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Background: Upper respiratory disease was reported over many seasons in Arabian foals on a single stud farm in the Middle East. Affected foals were noted to have mucopurulent nasal discharge, cough, fever and tachypnea. All affected foals had been empirically treated with a macrolide and rifampicin, by the referring veterinarian without improvement. On endoscopic examination, all affected foals had significant guttural pouch empyema (GPE)., Objectives: (1) To document a previously unreported presentation of guttural pouch empyema (GPE) in a family of juvenile Arabian foals; (2) To document the cytological and microbial composition of the empyema; (3) To identify clinical signs significantly correlated with the presence of GPE, as predictors for the need for guttural pouch (GP) endoscopy; (4) To demonstrate successful resolution of the identified syndrome with mechanical GP lavage and evidence based antimicrobial use, improving antibiotic stewardship and the one-health approach to respiratory disease in this demographic of foals., Methods: Evaluation and scoring of clinical signs, upper airway endoscopy and thoracic ultrasound were performed in 14 affected foals and 10 age-matched controls, followed by comparative tracheal and guttural pouch sputum culture and cytological evaluation. Therapeutic GP lavage was performed and response to therapy monitored., Results: GPE, cranioventrally distributed ultrasonographic lesions and opportunistic pathogen infection suggested a primary lesion of GPE with aspiration of GP discharge into the lungs. GP lavage resolved the empyema and associated clinical signs in all cases., Conclusions: Cytological examination of tracheal and guttural pouch aspirates revealed a neutrophilic exudate with lipid-laden phagocytes, suggestive of engulfed milk. Bacteriology revealed a high prevalence of Streptococcus equi ssp. zooepidemicus admixed with other opportunistic pathogens. Streptococcus equi ssp. equi was not isolated in any case., (© 2023 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

Background: Bacterial meningitis (BM) and meningoencephalitis (BMEM) are associated with high case fatality rates and neurologic sequelae in people, but limited data exists on outcome in dogs., Hypothesis/objectives: To report the clinicopathologic features, treatment and outcome of BM/BMEM in dogs, with a focus on clinical presentation, relapse and long-term neurological deficits., Animals: Twenty-four client-owned dogs diagnosed with BM/BMEM without empyema., Methods: Retrospective case series of dogs diagnosed with BM/BMEM from 5 veterinary referral hospitals between January 2010 and August 2020., Results: Twenty-four dogs were included. Median duration of clinical signs was 2 days (range ≤24 hours to 30 days) and signs recorded included pyrexia (3) and cervical hyperesthesia (10). Neurological deficits were present in 18 dogs including altered mentation (12), ataxia (8), nonambulatory status (8), head tilt (8), and cranial nerve deficits (13). Intracellular bacteria were visualized on cerebrospinal fluid (CSF) analysis in 15/24 dogs, with positive CSF bacteriological culture in 8/21. Otitis media/interna (OMI) was diagnosed in 15/24 dogs, of which 6/15 dogs underwent total ear canal ablation and lateral bulla osteotomy. Twenty dogs survived to hospital discharge. Median duration of antibiotic administrations was 8 weeks (range, 2-16 weeks). Glucocorticoids were administered to 15 dogs. Median follow-up time was 92 days (range, 10-2233 days). Residual neurological deficits were reported in 9 dogs, with a single case of suspected relapse., Conclusions and Clinical Importance: Clinical signs were variable in dogs with BM/BMEM, the nidus of bacterial infection was often OMI and the majority of dogs made a full recovery with treatment., (© 2023 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

A 5-month-old intact female mixed cat presented with repetitive paraplegia and drainage of pus from the back despite continuous antibiotic medication. Neurologic examination was consistent with below T3-L3 myelopathy. Computed tomography and magnetic resonance imaging revealed a contrast-enhanced mass in the L1-3 spinal canal, and bone fragments in the T13 and L1 spinal canal. Spinal epidural empyema was suspected, and hemilaminectomy was performed for T12-L2 on the right side and T11-12 on the left side. Bone fragments were diagnosed as sequestrum infected with Bacteroides sp. The cat recovered enough to ambulate next day. One month after surgery, there was no deficit in neurological function. This is the first report of spinal epidural empyema concurrent with sequestrum in a cat.

