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Examination of the respiratory tract in horses
Dr. Zoltan Bakos PhD, DipECEIM, MRCVS
Examination of the respiratory tract
•General impression
•Behaviour
•Posture
•Gait
•Body condition
•Abnormal sounds/noises, breathing
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Dyspnoea
Dyspnoea
Abdominal respiratory component
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Examination of the respiratory tract
•Steps of the physical exam• Nose and paranasal sinuses
• Guttural pouches
• Cough
• Larynx
• Trachea
• Thorax
• Inspection
• Smell
• Palpation
• Auscultation
• Percussion
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Examination of the nose
• Physical methods
• All can be used
• Direct auscultation (PPE)
• Percussion on the bones with the tipof the middle finger
• Normal findings
• Temperature of the region is equal tothe surroundings
• Palpation is not painful
• Percussion sound is sharp, bone-like
Examination of the nose
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Examination of the nose
• Nasal discharge
• Continuous or temporary
• Uni- or bilateral
• Amount and grade of discharge (mild, moderate, severe)
• Quality, colour and smell of discharge
• Serous, mucous, purulent, haemorrhagic, frothy, containing
food particles
• Origin
• Nose, paranasal sinus, pharynx, guttural pouch, trachea, lung, stomach
Examination of the nose
• Expired air
• Intensity of airflow
• Temperature of airflow
• Smell of expired air
• Normal findings
• Medium strength and temperature
• Odour is characteristic, not unpleasant
• Airflow is symmetrical bilaterally
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Examination of the paranasal sinuses
• Sinuses almost totally communicate
• Thin septum separates the rostral and
caudal maxillary sinus
• Maxillary sinus is affected most
frequently
• Primary disease
• Diseases of the upper cheek teeth
Examination of the paranasal sinuses
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Examination of the paranasal sinuses
• Physical methods
• Inspection, palpation, percussion (flexed middle finger)
• Normal findings
• Skin is intact, no alopecia or abnormal shape
• Temperature is equal to the surroundings
• Palpation is not painful
• Percussion sound is sharp, bone-like
Examination of the guttural pouches
• Diverticulum of the Eustachiantube (300-500 ml)
• Between the base of the skull, atlas and pharynx
• Stylohyoid bone splits it, smallerlateral and larger medialrecess/compartment
• Left and right pouches do notcommunicate
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Examination of the guttural pouches
• Physical methods
• Inspection, palpation, percussion (finger-to-finger orplessimeter and hammer)
• Normal findings
• The skin is intact, no alopecia is seen
• Temperature is equal to the surroundings
• Palpation is not painful
• Percussion sound is resonant
Cough
• Mode of emergence
• Spontaneous, induced
• Frequency
• Intensity
• Tone
• Occurance (e.g. at rest, during exercise)
• Duration
• Amount of secretion
• Pain
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Cough
• Induction of cough
• Press the arytenoid cartilages of larynx
• Press the first tracheal rings
• Normal findings
• No spontaneous cough
• Difficult or impossible to induce cough
• The induced cough is strong, sharp, low, short, dry, non-painful, snapping, does norrecur
Examination of the larynx
• Physical methods
• Inspection, palpation, auscultation
• Normal findings
• Skin is intact, no alopecia, shape is normal
• Temperature is equal to the
surroundings
• No alterations on palpation
• Very mild stridor on
auscultation
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Examination of the trachea
• Physical methods
• Inspection, palpation, auscultation
• Normal findings
• Skin is intact, no alopecia, shape is normal
• Temperature is equal to the surroundings
• No alterations on palpation
• Laryngeal noise is audible in a weaker form on auscultation
Examination of the thorax
• Physical methods
• Inspection, palpation, auscultation, percussion
• Inspection
• Shape, size, symmetry of hemithoraces
• Breathing
• Respiratory rate, rhythm, type, depth
• Dyspnoea
• Inspiratory, expiratory and mixed types
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Dyspnoea
Examination of the thorax
• Auscultation
• Respiratory noises of the horse are weak
• Systematic approach
• Start cranially behind scapule
• Move 2-4 intercostal spaces (ICS) caudally
• Start dorsally in each ICS, move ventrally by 5-10 cm
• Check at least one inspiration and expiration at each spot
• Auscultate longer if you detect abnormal sounds
• Examine both hemithoraces
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Examination of the thorax
• Auscultation
• Basic respiratory noises: weak and soft in normal horses
• Normal
• Weaker than normal (decreased airflow, superficial breathing)
• Missing (pleural effusion, consolidated lung)
• Increased in intensity, louder, harsher (dyspnoe, increased airflow)
• Adventitious respiratory sounds
• Musical (wheezes): whistling
• Non-musical (crackles): clicking, rattling, crackling noises
Examination of the thorax
• Percussion
• Pleximeter and percussion hammer
• Percussion sound
• Noise created by instruments
• Sound of the chest wall
• Resonant sound of the air-filled lung
• Features of the percussion sound
• Intensity: strong/sharp or weak
• Frequency: high or low
• Tone: sonorous/resonant or dull
• Duration: shor or long
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Examination of the thorax
• Percussion
• Normal finding: strong/sharp, low, resonant, short
• Normal lung border
• Deltoid tuberosity: 7th ICS
• Point of shoulder: 10th ICS
• Ischiadic tuber: 14th ICS
• Tuber coxae: 16th ICS
• Endoscopy• Resting endoscopy• Dynamic endoscopy
• Treadmill• Telemetric (overground)
• Ultrasonography
• Radiography
• CT
• Thoracocentesis
• Thoracoscopy
• Lung function tests
• Nasal and pharyngeal
swabs
• Tracheal wash
• Bronchoalveolar lavage
• Arterial blood gas
analysis
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Respiratory endoscopy
Respiratory endoscopy
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Recurrent laryngeal neuropathy
Dynamic endoscopy
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Severe RAO
Thoracic ultrasonography
Reverberation artefact
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Thoracic ultrasonography
Comet tail artefact
Thoracic ultrasonography
Pleural effusion
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Thoracic radiography
Thoracic radiography
Normal and concave diaphragm, increasedinterstitial pattern
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Tracheal wash
Sample is suitable for bacterial and fungal culture and cytology
Bronchoalveolar lavage (BAL)
Sample is suitable for cytology
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BAL fluid samples
BAL fluid cytology
Tóth B.
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Thoracocentesis
Exudate, pleuritis
Blood, haemothorax
Thoracoscopy
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Pulmonary function tests
• Transpleural pressure change
• Pneumotachograph, flow measurement
• Resistance
• Dynamic compliance
• Arterial blood gas analysis
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