Fatal pulmonary hemorrhage in a horse during bronchoalveolar lavage - single case report.
Authors: Varegg Mathilde S, Kløverød Kine M, Austnes Malin K, Siwinska Natalia, Słowikowska Malwina, Zak Agnieszka, Madej Janusz A, Kandefer-Gola Malgorzata, Ciaputa Rafal, Nowak Marcin, Niedzwiedz Artur
Journal: BMC veterinary research
Summary
# Editorial Summary: Fatal Pulmonary Haemorrhage During Bronchoalveolar Lavage Bronchoalveolar lavage (BAL) is a commonly performed diagnostic procedure for investigating lower respiratory tract disease in horses, yet catastrophic complications remain poorly documented in the literature. This case report describes the first documented instance of fatal pulmonary haemorrhage occurring spontaneously during BAL, precipitated by severe coughing in a horse with no pre-existing haemostatic abnormalities or obvious anatomical compromise. Whilst pulmonary haemorrhage from invasive respiratory procedures is recognised following trauma to nasal structures or lung biopsy, this case suggests that vigorous coughing alone during BAL can cause sufficient parenchymal rupture and bleeding to prove rapidly fatal. For practitioners performing BAL diagnostics, the findings underscore the importance of careful patient selection, sedation protocols that permit adequate cough suppression without eliminating airway reflexes, and heightened vigilance for respiratory distress or haemoptysis during and immediately following the procedure. Understanding this rare but serious complication may inform risk-stratification decisions when considering BAL in horses with severe inflammatory airway disease or suspected conditions predisposing to compromised lung integrity.
Read the full abstract on PubMed
Practical Takeaways
- •Clinicians performing bronchoalveolar lavage should be aware of the rare but serious risk of fatal pulmonary hemorrhage, particularly if the horse develops severe coughing during the procedure
- •Emergency protocols should be in place for respiratory hemorrhage complications during diagnostic procedures
- •Consider risk-benefit analysis when bronchoalveolar lavage is indicated, and ensure appropriate monitoring and resuscitation equipment are available
Key Findings
- •Fatal pulmonary hemorrhage occurred in one horse during bronchoalveolar lavage procedure, triggered by severe coughing
- •This is the first reported case of spontaneous hemorrhage in a horse during bronchoalveolar lavage
- •Pulmonary hemorrhage is a rare but potentially fatal complication of diagnostic respiratory procedures in horses