Objective: To report the clinical outcomes of horses with chronic guttural pouch infection characterized by accumulation of mucopurulent material following transpharyngeal diode laser fenestration., Animals: 13 client-owned horses., Procedures: Horses undergoing diode laser fenestration for chronic guttural pouch infection were identified by medical record search. Signalment, disease history, presence of mucopurulent empyema or chondroids, and pre- and postoperative therapy were recorded. Owners were contacted for follow-up information at a minimum of 6 months following surgery., Results: 13 horses underwent laser fenestration for chronic guttural pouch infection. Thirteen had mucopurulent nasal discharge on presentation, and 3 were coughing. At follow-up, 12 horses treated with transpharyngeal diode laser fenestration had complete resolution of nasal discharge and coughing. One horse, despite resolution of guttural pouch infection on endoscopy, continued to have nasal discharge and coughing attributed to concurrent equine asthma syndrome. All owners expressed satisfaction with the surgical procedure and clinical resolution of guttural pouch infection., Clinical Relevance: This surgical technique for transpharyngeal diode laser fenestration of the guttural pouch was uncomplicated to perform and well tolerated in sedated horses and attributed to resolution of clinical signs associated with guttural pouch infection, and owners reported a high satisfaction with the clinical outcome. Implementing this surgical technique could be considered to hasten resolution of chronic guttural pouch disease in horses with few technique-related complications.

Objectives: The aim of this study was to evaluate whether clinical variables from the history, clinical presentation, and physical and neurological examinations of cats with vestibular syndrome were statistically predictive of the underlying diagnosis., Methods: In total, 174 cats presenting with vestibular syndrome between January 2010 and May 2019 were investigated. Univariate statistical analysis of clinical variables was performed and those statistically associated with a diagnosis were retained for multivariable binary logistic regression modelling., Results: The seven most prevalent diagnoses represented 95% of vestibular presentations, which included: otitis media/interna (n = 48), idiopathic vestibular syndrome (n = 39), intracranial neoplasia (n = 24), middle ear polyp (n = 17), feline infectious peritonitis (n = 13), thiamine deficiency (n = 13) and intracranial empyema (n = 11). Idiopathic vestibular syndrome was commonly associated with non-purebred cats and had 17.8 times the odds of an improving clinical progression (95% confidence interval [CI] 1.3-250.0; P  = 0.03). Intracranial neoplasia was associated with older age and chronic onset of clinical signs, and was significantly more likely to have a central vestibular neuroanatomical localisation (95% CI 8.5-344,349,142.0; P  = 0.015) with postural deficits on neurological examination. Thiamine deficiency was more common in female cats, with 52.6 times the odds of a waxing and waning clinical progression (95% CI 1.2-1000; P  = 0.038) and 6.8 times the odds of presenting with bilateral vestibular signs (95% CI 1.0-45.7; P  = 0.047) and wide excursions of the head (95% CI 1.0-45.7; P  = 0.047). Middle ear polyps were associated with 8.8 times the odds of presenting with Horner syndrome (95% CI 1.5-50.0; P  = 0.015)., Conclusions and Relevance: Although it may be difficult to identify the underlying diagnosis in cats with vestibular syndrome from the presenting features alone, there are instances in which discrete clinical features may help to guide clinical reasoning when evaluating cats with vestibular presentations.

Objective: To describe the clinical presentation, advanced imaging findings, and short- and long-term outcomes in dogs with intracranial empyema., Design: Retrospective case series., Animals: Client-owned dogs diagnosed with intracranial empyema., Methods: Medical records from 2 referral hospitals were searched for dogs diagnosed with intracranial empyema. To be included in this study, dogs had to fulfill 1 or more of the following 3 inclusion criteria: a magnetic resonance imaging (MRI) scan with space occupying accumulation of extra-axial material suggestive of empyema, a cerebrospinal fluid analysis suggestive of empyema, or direct visualization of purulent material during intracranial surgery., Results: Nine dogs with intracranial empyema were included, with a median age of 3.5 years (range: 4 mo-12.5 y). All presented as emergencies with 7 of the 9 dogs showing neurological abnormalities and 2 of the 9 with retrobulbar swelling and exophthalmos. Six had surgical intervention, 1 was medically managed, and the remaining 2 dogs were euthanized. Typical MRI findings included extra-axial, T1-weighted hypo- to isointense, T2-weighted hyperintense material compared to gray matter with varying degrees of contrast enhancement, with 6 of 8 showing evidence of contiguous infection from adjacent structures on MRI. For 7 dogs, ≥1 samples were sent for culture and sensitivity, with Enterococcus (surgical swab), Streptococcus pneumonia (from cerebral spinal fluid), and coagulase positive Staphylococcus (ear swab) being cultured. The median antimicrobial course length was 6 weeks (range: 2-28 wk). All dogs for which treatment was attempted survived to discharge, with a median hospitalization time of 7 days (range: 4-10 d). Four of the 7 are still alive at the time of writing (1 lost to follow-up; 2 euthanized for other reasons) with all 4 considered neurologically normal with a successful long-term outcome., Conclusion: Although intracranial empyema in dogs is a rare condition, excellent outcomes are possible in those cases treated appropriately., (© Veterinary Emergency and Critical Care Society 2019.)

