A 17-year-old Percheron gelding presented to Cornell’s Equine and Nemo Farm Animal Hospital following a three-week history of intermittent pyrexia and weight loss. Clinical signs were preceded by an episode of choke and did not improve despite treatment with multiple antibiotics and non-steroidal anti-inflammatories by the gelding’s referring veterinarian.
Upon presentation, the gelding was tachycardic, tachypneic, and had an increased respiratory effort. On the left, lung sounds were absent ventrally and decreased dorsally. Ultrasound showed a significant amount of hyperechoic fluid in the left cranio-ventral pleural space. A chest tube was placed and 10 liters of purulent, fetid fluid drained from the pleural space which was then lavaged and infused locally with antibiotics. Culture results showed a mixed infection with ​Trueperella pyogene​s, ​Peptostreptococcus anaerobiu​s, and ​Bacteroides pyogenes​. Over the next two weeks, the gelding was kept on systemic broad-spectrum antibiotics with anaerobic coverage while being medically managed for pleuropneumonia and endotoxemia. At discharge, he had improved clinically but continued to have a moderate amount of lung pathology based on ultrasound.
Following discharge, the gelding returned for a 2-week and 4-week recheck. At the first recheck, a chest tube was placed over the left cranioventral lung lobe based on ultrasound and 7.5 liters of flocculent mucopurulent fluid was drained. The pleural space was then lavaged and infused locally with antibiotics. At the second recheck, ultrasound showed a large amount of hypoechoic fluid in the left cranio-ventral pleural space. Due to reoccurrence, treatment options moving forward were discussed and a standing left-lateral thoracotomy was elected. The procedure went well and the gelding was discharged two-weeks later to the care of his owners to continue post-operative management. This senior seminar will focus on the pathophysiology of pleuropneumonia in horses, treatment options, and management following thoracotomy.