Iatrogenic lipoid pneumonia in an adult horse

By Jenni Varjonmaa VM1

Outline

Keywords

Introduction

Patient's history

Clinical findings

Further investigation and therapy

Post-mortem findings

Discussion

Conclusions

References

Keywords

Lipoid pneumonia

Mineral oil

Nasogastric intupation

Introduction

Mineral oil is commonly used in equine practice

A lubricant in cases of gastrointestinal impaction

A purgative in cases of potential toxicosis

Administration of mineral oil via nasogastric intubation carries a risk of causing lipoid pneumonia

Lipoid pneumonia: A severe inflammatory reaction to the presence of oil in the lungs

NB! Usually fatal to horses

Patient's history

A 20-year-old gelding presented with a history of acute respiratory distress

Had begun after administration of a mineral oil and water mix, via nasogastric intubation, for treatment of suspected gastrointestinal dysfunction

Signs of acute respiratory distress:coughing, increased respiratory effort and rate, profound nostril flare, anxiety

After the initial tratment there were no signs of improvementfor further evaluation

Clinical findings

The gelding was in a good body condition but sweating

Tachycardic (88 beats/min)

tachypnoeic (26 breaths/min)

Bloody discharge from both nostrils

Bilateral inspiratory and expiratory wheezes in the caudodorsal lung fields

Reduced vesicular sounds bilaterally in the ventral lung fields

Further investigation and therapy

An arterial blood gas analysis revealed:

Arterial hypoxaemia (64mmHg, reference range rr. 90-115 mmHg)

Mild oxygen desaturation (92.3%, rr. > 95%)An intra-nasal cannula and oxygen insufflation initiated (15L/min) A long-term catheter and treatment with intravenous fluids

The arterial blood gas values deteriorated

Thoracic radiographs revealed aspiration pneumonia

[Picture]: Lateral radiograph of the caudodorsal lung field. A mixedbronchoalveolar-interstital pattern (typical of aspiration pneumonia) is present (arrows).Further investigation and therapy

Physical examination, diagnoctic findings and continued decline in the horse's conditioneuthanasia

Post-mortem findings

Marked congestion of the trachea, particularly in the distal half, with a large quantity of oil globlets present in the lumen

Pulmonary emphysema

A large amount of oil globules were apparent in the pulmonary parenchyma

Lipid droplets are grossly visible withinthe lumen of the trachea (arrows).

Discussion

Respiratory distress with a history of nasogastric intubation The majority of cases of lipoid pneumonia

Equine lipoid pneumonia are chronic rather than acute in nature

Horses with potential lipoid pneumonia

Thoracic auscultation reveals abnormal lung sounds

Thoracic ultrasonography reveals an increased number of comet tails

Discussion

Ante-mortem diagnosis of lipoid pneumonia can be made by confirming the precence of lipid within the lower highway by examiniting fluid obtained

From a bronchoalveolar lavage (BAL)

From trans-tracheal wash/aspiration

To identify the specific type of lipid compound in the lung tissue; chemical analysis, spectroscopy and chromatography

Treatment of exogenous lipoid pneumonia:

consisting of supportive care and antibiotics if secondary complications arise

Conclusions

Veterinarians should be aware that aspiration of fluids during nasogastric intubation is a serious risk of lipoid pneumonia and restrain properly the horse and carefully check that the tube is still in place if any movement occurs

Sick, sedated or refluxing animals may have a reduced swallowing reflex which makes it difficult to properly place the tube

The stomach tube may be in the oesophagus resulting in regurgitation and aspiration

References

Iatrogenic lipoid pneumonia in an adult horse (Irish Veterinary Journal Volume 63 Number 5 20)

Carolyn Cummins, Lisa Katz, Eva Maischberger and Lucy Metcalfe

Section of Veterinary Clinical Studies, University Veterinary Hospital, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin

http://www.irishvetjournal.org/content/pdf/2046-0481-63-5-303.pdf

Thank you for your attention!