The above image is an endoscopic view into the left nasal passage of a warmblood gelding with a recent history of a intermittent, bloody discharge (epistaxis) from the left nostril. At presentation, there was a moderate decrease in airflow through the left nostril and a small trickle of blood was noted exiting the left nostril. Endoscopy revealed a soft tissue mass that was centered within the region of the ethmoid turbinate. The mass was golden in color and was exuding small amounts of blood. These findings are consistent with an ethmoid hematoma which is a locally destructive mass of the nasal passages and paranasal sinuses. Ethmoid hematomas resemble tumors in appearance and development but are not neoplastic. Treatment options include surgical resection and/or intramural injections with formalin.
The ethmoid hematoma was treated with approximately 20cc of formalin that was injected via an endoscopic guided technique using a guarded endoscopic needle (above image). This procedure is easily performed in a standing horse with moderate sedation. The treatment may need to be repeated depending on the response to therapy.
The above image was taken 2 months after the initial formalin injection. The ethmoid hematoma is 60-75% smaller yet required a follow-up injection of formalin. Clinical signs resolved within 30 days after the initial formalin injection. Common causes of epistaxis in a horse include ethmoid hematomas, fungal infections of the guttural pouch, fungal infections of the nasal passages and/or pharynx, skull fractures, EIPH and sinus infections. These types of medical issues can be serious problems and require endoscopy plus skull radiographs to diagnose.
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