The Modern Equine Vet
September 2023
Vol 13 Issue 9 2023
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Providing a Clear Win Against Infection

By Burgetta Eplin Wheeler

The radiograph of Vinny the chestnut horse’s head was shadowy, and therefore, inconclusive about whether an infected tooth might be causing his chronic sinus drainage from 1 nostril.

Antibiotics had stopped the drainage for a while, but it returned in the same nostril, indicating Vinny probably had a bacterial infection, explained Cathy Lombardi, DVM, Vinny’s local veterinarian who serves at The Oaks Equine & Farm Services in Smithfield, Va.

Until NC State College of Veterinary Medicine installed a standing equine computed tomography scanner, the protocol would have been to keep trying antibiotics and hope the problem became clearer or even to remove the suspicious tooth without being confident it was the cause.

“With the CT, it was instantly obvious what tooth it was,” Dr. Lombardi said. “You could clearly see that the area between the sinus and oral cavity had been completely taken over by infection. It’s so obvious on the CT, and it’s just not obvious on the X-ray.”
With the help of generous donors, NC State installed the standing CT scanner in its large animal veterinary center last year.

The standing CT allows horses to walk into stocks on a platform that then lowers the animal below the floor until its head is level with the scanner. The CT machine then moves back and forth over the horse’s head and neck. Though the horses are sedated, they don’t have to be put under general anesthesia, which is a huge benefit for animals their size.

“With the standing CT, we do not have to anesthetize a horse and put them on their side or back to get these images,” said Callie Fogle, DVM, a professor of equine surgery who performed Vinny’s surgery. “Especially with older horses like Vinny, sometimes it can be more difficult for them to stand up from general anesthesia.”

The CT scan allows for a confident diagnosis that then can be treated surgically, whether it’s a tooth abstraction or sinus mass removal. The ability to diagnose and treat disease of the horse’s head while the horse is standing has also made it safer and less expensive.

“Having access to these very detailed 3-dimensional images from the CT scan as a part of the work-up in most of our head surgeries allows us to perform better presurgical planning and a more thorough and focused surgery, which means a better chance of resolving the disease,” Dr. Fogle said.

In its continuous quest to offer the best of veterinary care, the NC State Veterinary Hospital has installed standing CT equipment that allows our equine experts to scan the head and throat latch of horses without having to put the animals under general anesthesia.

Lisa Bambury, of Chesapeake, Va., has had Vinny for 11 years, and Dr. Lombardi has been his veterinarian the whole time. Ms. Bambury describes Vinny, her first horse, as the class clown.

“All he wants to do is run around and play,” said Ms. Bambury, who rode horses in her teens but returned to horse-riding seriously in her 40s. “Either you’re born adoring horses or you’re not. My husband has learned to love Vinny. He’s never been around them and didn’t realize they have personalities and attach to their person. Vinny is very playful. And curious.”

After she began treating Vinny’s nasal discharge in November, Dr. Lombardi suggested they send the inconclusive radiographs to NC State equine experts, who recommended that Vinny have the CT scan.

The veterinarians had the results within the hour after the scan and scheduled surgery to remove the tooth and clean out the infection contained within his sinus the next day.

Vinny went home with a catheter in his nose so that Ms. Bambury could flush his sinuses for several more days.

“That CT scan is 100% appreciated,” Ms. Bambury said. “Without it, you’re lacking pieces of the puzzle going in to do surgery. Something’s wrong, you know it’s wrong, but you don’t know exactly where to go without that tool.”

“The nice thing about the college is you’ve got a whole lot of experts under one roof and the latest and greatest in diagnostic equipment, and that’s really a huge asset for our clients to have access to,” Dr. Lombardi said. “This is one of these good cases where we were able to get a clear definitive answer quickly and resolution very quickly, too. Everyone was very happy, including the horse.” MeV

This story was originally posted on the NC State University website. It was edited for length and style.

Before the standing CT imaging begins, Vinny is sedated, and his eyes are covered.

The cross-sectional view shown on a CT scan can help veterinarians better pinpoint what is causing a problem and where precisely it is located. In Vinny’s CT, above, the black arrow marks a defect in the bone surrounding a specific tooth. The infected tooth caused inflammation in his right sinus, which filled with fluid as shown by the orange arrow. The radiograph at the bottom right shows the same inflammation, but the image’s angle makes the cause of the irritation unclear.

Vinny, shown during his CT appointment, is happier after NC State vets helped clear his persistent sinus infection, his regular veterinarian says.
Images courtesy of NC State