What Is Your Diagnosis?

David M. Wong Department of Veterinary Clinical Sciences, Lloyd Veterinary Medical Center, College of Veterinary Medicine, Iowa State University, Ames, IA 50011

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William Gross Department of Veterinary Clinical Sciences, Lloyd Veterinary Medical Center, College of Veterinary Medicine, Iowa State University, Ames, IA 50011

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Mathew Madron Department of Veterinary Clinical Sciences, Lloyd Veterinary Medical Center, College of Veterinary Medicine, Iowa State University, Ames, IA 50011

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Cody J. Alcott Department of Veterinary Clinical Sciences, Lloyd Veterinary Medical Center, College of Veterinary Medicine, Iowa State University, Ames, IA 50011

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History

A 1-day-old 52-kg (114-lb) American Paint Horse filly was evaluated by a referring veterinarian for acute onset of colic and abnormal upper respiratory tract noises. The foal was treated with a sodium phosphate-based enema with no improvement in clinical signs and was referred for further evaluation.

On physical examination, the foal had moderate signs of abdominal pain and abdominal distension along with a mildly abnormal upper respiratory tract noise heard on both inspiration and expiration. The colic signs resolved with administration of analgesics and an acetylcysteine retention enema along with feed restriction for 10 hours. However, the abnormal upper respiratory noise was still present the following day, and dysphagia was suspected on the basis of the observation of small amounts of milk dribbling from the foal's mouth and nares after suckling. In addition, part of the air stream was diverted through the mouth during exhalation. No abnormalities were detected during auscultation of the thorax. Results of CBC, serum biochemical analysis, and arterial blood gas analysis were within reference limits. Radiographs of the head and cranial portion of the neck were obtained (Figure 1).

Figure 1—
Figure 1—

Lateral (A) and dorsoventral (B) radiographic views of the head and cranial portion of the neck of a 1-day-old American Paint Horse filly evaluated because of abnormal upper respiratory tract noises and suspected dysphagia.

Citation: Journal of the American Veterinary Medical Association 238, 2; 10.2460/javma.238.2.157

Determine whether additional imaging studies are required, or make your diagnosis from Figure 1—then turn the page

Radiographic Findings and Interpretation

Right of midline in the laryngopharynx is a 4 × 2-cm soft tissue opaque mass that is confluent with the caudoventral aspect of the soft palate (Figure 2). The margins of the mass are smooth and convex; cranially, the mass is slightly lobulated. The epiglottis is ventral to the mass and soft palate. No other abnormal findings are evident. Differential diagnoses for soft tissue masses involving the soft palate or pharynx in neonatal foals include cysts (ie, subepiglottic, pharyngeal, or soft palate), granuloma, hematoma, and pharyngeal abscess.

Figure 2—
Figure 2—

Same radiographic images as in Figure 1. A—Notice the well-defined soft tissue mass (white arrows) involving the caudoventral aspect of the soft palate; the epiglottis (black arrow) is ventral to the mass and soft palate (white arrowhead). B—The caudal aspect of the soft tissue mass is visualized on the dorsoventral view (black arrows).

Citation: Journal of the American Veterinary Medical Association 238, 2; 10.2460/javma.238.2.157

Comments

The nasopharyngeal region was examined endo-scopically, and bulging of the soft palate dorsally was observed. The epiglottis could not be viewed. The soft tissue structure could not be directly viewed in the nasopharynx. Subsequently, with the foal under general anesthesia, the oropharynx and laryngopharynx were examined endoscopically, which confirmed the presence of a multiloculated soft tissue mass involving the caudoventral aspect of the soft palate. Anatomically, the epiglottis was normal except for the abnormal position.

The mass, presumed to be a soft palate cyst, was ablated with a diode laser passed through the biopsy channel of the endoscope with the foal under general anesthesia. Clear fluid was drained from the cyst as it was ablated. The foal recovered from anesthesia un eventfully and began to suckle shortly after recovery. The abnormal upper respiratory tract noise was not heard, but the foal was still dysphagic and exhalation through the mouth was still observed. Swelling of the soft palate was observed 2 days after the procedure via endoscopic examination of the nasopharynx and likely accounted for the persistence of clinical signs. The foal was subsequently discharged 2 days after the procedure. Findings on both physical and endoscopic examinations 4 weeks after discharge were normal with no dysphagia or exhalation through the mouth observed.

The most common clinical sign of pharyngeal or palatal cysts is an abnormal upper respiratory tract noise, but signs may also include choke, cough, nasal discharge, and breathing through the mouth.1–3 Pharyngeal cysts are most commonly located in the subepiglottic region but may also occur in the dorsal aspect of the pharynx.2 Soft palate cysts in 2 horses have been reported1; clinical signs in those 2 horses were similar to those observed in the foal of this report. The radiographic images of the foal of this report were valuable in localizing and partially defining the cause of the clinical signs observed.

References

  • 1.

    Haynes PFBeadle REMcClure JR, et al. Soft palate cysts as a cause of pharyngeal dysfunction in two horses. Equine Vet J 1990; 22:369371.

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  • 2.

    Koch DBTate LP Jr. Pharyngeal cysts in horses. J Am Vet Med Assoc 1978; 173:860862.

  • 3.

    Sinclair EA. Pharyngeal cyst in a 5-year-old Dutch Warmblood. Can Vet J 2008; 49:806808.

  • Figure 1—

    Lateral (A) and dorsoventral (B) radiographic views of the head and cranial portion of the neck of a 1-day-old American Paint Horse filly evaluated because of abnormal upper respiratory tract noises and suspected dysphagia.

  • Figure 2—

    Same radiographic images as in Figure 1. A—Notice the well-defined soft tissue mass (white arrows) involving the caudoventral aspect of the soft palate; the epiglottis (black arrow) is ventral to the mass and soft palate (white arrowhead). B—The caudal aspect of the soft tissue mass is visualized on the dorsoventral view (black arrows).

  • 1.

    Haynes PFBeadle REMcClure JR, et al. Soft palate cysts as a cause of pharyngeal dysfunction in two horses. Equine Vet J 1990; 22:369371.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Koch DBTate LP Jr. Pharyngeal cysts in horses. J Am Vet Med Assoc 1978; 173:860862.

  • 3.

    Sinclair EA. Pharyngeal cyst in a 5-year-old Dutch Warmblood. Can Vet J 2008; 49:806808.

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