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Equine Clinical Case Challenge – Lethargy
History A 2-year-old Warlander mare presented with a history of lethargy.Presentation Initial physical exam revealed a temperature of 99 degrees, heart rate ...
September 20, 2017

History

A 2-year-old Warlander mare presented with a history of lethargy.
Presentation

Initial physical exam revealed a temperature of 99 degrees, heart rate ranging from 84-100 beats/minute and a respiratory rate of 16 breaths/minute. Blood work revealed a PCV of 16%, total protein of 4 g/dl and a lactate of 9.6 mmol/L.

Below is the ultrasound obtained from the left 13th intercostal space (dorsal is on the right of the image).

What structures and abnormalities do you see? What is your differential diagnosis?

Notice the hypoechoic areas within the spleen. Additional differentials for this appearance of the spleen should include neoplasia or splenic abscess. However, with the acute nature of the clinical signs and the visible kick mark along the left abdomen (see picture), the final diagnosis seemed likely.

Diagnosis

ultrasound case challenge
The horse above suffered from a splenic hematoma/tear with associated hemoabdomen.

Notice, in the below ultrasound, the enteritis characterized by thickened, edematous small intestinal walls that was caused by the inflammatory environment within the abdomen.

Treatment

Treatment consisted of IV fluid therapy and aminocaproic acid (antifibrinolytic). Cross-matching was performed, but in the end a blood transfusion was not required. At the time of discharge four days later, blood work revealed a PCV of 30%, total protein of 7.9 g/dl and a lactate of 2.2 mmol/L.