Equis ISSN 2398-2977

Ethmoid: hematoma

Contributor(s): Patrick Colahan, Paddy Dixon, Vetstream Ltd

Introduction

  • An expanding lesion on the ethmoid turbinate or adjacent paranasal sinuses that causes a low-grade intermittent nasal hemorrhage.
  • Cause: unknown; not neoplasia.
  • Signs: epistaxis, respiratory noise; rarely neurologic signs.
  • Diagnosis: endoscopy, radiography.
  • Treatment: surgical excision / laser therapy / chemical ablation.
  • Prognosis: good following surgical treatment; 25% recur.
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Pathogenesis

Etiology

  • Unknown.
  • Postulated causes include chronic infection, repeated trauma, congenital disorder and neoplasia.

Pathophysiology

General

  • Angiomatous mass of unknown origin on the ethmoid turbinates, occasionally other sinuses.
  • Spontaneously bleeds → serosanguinous nasal discharge, usually unilateral.
  • Progressive growth into nasal passages and nasopharynx or paranasal sinuses → obstruction and destruction of adjacent tissue.
  • In severe cases, the growing mass deforms the profile of the fronto-nasal bones and can obstruct the corresponding nasal passage.
  • Hematoma on ethmoid → periodic rupture of mucosal capsule and hemorrhage into ethmoidal sinuses and caudal maxillary sinus → epistaxis.
  • Obstructed sinus drainage → mucous retention → secondary sinusitis.
  • Obstructed airflow → dyspnea.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Tremaine W H (2013) Progressive ethmoid hematoma. Equine Vet Educ 25 (10), 508-511.
  • Smith L J & Perkins J (2009) Standing surgical removal of a progressive ethmoidal haematoma invading the sphenopalatine sinuses in a horse. Equine Vet Educ 21 (11), 577-581 VetMedResource.
  • Tremaine W J (2009) The diagnosis and treatment of progressive ethmoidal haematomas.Equine Vet Educ21(11), 582-583.
  • Archer D (2008)Differential diagnosis of epistaxis in the horse. In Pract 30 (1), 20-29 VetMedResource.
  • Marriott M R et al (1999) Treatment of progressive ethmoidal haematoma using intralesional injection of formalin in three horses. Aust Vet J 77 (6), 371-373 PubMed.
  • Tremaine W H, Clarke C J & Dixon P M (1999) Histopathological findings in equine sinonasal disorders. Equine Vet J 31 (4), 296-303 PubMed.
  • Schumacher Jet al (1998) Transendoscopic chemical ablation of progressive ethmoidal hematomas in standing horses. Vet Surg 27, 175-181 PubMed.
  • Bell B T, Baker G J, Abbott L C, Foreman J H & Kneller S K (1995) The macroscopic vascular anatomy of the equine ethmoidal area. Anat Histol Embryol 24 (1), 39-45 PubMed.
  • Lane J G (1993) The management of sinus disorders of horses - Part 1. Equine Vet Educ 5, 5-9 VetMedResource.
  • Lane J G (1993) The management of sinus disorders of horses - Part 2. Equine Vet Educ 5, 69-73 VetMedResource.
  • Greet T R (1992) Outcome of treatment in 23 horses with progressive ethmoidal hematoma. Equine Vet J 24, 468-471 PubMed.

Other sources of information

  • Schumacher J (1999) Progressive ethmoidal haematoma. In: Proc 38th BEVA Congress. pp 152.


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