Ethmoid Hematomas

Introduction: Ethmoid hematomas are slow-growing tumors that originate in the turbinates and associated sinuses of the nasal cavity. This problem is found most commonly in animals over 8 years of age of the Thoroughbred, Warmblood, and Arabian breeds. The exact cause for these growths is unknown at this time.

Clinical Signs: Most horses with ethimoid hematomas are taken to a veterinarian because of bleeding from the nose (epistaxis). This bleeding can occur in one or both nostrils depending on the location of the tumor. The bleeding will often come and go and can be anything from a blood tinged discharge to a trickle of blood. Some horses may experience coughing and abnormal respirations/noise during exercise.

Diagnosis: Endoscopy is the most common method of diagnosing this problem in the horse (see page D200). An endoscopic exam is a procedure where a small camera is inserted into one of the nostrils into the sinuses and turbinates of the horse. With this procedure, ethmoid hematomas can be directly identified and evaluated. Most ethmiod hematomas have a red to red-purple or yellow to yellow-green appearance. These masses will often bleed when contact is made with the endoscope. Depending on the situation, some masses are identified with a radiograph (X-ray) of the head and sinuses.

Treatment: The safest and least invasive treatment for ethmoid hematomas involves injecting the mass with formalin. This is usually done using an endoscope in a standing, but sedated horse. During this procedure, formalin is injected directly into the tumor using a needle-like instrument on the end of the endoscope. The formalin will cause the mass to deteriorate. Dead tissue can then be removed at subsequent visits. This procedure may need to be performed every 10-14 days until the tumor is completely removed. A second method of removing ethmiod hematomas is surgery. During surgery, the mass is removed by lasers, cryosurgery, or cutting. Because of the significant bleeding that can be involved with some of these procedures, the area is often packed with gauze.

Prevention: There is no known prevention for this problem.

Prognosis: These tumors have a tendency to reappear in 30-50% of the cases that have been treated.