Progressive ethmoid haematoma

"Cynders" is a 13 year old TB gelding who was presented to us by his owner Jodi for bloody discharge from one nostril, which recurred twice within a week.

Examination revealed a blood-tinged discharge from the right nostril and decreased resonance of the right side of the head during percussion. We were suspicious that Cynders may be suffering from an ethmoid haematoma and endoscopy confirmed our diagnosis.

An ethmoid haematoma is a blood-filled, soft tissue mass found in the nasal cavity or sinuses, originating from the ethmoid turbinates situated towards the back of the nasal cavity. The cause of progressive ethmoid haematoma (PEH) remains a mystery. These masses are not cancerous, but can be locally invasive and if left untreated, will progressively expand. Often more than one lesion is present.

The most common sign of PEH is epistaxis, or a bloody discharge from the nostril. This is caused by intermittent bleeding due to splitting of the surface of the lesion. Progressive expansion can eventually impair the horse's ability to breathe through the affected side and cause facial deformity.

Diagnosis is confirmed via nasal endoscopy which allows direct visualisation of the internal structures of the respiratory tract. Sometimes direct sinus endoscopy (via trephine holes through the skull) or radiography of the head can also be of assistance.

Treatment involves injection of the mass with formalin through an endoscope. Often multiple treatments are necessary and recurrence or development of new lesions is not uncommon. Surgical removal has largely been replaced by formalin injection.

Cynders has had his ethmoid haematoma injected once and is doing well. He reportedly has the spring back in his step and is coming back to see us in a month for repeat endoscopy and treatment as necessary.