Objectives: Feline intracranial abscessation or empyema is infrequently reported in the veterinary literature. To date, the largest study is based on a population of 19 cats with otogenic infection. The aim of this study was to review a larger population of cats with intracranial empyema from multiple aetiologies and document their signalment, imaging findings, treatment protocols (including medical and/or surgical management) and to compare outcomes., Methods: Cases presenting to a single referral centre over a 10 year period with compatible history, neurological signs and imaging findings consistent with intracranial abscessation and empyema were reviewed retrospectively., Results: Twenty-three cats met the inclusion criteria. Advanced imaging (CT and/or MRI) was performed in 22/23 cats; one case was diagnosed via ultrasound. Ten cases underwent medical and surgical management combined, 10 underwent solely medical management and three were euthanased at the time of diagnosis. Short-term outcome showed that 90% of surgically managed and 80% of medically managed cats were alive at 48 h post-diagnosis. Long-term survival showed that surgically managed cases and medically managed cases had a median survival time of 730 days (range 1-3802 days) and 183 days (range 1-1216 days), respectively. No statistical significance in short- or long-term survival ( P >0.05) was found between medically and surgically managed groups., Conclusions and Relevance: Feline intracranial abscessation and empyema are uncommon conditions that have historically been treated with combined surgical and medical management. This study documents that, in some cases, intracranial abscessation and empyema can also be successfully treated with medical management alone.

The mediastinal serous cavity is a normal anatomic space in the caudal mediastinum. Aims of this anatomic and case series study were to describe the signs of pathologic expansion of the mediastinal serous cavity observed during computed tomography (CT), review the underlying anatomy, perform a literature review, and evaluate the medical records of several dogs with mediastinal serous cavity empyema (paraesophageal empyema). The mesothelial lined mediastinal serous cavity is a cranial extension of the omental bursa, separated from the peritoneal cavity by the diaphragm, in the dorsal part of the caudal mediastinum, to the right of the esophagus, between the heart base and diaphragm. In five adult, large-breed dogs with surgically and histologically confirmed paraesophageal empyema, macroscopic plant material was found at surgery in two dogs, adherence to adjacent lung was present in three different dogs, accessory lobectomy was performed in two dogs with subacute-chronic pyogranulomatous pneumonia, and one dog had concurrent pyothorax and mediastinitis, but none had esophageal abnormalities. This study expands our understanding of the pathogenesis and basis for the imaging appearance of paraesophageal empyema in dogs by clarifying the underlying anatomic structures that direct development of this condition. The term empyema accurately describes this condition because the purulent material accumulates within an existing body cavity. The study also provides initial evidence that the development of paraesophageal empyema might be due to local extension of lung disease, such as foreign body migration or pneumonia. Computed tomography was helpful for diagnosis, assessing size, and determining the spread of disease., (© 2017 American College of Veterinary Radiology.)

A 40-day-old male, blue heeler puppy with hindlimb ataxia, nystagmus, apathy, motor incoordination and hyperaesthesia of the forelimbs died 3 days after the onset of clinical signs. Significant gross findings included cerebellar herniation, cerebral oedema and dilation of the third and right lateral cerebral ventricles due to the accumulation of a purulent exudate. Histopathological examination revealed pyogenic ventriculitis and purulent meningoencephalitis. Pure colonies of a coagulase-positive Staphylococcus were isolated from the purulent cerebral exudate. A polymerase chain reaction assay that targeted the 16S rRNA gene of bacteria amplified the desired product from bacterial colonies. Direct sequencing revealed the organism to be Staphylococcus pseudintermedius. Phylogenetic analyses showed that the organism was antigenically similar to Staphylococcus intermedius and Staphylococcus delphini, being part of the S. intermedius group of bacteria. These findings confirmed the participation of S. pseudintermedius in the development of the pathological manifestations and lesions observed in this puppy., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

