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ultrasound-guided fine needle aspirate of the mass yielded no material. Lancing of the structure with a stab incision from the lateral aspect of the femur was attempted and resulted in profuse haemorrhage. Sterile packing of the incision with a gauze roll was performed, after which the horse recovered uneventfully from anaesthesia.
Case management Haematological analysis was unremarkable with a PCV of 33%, red blood cell count of 7.11 ¥ 1012/l (rr of 5.5–9.5), white cell count of 6.14 ¥ 109/l (rr 6–12.0), with 82% mature and 6% immature neutrophils. Plasma fibrinogen level was 4 g/l (rr 1–4 g/l). The horse was administered penicillin (Benzyl Penicillin Fresenius)6 (22,000 iu/kg bwt i.v. q. 6 h), amikacin (Amikacin Fresenius, 25 mg/kg bwt i.v. q. 24 h)3 and metronidazole (Bemetazole, 15 mg/kg bwt per os q. 8 h)7. An epidural catheter (Epidural catheter set)8 was placed in the first coccygeal space and epidural analgesia administered with morphine (0.04 mg/kg bwt), detomidine (Domosedan, 0.002 mg/kg bwt)5 and lidocaine (Lignocaine 2%, 0.04 mg/kg bwt)9 every 6–8 h. A modified Robert Jones bandage, which included the
Fig 1: Severe right hindlimb swelling extending from the proximal femoral area to the distal aspects of the tarsus (arrowheads). A stab incision, packed with sterile gauze (white arrow), is present on the lateral femoral area. A modified Robert Jones bandage with a plantar splint is present (black arrow).
foot and a plantar splint, was placed on the affected distal limb to maintain the digit in extension. A support bandage was placed on the contralateral limb. The horse received 12 l intravenous crystalloid fluids during the night. During the first 2 days his level of comfort increased markedly. On the third day after admission, haematological analysis
was repeated, revealing a low normal PCV of 25%. No other abnormalities were present. Plasma fibrinogen and serum creatinine were within normal limits. The gauze packing in the previously mentioned incision was replaced without further bleeding. A bandage was applied to the right tarsus to reduce swelling. The epidural catheter was no longer patent and was removed. Phenylbutazone (Phenylarthrite)10 was added as an analgesic agent (2.2 mg/kg bwt i.v. q. 12 h). Due to low faecal production, magnesium sulphate (1 g/kg bwt) and 6 l of water were administered via nasogastric intubation. For the next 5 days the horse received hydrotherapy
Fig 2: Ultrasonographic image of a well encapsulated mass (white arrow) in the region on the proximal cranio-lateral region of the femoral diaphysis (arrowhead). Cranial is to the left.
Ventro-dorsal views of the right hemi-pelvis and medio-lateral views of the femur and stifle joint were obtained. No osseous abnormalities were evident in any of the radiographs. Ultrasonographic examination of the femoral area was repeated. A 7 ¥ 12 cm round structure with an irregularly marginated capsule-like structure with a heterogeneous lumen filled with hypoechoic contents and some hyperechoic particles was found at the proximal lateral region of and adjacent to the femoral diaphysis (Fig 2). These findings were consistent with an organising haematoma or an abscess. An
of the affected limb between daily bandage changes. The horse maintained a persistent tachycardia of 60–72 beats/min and low PCV (the lowest being 18% on the sixth day, with TSP 68 g/l) but showed marked clinical improvement. The swelling of the affected limb decreased, he became bright and alert and was able to bear full weight on the splinted limb. Medication was discontinued except for phenylbutazone (Phenylbutazone, 2.2 mg/kg bwt per os q. 12 h)11 and the gauze packing was removed from the incision. Due to financial constraints the horse was discharged from hospital on phenylbutazone (2.2 mg/kg bwt per os q. 24 h) with instructions to have the PCV monitored by the referring veterinarian. At this stage a torn muscle with peroneal nerve neuropathy possibly secondary to swelling or intramuscular haemorrhage (Katz et al. 1991; Kaymak et al. 2002) was considered the most likely diagnosis. The owners reported profuse haemorrhage from the
previous incision 4 days after discharge. The referring veterinarian packed and sutured the incision and referred the horse back to the OVAH. On presentation there was severe tachycardia (100 beats/min), tachypnoea (40 breaths/min), rectal temperature of 38.1°C, pale mucous membranes with a PCV of 21% and TSP of 70 g/l and grade 4/5 lameness of the
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