Nasal Bleeding: Vets, What's Your Diagnosis and Treatment?

Nasal Bleeding: Vets, What's Your Diagnosis and Treatment?

Photo: Harry Werner, VMD

By Harry Werner, VMD, WEVA Board Member


History: An 18-year-old Quarter Horse gelding’s groom noticed a slight blood stain on a fore fetlock but could find no wound (pictured at left). This episode repeated itself after each feeding. So the trainer notified the owner and recommended the horse be examined by a veterinarian. 

Physical Examination: After ruling out other potential diagnoses, the veterinarian focused on the horse’s mouth and skull. The veterinarian did not identify any source of bleeding, so he elected to perform upper airway endoscopy. This revealed a hematoma in the right paranasal sinus. 

Diagnosis: Ethmoid hematoma

Photo: Harry Werner, VMD

Treatment: The gelding was referred for laser ablation of the hematoma, recovered uneventfully, and had no recurrence at two years later.

Discussion: The ethmoid is a normal, very vascular structure high in the horse’s paranasal sinuses. Occasionally, its vessels will proliferate, resulting in a fragile mass that bleeds easily. As this horse spent all day in turnout, being brought in after dusk, the only apparent bleeding was the stained fetlock where the horse had wiped its nose. An attentive groom, responsible trainer, and concerned owner allowed an examination of an “externally normal” horse to diagnose the problem. All persons involved in a horse’s care should consider themselves members of that horse’s health care team. Above all, this means communicate!

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