CASE DESCRIPTION 5 dogs were examined because of clinical signs of myelopathy, including signs of pain associated with the spinal region and rapidly progressive neurologic deficits. CLINICAL FINDINGS In all dogs, results of MRI were consistent with spinal epidural empyema. Concurrent infectious processes were identified at adjacent or distant sites in all dogs, including diskospondylitis, prostatitis, dermatitis, paraspinal infection following a penetrating injury, urinary tract infection, and pyothorax. Bacteria were isolated from 3 dogs; Escherichia coli was isolated from blood, urine, and prostatic wash samples from 1 dog; a Pasteurella sp was isolated from a percutaneous aspirate from an adjacent infected wound in a second dog; and a Corynebacterium sp was isolated from a thoracic fluid sample from a third dog. For the remaining 2 dogs, results of bacterial culture were negative. TREATMENT AND OUTCOME All dogs showed clinical improvement within 2 weeks after initiation of antimicrobial treatment, and all had an excellent long-term outcome. CLINICAL RELEVANCE In dogs, spinal epidural empyema has previously been regarded as a surgical emergency. Findings for dogs in the present report suggested that, as is the case for humans, selected dogs with spinal epidural empyema may be successfully managed with medical treatment alone.

Odontogenic facial abscesses associated with periapical infections and osteomyelitis of the jaw represent an important part of the acquired and progressive dental disease syndrome in pet rabbits. Complications such as retromasseteric and retrobulbar abscesses, extensive osteomyelitis of the mandible, and empyemas of the skull are possible sequelae. Standard and advanced diagnostic imaging should be pursued to make a detailed and proper diagnosis, and plan the most effective surgical treatment. This article reviews the surgical anatomy, the pathophysiology, and the classification of abscesses and empyemas of the mandible, the maxilla, and the skull. It also discusses surgical techniques for facial abscesses., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Reasons for Performing Study: Empyema of the nasal conchal bullae has recently been identified in horses suffering from chronic unilateral nasal discharge. The diagnosis and management of such cases has not been reported previously., Objectives: To describe the diagnosis and treatment of cases suffering from empyema of the nasal conchal bullae and report the frequency of diagnosis from a population of horses referred for head computed tomography (CT)., Study Design: Retrospective case review., Methods: Records from cases diagnosed with nasal conchal bulla disease using CT were reviewed., Results: Abnormalities of the nasal conchal bullae were identified by CT in 10 cases (8 ventral conchal bulla, 2 dorsal conchal bulla), from 102 equine head CT examinations. Eight cases were subsequently treated at the study clinic, 7 of which had concurrent paranasal sinus disease. In 3 cases, fenestration of the ventral conchal bulla per nasum facilitated drainage and clearance of empyema., Conclusions: Disease of the conchal bullae should be considered as a potential cause of chronic unilateral nasal discharge in horses. Clearance of empyema within these bullae is unlikely to occur through lavage of the paranasal sinuses alone. Where necessary, fenestration of the bulla allows physical removal of infected material., (© 2014 EVJ Ltd.)

A case of canine discospondylitis and epidural empyema due to Salmonella species is reported. The history, clinical signs, and magnetic resonance imaging were suggestive of discospondylitis and empyema, which was subsequently confirmed by blood cultures. To the authors' knowledge, this is the first reported case of canine discospondylitis due to Salmonella species.

The diagnosis and surgical treatment of spinal epidural empyema (SEE) in a 2-year-old neutered male domestic shorthaired cat is described. SEE was diagnosed by computed tomographic myelography (CT myelography) and surgical exploration. The lesion was missed on both non-enhanced CT and conventional myelography. SEE should be considered in the differential diagnosis of progressive myelopathy in cats, and CT myelography should be undertaken when magnetic resonance imaging (MRI) cannot be performed., (Copyright 2010 ISFM and AAFP. Published by Elsevier Ltd. All rights reserved.)

