Acute hemorrhagic pulmonary infarction and necrotizing pneumonia in horses: 21 Cases (1967-1993)

Objective - To characterize history, clinical signs, and pathologic findings in horses with histologically confirmed acute hemorrhagic pulmonary infarction and necrotizing pneumonia. Design - Retrospective study. Animals - 21 horses. Results - 19 of the 21 horses were Thoroughbred racehorses in training. Eighteen horses had had strenuous exercise immediately prior to onset of illness. Fifteen horses had a serosanguineous nasal discharge during hospitalization. Seventeen horses had radiographic evidence of pulmonary consolidation and pleural effusion. Nine of 14 horses had ultrasonographic evidence of large pulmonary parenchymal defects consistent with consolidation. Pleurocentesis yielded a suppurative, serosanguineous effusion in the 14 horses in which it was performed. Bacteria were isolated from all transtracheal aspirates (14) and from 6 of 12 pleural fluid samples. Actinobacillus suis-like organisms and Streptococcus equi subsp zooepidemicus were most commonly isolated. Nineteen horses were hospitalized and treated. Mean duration of treatment was 5 days, and most horses were euthanatized because of secondary complications, continued costs of medical treatment, or poor prognosis for future performance. Pathologic lesions included well-demarcated regions of hemorrhagic pulmonary infarction with necrosis and a serosanguineous pleural effusion. Thrombosis of pulmonary vessels was found in 11 horses. Clinical Implications - An acute or peracute onset of severe respiratory distress, with serosanguineous nasal discharge, ultrasonographic and radiographic evidence of severe pulmonary consolidation, and serosanguineous suppurative pleural effusion, is strongly suggestive of pulmonary infarction in horses. Horses with pulmonary infarction responded poorly to conventional treatment for pleuropneumonia and had a poor prognosis for recovery.