 7-year-old warmblood mare was referred because of a respiratory tract disorder; pulmonary granular cell tumor was diagnosed. Pulmonary granular cell tumor is a locally invasive but rare type of tumor with low metastatic potential. The entire right lung was resected to ensure removal of all neoplastic tissue. The horse recovered well and has minimal difficulties functioning with one lung. Most of these tumors are diagnosed during postmortem examination. To our knowledge, this is the first report of pulmonary granular cell tumor treated by complete lung resection in a horse.
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Member:
jennbk12
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Posted on Tuesday, Nov 27, 2018 - 1:51 pm:
I have a bronchoscopy scheduled for Thursday at 9:30 a.m at Texas A&M.
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Moderator:
DrO
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Posted on Wednesday, Nov 28, 2018 - 9:12 am:
Good Luck Jenn, let us know how it goes.
DrO
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