Transarterial Embolization in a Thoroughbred Gelding with Guttural Pouch Mycosis

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An 11-year-old Thoroughbred gelding was referred to Cornell’s Equine & Nemo Farm Animal Hospital for emergency evaluation due to severe epistaxis. The gelding had a month long history of nasal discharge, ranging from mucoid and yellow to small volumes of sanguineous discharge. On presentation, the gelding was bright, alert, and responsive. Physical examination showed evidence of prior sanguineous nasal discharge from the left nostril with no active bleeding, moderate tachycardia and pale mucous membranes. Differentials for the gelding included trauma, guttural pouch mycosis, ethmoid hematoma, and neoplasia. Anemia and hypoproteinemia were identified on intake bloodwork. Upper airway endoscopy revealed extensive clot formation and fungal plaques in the left guttural pouch, confirming guttural pouch mycosis. Transarterial embolization by a minimally invasive surgical technique, involving occlusion with coils and nitinol vascular plugs, was selected as the treatment modality. The gelding was admitted to the hospital and was cross matched with a blood donor in preparation for a transfusion during the procedure. He was started on aminocaproic acid to stabilize clot formation. He was also started on broad spectrum antibiotics to treat any secondary bacterial infection as well as prophylactically for surgery. Under general anesthesia, transarterial embolization was achieved with two Amplatzer ™ nitinol vascular plugs deployed in the internal carotid artery and embolization coils deployed into the maxillary artery and external carotid artery. Two days post-operatively, the gelding’s guttural pouch was fenestrated by a transnasal endoscopic laser surgery to improve access for topical antifungal application as well as to change the guttural pouch environment. The gelding was discharged from the hospital and was reported to be doing well two weeks after the procedure.

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Guttural Pouch Mycosis; Transarterial Embolization; Epistaxis


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