Guttural pouch tympany or empyema in 38 ٍStraight Egyptian Arabian foals: clinical presentation, diagnostic features...

As a breed, Straight Egyptian Arabian horses are susceptible to many disorders that mostly affect the head, such as guttural pouch (GP) tympany and empyema. This retrospective study evaluated the findings of clinical examination, ultrasonography, endoscopy, laboratory analyses and outcome of treatment of 38 Straight Egyptian Arabian foals with GP tympany and empyema.

Data from medical records of foals diagnosed with GP tympany or empyema over a 2-year period (2024-2025) were reviewed. Foals with verified GP tympany or empyema who had complete medical records and had not previously received antibiotics and/or corticosteroids met the inclusion criteria. Foals with incomplete records, unconfirmed diagnosis or concurrent diseases likely to influence the evaluated variables were excluded. Outcomes of treatment (recovery and recurrence) were compared with diagnostic features and treatment modalities. The data were statistically analyzed.

Out of 237 foals presented with various disorders, 38 foals had GP tympany and empyema, representing 16.03% of the total examined foals. Out of 38 foals with GP tympany and empyema, there were 29 females (77.8%) and 9 males (22.2%). The frequencies of GP tympany and empyema were significantly higher in the first month of life (47.4%) than the 8-9-month period (10.5% ((P < 0.05). Bilateral GP tympany and empyema were recorded in 30 foals (78.9%). While eight cases (21.1%) had unilateral GP tympany and/or empyema. The studied foals had GP tympany (25/38, 65.8%) or GP empyema (13/38, 34.2%). Out of 25 foals with GP tympany, five foals (20%) had complicated GP tympany with microbial infections. Ultrasonography examination of the GP tympany and empyema had a diagnostic value in 15.8% of the cases. In foals with GP tympany, endoscopy revealed distention of the afflicted GP with air, dorsal or lateral nasopharyngeal compression, and a stretched, thinning, pale mucosal lining. However, mucopurulent material and hyperemic, uneven GP mucosa were observed in one or both GPs in foals with GP empyema. Foals with uncomplicated GP tympany had normal hematology and serum chemistry. While foals with GP empyema and complicated GP tympany exhibited mild to moderate leukocytosis, neutrophilia with left shift in severe infection, hyperfibrinogenemia, mild hyperproteinemia, mild hyperglobulinemia (in chronic cases), mild hypoalbuminemia (in chronic cases), and increased serum amyloid A. Out of 38 foals with GP tympany and empyema, 18 foals (47.4%) had microbial infections. The microbial isolates were double mixed infections (50%) and triple mixed infection (50%). The most commonly isolated bacteria were α-hemolytic S. equi ssp. equi (13/18, 72.2%). Out of 36 treated foals, 33 foals (91.7%) with GP tympany and empyema recovered after 4-6 weeks of treatment by placement of a transnasal Foley catheter under the guidance of endoscopy with repeated lavage and administration of appropriate antibiotics. Three recurrent cases were successfully treated with transendoscopic laser fenestration of both GPs into pharyngeal cavity.

Arabian foals with GP tympany and/or empyema have characteristic clinical signs and endoscopic findings and nonspecific findings of hematology and serum chemistry. Although ultrasonography is a helpful diagnostic technique for foals with GP empyema and complicated GP tympany, endoscopy remains the gold standard for confirming the diagnosis of GP illness. All foals with GP empyema and complicated tympany should undergo culture and sensitivity test for a proper diagnosis and course of therapy because all cases of GP empyema and complicated cases of GP tympany have double and triple mixed microbial infections.