Bullous emphysema with haemorrhage in a premature foal

Abstract

Summary A Warmblood foal was admitted at one day of age because of prematurity and seizures. Clinical and clinical pathology abnormalities were consistent with prematurity and suspected hypoxic seizures that responded to anti‐convulsive therapy. The foal stabilised after several days of intensive care but then developed an airway infection. Thoracic radiographs showed multiple cavitary lesions and ultrasound examination suggested intra‐cavital haemorrhage. The foal went on to develop septicaemia and was subjected to euthanasia. Post mortem examination revealed multiple bullous emphysema with haemorrhage. This disorder should be considered in the differential diagnosis of foals having air‐fluid filled cavities on thoracic radiographs.

Neonatal respiratory distress and sepsis in the premature foal: Challenges with diagnosis and management

“…It is interesting to note that some biomarkers for sepsis were within reference ranges during the early stages of the foal's treatment (such as the results of haematology and determination of plasma fibrinogen concentration). As noted by Bezdekova et al . (2012), the vigilant veterinary diagnostician must be aware of potentially misleading laboratory results and be suspicious of sepsis in cases such as this, even in the absence of supporting laboratory data.…”

“…The foal had continued to progress well into adulthood. As with the antecedent case (Bezdekova et al . 2012), the cause of pulmonary emphysematous bullae in our foal was unclear.…”

“…Many aspects of the accompanying clinical report (Bezdekova et al . 2012) are deserving of significant discussion and speculation.…”

“…The foal reported in the accompanying article (Bezdekova et al . 2012) was unquestionably premature, small for its birth weight, and had been born unready for extrauterine life, but significant clinical, radiographic and laboratory characterisations had not been performed during the first 24 h of its life.…”

“…The differential diagnosis of seizures in a newborn foal is extensive. Although the authors of the accompanying article (Bezdekova et al . 2012) speculated that the foal's seizures may have resulted from (unspecified) cerebral hypoxia, other likely candidates for the aetiology of seizures in this case would include PAS (hypoxic/ischaemic encephalopathy or maladjustment), intracranial trauma (haemorrhage or oedema), sepsis, viral/bacterial meningoencephalitis, or a developmental/congenital brain abnormality (such as hydrocephalus) (Paradis 2006; Mayhew 2009).…”