Guttural pouch diseases pose serious challenges in diagnosis and treatment. Complications from treatment are common and often life-threatening, largely because the unique anatomy of the guttural pouches brings them into intimate contact with the nervous, respiratory, and cardiovascular systems. There is little forgiveness for surgical errors, and so the surgeon should focus on ways to anticipate and prevent them. As with any disease, errors in diagnosis can set the stage for many surgical errors and must be recognized. This article deals with errors that can be expected after the most common surgical treatments for guttural pouch diseases.

Purulent vaginal discharge in a bitch in which ovariohysterectomy has been performed is often caused by inflammation of the uterine stump. The inflammation is due to either cystic endometrial hyperplasia (CEH) induced primarily by progesterone from remnant ovarian tissue or exogenous progestagens, or it is due to the presence of unabsorbed suture material. This report describes a 9-year-old Irish setter with hemopurulent vaginal discharge and non-pruritic symmetrical alopecia, which had undergone ovariohysterectomy 3.5 years ago and which had been treated with estriolum daily for the past 2.5 years because of urinary incontinence. Vaginoscopy revealed hemopurulent discharge throughout the vagina and vestibule. Cytological examination of ultrasound-guided fine-needle aspiration biopsies of a large mass in the hypogastricum, which appeared to be the uterine cervical stump, revealed septic purulent inflammation. The concentration of plasma progesterone was low and the concentration of plasma 17-ss oestradiol did not increase after gonadotrophin-releasing hormone administration. No remnant ovarian tissue was found by abdominal ultrasonography, laparotomy, or histological examination of mesovarian pedicles. Laparotomy revealed uterine stump empyema. Histological examination of the surgically removed mass excluded both CEH and unabsorbed suture material as the cause of the stump empyema. Instead, it is hypothesized that the long-term treatment with estriolum was a causative factor. This suggests that bitches treated with estriolum should be examined regularly.

Spinal epidural empyema is defined an accumulation of purulent material in the epidural space of the vertebral canal. Spinal epidural empyema should be considered as a differential diagnosis in dogs with pyrexia, spinal pain, and rapidly progressing myelopathy. Magnetic resonance (MR) imaging is the imaging test of choice in humans. Here, we describe the MR imaging features of five dogs with confirmed spinal epidural empyema. The epidural lesions appeared as high or mixed signal masses in T2-weighted (T2W) images. Increased signal within the spinal cord gray matter at the site of the lesion was detected in T2W images in all dogs. Two patterns of enhancement were detected on postcontrast T1-weighted (T1W) images. Mild to moderate peripheral enhancement was seen in three dogs and a diffuse pattern of enhancement was seen in one. Discospondylitis was identified in three dogs on T1W postcontrast images. Decompressive spinal surgery was performed in all dogs. Bacteria isolated from the abnormal epidural tissue were Enterobacter cloacae, coagulase-positive Staphylococci, Pasteurella multocida, and Escherichia coli. In one dog bacteria were not isolated. These MR imaging features, along with appropriate clinical signs, can allow prompt diagnosis and appropriate treatment planning.

A 12-year-old, grey, crossbred pony mare was presented with a swelling in the neck over the area of the 2nd cervical vertebra (C2), which was found to be painful on palpation. The neck was held stiffly. Radiography of the cervical region showed a focal area of increased radio-opacity over the dorsal, caudal and lateral aspect of the dorsal spinous process of C2. Ultrasound confirmed the presence of a hypoechoic area approximately 15 cm in diameter superimposed over the dorsal spinous process of C2. An aspirate was taken of the mass, which revealed purulent exudate confirming the diagnosis of an abscess. The abscess was lanced with a scalpel blade and samples of the purulent material revealed a pure culture of Streptococcus equi subsp. equi. The guttural pouches (Eustachian tube diverticulae (ETD)) were then evaluated endoscopically and multiple chondroids were seen filling most of the right ETD. Surgery was subsequently performed and 189 chondroids were removed via a right-sided hyovertebrotomy. The ETDs were flushed and penicillin installed into both ETDs on 3 different occasions via a catheter introduced using a fibre optic scope. This procedure was repeated until a negative culture status was achieved in order to eliminate the carrier status.

Spinal epidural empyema (SEE) represents a severe pyogenic infection of the epidural space. Clinical signs of the disease are non-specific--increased body temperature, intense neck pain, neurological signs of a transverse myelopathy--and can lead to severe and permanent neurological deficits. This report describes the diagnosis and successful surgical treatment of cervical SEE secondary to grass awn migration in a cat. Although it is uncommon, this disease should be suspected in cats with progressive myelopathy. Early diagnosis and emergency surgery combined with antibiotic therapy are required to allow a complete recovery.

