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Guttural Pouch Mycosis in a 7-year-old Quarter Horse Gelding

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A 7-year-old Quarter horse gelding presented to Cornell’s Large Animal Emergency Service for evaluation and treatment of unilateral epistaxis caused by guttural pouch mycosis. The client found the patient in the barn in the morning with a large pool of blood and unilateral epistaxis. The bleeding was stopped with cold hydrotherapy. The referring veterinarian examined the patient endoscopically and determined that the bleeding was coming from the right guttural pouch. A diagnosis of guttural pouch mycosis was made and the patient was referred to Cornell for treatment. On presentation, the patient was bright, alert, and responsive with normal vital signs. The patient’s mucous membranes were pale with a prolonged capillary refill time of 3 seconds. There was a trickle of blood coming from the right nostril. The patient was also anemic with a PCV of 24%. Endoscopy revealed a large blood clot in the right guttural pouch and a white to tan plaque in close proximity to the internal carotid artery. The left guttural pouch appeared normal. A diagnosis of right guttural pouch mycosis was confirmed. The patient was taken to surgery the following day and two stainless steel embolization coils were placed in the internal carotid artery proximal to the lesion to stop bloodflow to the mycotic plaque. The patient recovered well from surgery, and his PCV increased to 29%. An endoscopic examination was performed before the patient was discharged, and revealed no pulse in the internal carotid artery and symmetrical arytenoids. A follow up conversation with the referring veterinarian revealed that the patient has recovered well from the procedure with no further episodes of epistaxis. This paper will review guttural pouch anatomy, review differentials for epistaxis, and describe guttural pouch mycosis as well as treatment options.

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2016-02-03

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Guttural pouch mycosis, transarterial coil, epistaxis, Aspregillus nidulans

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case study

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