Empyema of the nasal conchal bulla as a cause of chronic unilateral nasal discharge in the horse: 10 cases (2013-2014).
Authors: Dixon P M, Froydenlund T, Luiti T, Kane-Smyth J, Horbal A, Reardon R J M
Journal: Equine veterinary journal
Summary
# Editorial Summary: Empyema of the Nasal Conchal Bulla Chronic unilateral nasal discharge in horses can originate from several sources, but empyema of the nasal conchal bullae—small air-filled structures within the ethmoid bone—has only recently been characterised as a significant differential diagnosis. This retrospective review examined 10 cases identified via computed tomography from a population of 102 horses undergoing head imaging, revealing that conchal bulla disease accounted for approximately 10% of CT referrals, with 80% affecting the ventral bulla and 20% the dorsal bulla. Of the eight cases treated surgically, seven had concurrent paranasal sinus disease complicating the clinical picture, and whilst three cases benefited from per nasal fenestration allowing direct drainage and removal of infected material, the authors emphasise that lavage alone—the standard treatment for sinusitis—is unlikely to achieve clearance within these confined structures. For practitioners investigating persistent unilateral nasal discharge unresponsive to conventional sinus management, recognition of conchal bulla involvement and consideration of direct surgical fenestration may prove necessary to achieve resolution, particularly when imaging facilities are available to confirm the diagnosis.
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Practical Takeaways
- •Suspect conchal bulla empyema in horses presenting with chronic unilateral nasal discharge, especially when sinus lavage alone fails to resolve clinical signs
- •CT imaging is essential for diagnosis of conchal bulla disease; standard radiography may miss these lesions
- •Fenestration via the nasal passage offers an effective treatment option to physically remove infected material from affected bullae
Key Findings
- •Nasal conchal bulla abnormalities identified in 10 of 102 equine head CT examinations (9.8%), with 8 affecting ventral and 2 affecting dorsal bullae
- •Seven of eight treated cases had concurrent paranasal sinus disease
- •Fenestration of the ventral conchal bulla per nasum successfully facilitated drainage and clearance of empyema in 3 cases
- •Paranasal sinus lavage alone is unlikely to clear empyema from the conchal bullae; direct fenestration is necessary for resolution