Objective: To report use of a modified Whitehouse approach in standing horses for management of inspissated guttural pouch empyema., Study Design: Retrospective study., Animals: Adult horses (n=10) with guttural pouch empyema., Methods: Inspissated exudate in 1 or both guttural pouches was removed surgically through a modified Whitehouse approach, with the horses standing and sedated. Medical records of affected horses were reviewed to determine history; physical, endoscopic, and radiological examination findings; surgical technique; complications, and outcome., Results: All horses had purulent nasal discharge; 3 horses had dysphagia, 2 had recurrent laryngeal neuropathy on the side affected by guttural pouch empyema, and 1 had persistent soft palate displacement. Inspissated exudate was removed safely without causing apparent discomfort. Eight horses returned to their previous level of athletic activity after surgery; 1 horse dysphagic before surgery, was euthanatized because of persistent dysphagia after surgery, and 1 horse died 1 week after surgery for unknown reasons. Streptococcus equi subsp equi was isolated from the affected guttural pouch of 3 horses., Conclusions: Inspissated exudate can be removed surgically from the guttural pouch in standing horses through a modified Whitehouse approach., Clinical Relevance: To eliminate risks associated with general anesthesia and avoid surgical suite contamination, removal of chondroids can be performed in standing sedated horses through a modified Whitehouse approach.

Infectious conditions of the equine head are commonly encountered in clinical practice. Pathogenic bacterial, viral, and fungal organisms may localize in the extensive nasal passages, paranasal sinuses, and guttural pouches, creating a range of clinical signs and conditions that can be severe enough to lead to unexpected fatality. Renewed interest in equine dentistry has led to a greater recognition of dental disease that is associated with infection. This article focuses on bacterial and fungal infections of the main anatomic regions of the equine head, where advances in diagnosis and management have been made or consolidated in recent years. It also addresses recent advances made in the area of infectious equine corneal disease, including bacterial, viral, and fungal etiologies. Recent developments in equine recurrent uveitis as it relates to infectious diseases and ocular manifestations of systemic disease are also discussed.

Objective: To characterize the clinical signs, diagnostic and surgical findings, and outcome in dogs with spinal epidural empyema (SEE)., Study Design: Retrospective study., Animals: Seven dogs., Methods: Dogs with SEE between 1992 and 2001 were identified from a computerized medical record system. Inclusion criteria were: neurologic examination, vertebral column radiographs, myelography, antimicrobial culture and susceptibility of material collected surgically from the vertebral canal, a definitive diagnosis of SEE confirmed by surgery, and microscopic examination of tissue from the vertebral canal., Results: Common signs were lethargy, fever, anorexia, apparent spinal pain, and paraparesis/plegia. Common laboratory abnormalities were peripheral neutrophilia, and neutrophilic pleocytosis in cerebrospinal fluid (CSF). Three dogs had concurrent discospondylitis and 1 of these had vertebral luxation. On myelography, extradural spinal cord compression was focal (2 dogs), multifocal (3), or diffuse (2). Bacteria were isolated not from CSF but from blood, surgical site, pleural fluid, or urine in 6 dogs. Dogs were administered antibiotics and had surgical decompression by hemilaminectomy. Five dogs improved neurologically and had a good long-term outcome. Two dogs were euthanatized, 1 because of worsening of neurologic signs and pneumonia, and the other because of herniation of a cervical intervertebral disc 1 month postoperatively, unrelated to the SEE., Conclusion: Dogs with SEE may have a good outcome when treated by surgical decompression and antibiotic administration., Clinical Relevance: SEE should be included in a list of possible causes for dogs with fever, apparent spinal pain, and myelopathy.

