Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland.
Department of Internal Diseases with Clinic for Horses, Dogs and Cats, Wroclaw University of Environmental and Life Sciences, Grunwaldzki 47, 50-366, Wroclaw, Poland.
BMC Vet Res. 2019 May 24;15(1):169. doi: 10.1186/s12917-019-1922-9.
Pulmonary hemorrhage is a rare cause of death in horses. Hemorrhage within the respiratory tract has many causes, including mycosis of the guttural pouch, invasive procedures causing serious trauma to nasal conchae, or lung biopsy. We report on a rare case of a fatal pulmonary hemorrhage in a horse after a severe cough during bronchoalveolar lavage. To the best of our knowledge, this is the first report of spontaneous hemorrhage in a horse during bronchoalveolar lavage.
A 21-year-old mare which belonged to the didactic herd of The Faculty of Veterinary Medicine underwent BAL procedure for training purposes. Clinical examination prior to the procedure did not reveal any abnormalities and the horse had been classified as healthy. The horse was sedated with 0.01 mg/kg of detomidine and 0.01 mg/kg of butorphanol. The silicon BAL catheter was passed through the nasal passage into the trachea and then into the bronchus. Before catheter was wedged, the mare began to cough heavily and massive haemorrhage from mouth and nostrils occurred. Despite fluid therapy, shock occurred within 15 min and the mare was euthanized. Upon necropsy, site of hemorrhage was identified in the left lobar caudal bronchi, from a large blood vessel running directly beneath the bronchial wall. Upon histology, a chronic lympho-plasmocytic inflammatory process in left bronchi was identified. Moreover, Masson's trichrome staining revealed severe, perivascular fibrosis.
Although BAL is a relatively safe procedure, and such complications should be treated as extremely rare, this case indicates that, in some individuals with specific subclinical problems, even mild physical force such as a cough can lead to rupture of the artery.
肺出血是马死亡的罕见原因。呼吸道出血有许多原因，包括咽囊真菌病、鼻甲骨严重创伤的侵入性操作或肺活检。我们报告了一例在支气管肺泡灌洗后剧烈咳嗽导致马致命性肺出血的罕见病例。据我们所知，这是首例在支气管肺泡灌洗过程中马自发性出血的报告。
一匹 21 岁的母马属于兽医学院教学马群，为了训练目的进行 BAL 程序。在进行该程序之前，临床检查未发现任何异常，马被归类为健康。马用 0.01 mg/kg 的地托咪定和 0.01 mg/kg 的布托啡诺进行镇静。硅 BAL 导管通过鼻道进入气管，然后进入支气管。在导管楔入之前，母马开始剧烈咳嗽，口鼻大量出血。尽管进行了液体治疗，但在 15 分钟内出现休克，马被安乐死。尸检时，在左肺叶尾支气管发现出血部位，来自直接位于支气管壁下方的大血管。组织学检查发现左支气管有慢性淋巴浆细胞炎症过程。此外，Masson 三色染色显示严重的血管周围纤维化。
尽管 BAL 是一种相对安全的程序，这种并发症应被视为极为罕见，但本例表明，在某些具有特定亚临床问题的个体中，即使是轻微的体力活动，如咳嗽，也可能导致动脉破裂。
