Success Story: Ethmoid Hematoma
In July of 2012, Jimmy, a 22 year-old Thoroughbred gelding, was brought to the UF Large Animal Hospital because he was bleeding from both nostrils and his right eye had severe swelling. His owner, Lisa Batts, traveled through a tropical storm to get to Gainesville at 1 a.m.
“There was a medical team waiting for Jimmy,” Batts said. “When we arrived, they rushed him right into the hospital and immediately got to work. Jimmy had so much swelling that his airways were being choked off and his right eye had started to protrude out of the socket.”
The UF Emergency Services were there to meet Jimmy; Dr. Chris Sanchez, board-certified veterinary internal medicine specialist and associate professor, immediately examined him.
“Jimmy was having trouble breathing so we immediately performed a tracheotomy and gave pain medications to make him more comfortable,” Dr. Sanchez said. “We needed to see what was causing the swelling and blocking Jimmy’s airway, so we took radiographs and performed an endoscopy which showed a very large mass within the sinuses and significant swelling in his throat.”
The next day, Dr. Sanchez spoke with Dr. Sarah Graham, board-certified veterinary surgeon and clinical assistant professor, about the radiographs and endoscopic findings. They discussed the options and recommended a CT scan before proceeding. Due to Jimmy’s age and the extreme size of the mass, there was some concern that it could be a tumor. A CT of the head would help to define the mass and determine if it was operable or not.
“Based on the doctors’ advice, I asked for the CT and it showed that although the mass was very large, they said that it did not look like cancer,” Batts said. “The doctor then took me into the teaching classroom so that she could show me a horse skeleton and explain the procedure that they would perform to remove the mass and save his life.”
After a scary start, the CT scan gave hope that Jimmy could be cured with surgery.
“The CT showed an expansive mass that had filled the sinuses, deformed the bone and caused the eye to protrude from the socket,” Dr. Graham said. “The good news was that it did not appear aggressive in nature. We were fairly certain that Jimmy could be treated and would have a good prognosis for recovery. So, we elected to perform a frontonasal sinus flap with the horse awake and standing but sedated.
“The frontonasal bone flap approach, which was originally developed by UF’s own Dr. David Freeman, involves cutting the bone on the front of the horse’s head so that you have a large window into the sinuses. This way we could access the origin of the mass and remove it in one big piece,” said Dr. Graham.
The procedure was done standing in order to decrease the risk of bleeding and increase surgical exposure. It also reduces the cost and risks associated with general anesthesia. According to Dr. Graham, “most horses tolerate the procedure extremely well. With appropriate local blocks and pain medications, I don’t think it is any more painful this way.”
The surgery was a success and Jimmy stayed at UF for a few days to recuperate before going back home. The mass was diagnosed as an Ethmoid Hematoma. This type of mass is unique to horses, is not cancerous and complete removal is often curative. Jimmy’s clinical signs were particularly severe; the first sign for most horses with this condition is low-level bleeding from one nostril.
“Within six weeks, Jimmy and I started riding again and we haven’t stopped since,” Batts said. “Jimmy will be 23 this May and I have a new appreciation for how precious every ride is because he may not be with me forever. Jimmy and I are still having a great time and I love every hair on his head.”
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