Objective: To describe removal of guttural pouch chondroids through a laser fenestrated mesial septum in a pony with an obstructed pharyngeal ostium of the left guttural pouch., Study Design: Case report., Animals: Pony., Methods: Transendoscopic laser neodymium:yttrium aluminum garnet (Nd:YAG) fenestration of the mesial guttural pouch septum was made by contact method (bare fiber, 15-25 W, exposure time 4 seconds). Dissected tissue was removed by transendoscopic monopolar electrosurgery (loop electrode, cutting blade) and multiple chondroids of varying size were removed from the left guttural pouch through the fenestration., Results: After removing all chondroids and repeated flushing of the left guttural pouch via the right side, inflammation of the guttural pouch membranes decreased remarkably. The pony was discharged with instructions for transendoscopic lavage once weekly and was reevaluated at 2 months. A permanent septal fenestration was observed and the pony was free of abnormal clinical signs and being used for carriage driving competitions., Conclusion: Nd:YAG laser fenestration of the mesial septum is an approach for access to guttural pouch chondroids., Clinical Relevance: When guttural pouch empyema and/or chondroids is associated with adhesion of the pharyngeal ostium, laser fenestration of the mesial septum from the opposite guttural pouch should be considered as an alternative approach for access, rather than classic external surgical approaches.

Objective: To determine vasopressin (VP) secretory capacity during osmotic stimulation and the response to desmopressin treatment in dogs with pyometra and control dogs., Animals: 6 dogs with pyometra before and after ovariohysterectomy and 6 control dogs., Procedure: Urine osmolality (Uosm) was measured during 12 hours. Values measured on the first day defined the basal Uosm pattern. On the second day, dogs were given desmopressin to induce a desmopressin-stimulated Uosm pattern. On day 3, the VP response to osmotic stimulation was examined., Results: Median Uosm on day 1 was 340 mOsm/kg (range, 104 to 1,273 mOsm/kg) and 807 mOsm/kg (range, 362 to 1,688 mOsm/kg) in dogs with pyometra before and after surgery, respectively, and 1,511 mOsm/kg (range, 830 to 1,674 mOsm/kg) in control dogs. Median Uosm during desmopressin treatment was 431 mOsm/kg (range, 168 to 1,491 mOsm/kg) and 1,051 mOsm/kg (range, 489 to 1,051 mOsm/kg) in dogs with pyometra before and after surgery, respectively, and 1,563 mOsm/kg (range, 1,390 to 2,351) in control dogs. In dogs with pyometra, threshold for VP secretion was lower before surgery (median, 340 mOsm/kg; range, 331 to 366 mOsm/kg) than after surgery (median, 358 mOsm/kg; range, 343 to 439 mOsm/kg) or in control dogs (median, 347 mOsm/kg; range, 334 to 360 mOsm/kg). Highest maximum plasma VP values were found in dogs with pyometra., Conclusions and Clinical Relevance: Dogs with pyometra had increased urine concentration in response to desmopressin but not to the degree of control dogs, whereas VP secretory ability was not reduced.

The computed tomographic (CT) appearance of epidural empyema in a 5.5-month-old, intact male boxer dog is described. Epidural empyema was diagnosed by means of CT, surgery, and bacterial culture. The imaging and pathogenesis of epidural abscesses and the pitfalls of differentiating caudal fossa lesions from severe cranial cervical lesions are discussed.

Guttural pouches are unique anatomic structures in Equidae. Conditions affecting the guttural pouches present with clinical signs that are not observed in other domestic species, and treatment of some of these conditions can be challenging. This article describes the anatomy and examination of the guttural pouches and reviews the presenting signs and treatment of the more common conditions affecting them, including empyema, tympany, mycosis, and stylohyoid arthropathy.

Epidural spinal cord compression was visualized myelographically in a dog presented for rapid development of paraparesis. A large, fluid-filled pocket in the epaxial musculature was found at surgery and appeared to communicate with the first lumbar vertebra. Unfortunately, cytopathological evaluation of the fluid was not performed. No etiological agents were isolated on aerobic culture. The dog responded well to decompressive surgery and medical therapy consisting of antibiotics, pain medication, and nursing care. In the veterinary literature, only two studies of spinal epidural empyema in the dog have been reported. Of these dogs, one had successful decompressive surgery performed. The other dogs in these two reports were euthanized. The dog presented in this report fully recovered. Spinal epidural empyema should be considered as a differential diagnosis in dogs presenting with a fever and a rapidly progressing myelopathy.

Two horses with chronic empyema of the auditory tube diverticulum (guttural pouch) were refractory to medical treatment; empyema was bilateral in 1 horse and unilateral in the other. Both horses were treated by fistulation of the cartilage of the pharyngeal orifice by use of a neodymium:yttrium-aluminum-garnet laser in a noncontact manner. To maintain patency of the fistulae, indwelling catheters were placed into the openings created by the laser. For both horses, long-term follow-up did not reveal complications, and both owners were satisfied with results of the procedure. The authors recommend this procedure for horses that are unresponsive to medical treatment for chronic guttural pouch empyema.

