Sudden death attributable to exercise-induced pulmonary hemorrhage in racehorses: nine cases (1981-1983)

Pathologic changes are described in 11 horses that died during racing or training; 9 died of acute pulmonary hemorrhage (exercise-induced pulmonary hemorrhage), 1 died of exsanguination, and 1 died of CNS trauma. Cardiac lesions were not found in any horse. Severe engorgement of pulmonary vessels, with hemorrhage into alveoli, airways, interstitium, and subpleural tissues, was observed in all 9 horses that died of exercise-induced pulmonary hemorrhage. Infiltration of eosinophils and/or lymphocytes around vessels and airways was seen in 6 horses. Focally extensive fibrosis was observed in the pleura and interstitium of 6 horses, and collections of siderophages were seen in the fibrous tissue and in the airways. Focal occlusion of bronchioles with inspissated mucus, such as that associated with small airway disease, was found in 4 horses. Underlying respiratory tract lesions, particularly those associated with small airway disease or bronchiolitis, may have a role in fatal pulmonary hemorrhage.