Received: 13 July 2022 | Accepted: 27 November 2023 DOI: 10.1111/eve.13935_1
C A S E R E POR T
Haemopneumothorax as a complication of bronchoalveolar lavage
Elizabeth K. Kopec | Richard Hepburn | Becky Jones | Sarah Smith B & W Equine Hospital , Gloucestershire , UK
Correspondence: Elizabeth K. Kopec Email:
lizzie.kopec@hotmail.co.uk
SUMMARY This is a single case report of an 8- year- old Thoroughbred gelding that de- veloped haemopneumothorax as a complication of a bronchoalveolar lavage (BAL) procedure. BAL was performed due to recurrent episodes of EIPH. Haemopneumothorax as a complication of BAL has not been reported in the horse or any other species. BAL is considered a safe procedure with minimal complication risk. Haemopneumothorax has only been reported in the horse following trauma to the thoracic cage. The horse was admitted 2 days follow- ing the BAL procedure due to dullness and tachypnoea. Clinical findings and diagnostic imaging (thoracic radiography and ultrasonography) diagnosed bi- lateral haemopneumothorax. A transtracheal aspirate (TTA) suggested septic inflammation whilst thoracocentesis on admission identified haemorrhagic effusion. Microbiological culture results from the thoracocentesis received 7 days following admission identified profuse growth of lactose- fermenting coliforms. Initial treatment comprised a single treatment of tranexamic acid as a putative antifibrinolytic agent, broad- spectrum antimicrobials and nonsteroidal anti- inflammatories. The horse improved until day six of hos- pitalisation when he became pyrexic. The hemithoraces were drained due to concern that a septic focus may have developed as a result of the injury associated with haemothorax. The pneumothorax on the left side was de- compressed. Pyrexia resolved within 24 h of drainage. Cytological analysis of fluid was consistent with previous haemorrhage but was not consistent with
infection. A TTA was performed to reassess for inflammation/infection in the lower respiratory tract and microbiological culture grew a nonhaemolytic staphylococcus sensitive to the antimicrobials the horse had been receiv- ing since admission. Repeat thoracic radiography showed the haemothorax and pneumothorax to be largely resolved; however, a horizontal fluid–gas interface spanning three rib spaces had become apparent approximately 2 cm ventral to the vertebral column which was localised to the mid- dorsal tho- rax. Ultrasound examination identified a focal hypoechoic area, suggestive of fluid, approximately 2–3 cm deep to the pleural surface of the left mid- cranio- dorsal lung was now apparent. This was suspected to be the site of the origin of haemorrhage. It was hypothesised that this represented an area of lung fibrosis that had resulted from previous episodes of EIPH and had been damaged during the BAL procedure. The horse was discharged and returned to racing 297 days post- admission to the hospital.
K E YWORDS horse , BAL , bronchoalveolar lavage , EIPH , haemopneumothorax
Key points
• Bronchoalveolar lavage (BAL) is considered a safe procedure with few complications that are often transient in nature. In horses, there is a single report of BAL causing fatal haemor- rhage in a mare following BAL procedure. Owners should be appropriately informed of potential complications of the procedure.
FIGURE 1 B- mode ultrasound images of the left thorax taken 13 days post- admission, using a convex abdominal probe and in a longitudinal orientation. The image shows a superficial hypoechoic area, consistent with fluid. The ventral margin is outlined by a hyperechoic rim, consistent with lung surface. There is reverberation artefact (B lines) present, consistent with an irregular pleural margin (white arrows).
• Haemopneumothorax as a complication of BAL has not been reported in the horse or any other species. The area of abnor- mality seen in this horse was suspected to be the site of the origin of haemorrhage (Figure 1). It was hypothesised that this represented an area of fibrosis of the lung that had resulted from previous episodes of EIPH and had been damaged during the BAL procedure.
• In this case study, the horse made a full recovery and returned to racing following bilateral haemopneumothorax as a com- plication of BAL.
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Equine Vet Educ. 2024;36:292.
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