Objective: To identify features of guttural pouch (auditory tube diverticulum) empyema in horses and compare findings of uncomplicated guttural pouch empyema with guttural pouch empyema complicated by chondroids., Design: Retrospective study., Animals: 91 horses with guttural pouch empyema., Procedure: Medical records of horses with guttural pouch empyema were reviewed., Results: The most common owner complaint and abnormal finding was persistent nasal discharge. Chondroids were detected in 21% (19/91) of affected horses. Streptococcus equi was isolated from the guttural pouch in 14 of 44 horses; for Streptococcus spp, in vitro resistance to sulfadimethoxine and trimethoprim-sulfamethoxazole was detected. Retropharyngeal swelling and pharyngeal narrowing were significantly more prevalent in horses with chondroids, compared with horses with uncomplicated empyema. Ninety-three percent of affected horses were discharged from the hospital; at time of discharge, 66% had complete resolution of disease, 19% had improvement without resolution, and 15% did not have improvement., Conclusions and Clinical Relevance: Horses with persistent nasal discharge should be examined endoscopically for guttural pouch empyema. Treatment with lavage offers a good prognosis for resolution of uncomplicated guttural pouch empyema. Aggressive treatment with lavage and endoscopic snare removal of chondroids offers a good prognosis and may make surgical intervention unnecessary.

A 6-year-old, 420-kg quarter horse gelding was presented with a 2-month history of difficulty swallowing and dyspnea. The horse was diagnosed with a right guttural pouch empyema with many large chondroids. Two surgeries were required to completely remove all the chondroids from what proved to be a primary distension of the guttural pouch lateral compartment.

Extensive, diffuse, epidural spinal cord compression was visualized myelographically in two dogs presented for rapid development of nonambulatory tetraparesis and paraplegia, respectively. Purulent fluid containing bacterial organisms was aspirated percutaneously under fluoroscopic guidance from the epidural space of each dog. One dog responded poorly to aggressive medical therapy, which included installation of an epidural lavage and drainage system. Both dogs were euthanized due to the severe nature of their disorder and the poor prognosis. Spinal epidural empyema (i.e., abscess) is a rare condition in humans and has not been reported previously in the veterinary literature. Spinal epidural empyema should be considered as a differential diagnosis in dogs presenting with painful myelopathies, especially when accompanied by fever.

Pleural effusions can cause dyspnea and cyanosis, and are caused by cardiomyopathy, pyothorax, FIP, FeLV-related disease and trauma. Thoracentesis is used to obtain fluid samples for cytologic examination and culture. Radiographs made after thoracentesis may reveal the cause. Lymphosarcoma causes a sterile exudate containing neoplastic cells. Congestive cardiomyopathy causes a transudate or modified transudate. The sterile exudate of FIP has a proteinaceous background on cytologic examination. The exudate of pyothorax is septic. Treatment depends on the cause but generally includes thoracentesis and supportive care. Cardiomyopathy causes dyspnea, cyanosis, murmurs, gallop rhythms and other arrhythmias. Radiography reveals a globoid heart in the congestive form and a "valentine-shaped" heart in the hypertrophic form. Treatment of congestive cardiomyopathy involves use of furosemide, but is usually unrewarding. Hypertrophic cardiomyopathy is treated with propranolol. Fever may be caused by infection, immune-mediated disease, neoplasia and unknown causes. Treatment is aimed at removal of the underlying cause.

There are four factors that govern fluid movement to or from the pleural space: hydrostatic pressure, colloid osmotic pressure, filtration coefficient, and lymphatic function. When any of these factors are altered, fluid accumulates within the pleural space. Congestive heart failure, pancreatitis, neoplasia, hypoalbuminemia, and pulmonary thromboembolism can evoke pleural effusions by altering normal fluid transport mechanisms. This approach to pleural effusion helps to explain fluid accumulation. Chylothorax, hemothorax, and empyema are also covered in the article.

A 2-year-old, neutered, male cat was euthanatized because of difficult repiration and inability to rise. Necropsy revealed pyothorax. Corynebacterium pyogenes was grown from the purulent thoracic exudate. A Borrelia-like microorganism was demonstrated in the exudate, using phase-contrast microscopy.