EQUINE VETERINARY EDUCATION / AE / FEBRUARY 2022
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a)
b)
c)
d)
Fig 5: Follow-up CT examination of the head performed 30 days after discharge (55 days post-presentation). Transverse images a) (rostral), b) (orbital), c) (caudal) and d) (cervical) correspond to the images in Figures 2 and 3. There is resolution of the previously identified emphysema. There is moderate thickening of the soft tissues of the ventral conchal sinus consistent with chronic sinusitis (arrowhead).
common aetiology of post-intramuscular injection (Peek et al. 2003). In both of these regions, the clinician is quickly able to perform a therapeutic fasciotomy to expose the causative anaerobic bacteria to air. In the cervical region, the fasciotomies are made dorsal to the vertebral column and ventral to the nuchal ligament, while in the gluteal region the position of the sciatic nerve should be avoided. In direct contrast, the head presents a particular anatomical challenge. The abundance of vital structures in the affected region made the prospect of performing fasciotomies in this region daunting. The CT helped to target the guide and minimise the number of incisions required, while also helping to approximate the position of the distorted anatomy. The extension of the emphysema to the cranial cervical musculature observed on the second CT increased concern for development of ataxia and for long-term consequences
of the infection such as right laryngeal neuritis/chondritis. Fortunately, following the second fasciotomy procedure and the addition of gentamicin to the treatment protocol, the infection began to resolve, as demonstrated by the slow resolution of the emphysema identified by CT and by improvement of clinical signs and attitude. As well as aiding in diagnosis, surgical planning and
clinical monitoring of the infection, the serial CT examinations were helpful for communication with the owner. The extensive gas bubbles within the soft tissues were easy for the owner to recognise and aided in their understanding of the case. Although not inexpensive, the owner felt the evidence of improvement that the CTs provided was of great emotional value, particularly as visitation of the gelding was not permitted due to the hospital policy instated during the COVID-19 outbreak. The availability of a standing head CT
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