Guttural pouch empyema

What is guttural pouch empyema?
The guttural pouches are air-filled extensions of the Eustachian tubes in horses. They contain vital structures such as the carotid arteries and several cranial nerves.

Guttural pouch empyema is the accumulation of pus in one or both pouches, most often as a complication of throat infections caused by Streptococcus equi subsp. equi (Strangles) or S. zooepidemicus.

Symptoms

• Thick, purulent nasal discharge, sometimes with a foul odor
• Swelling behind the jawbones
• Difficulty swallowing or chewing
• Fever and lethargy
• Severe cases: respiratory distress

Diagnosis
Diagnosis is made via endoscopy of the upper airway, where pus is seen inside the guttural pouch. Radiographs or ultrasound can be used to evaluate the amount of pus or detect hardened pus masses (chondroids).

Treatment

• Endoscopic lavage of the guttural pouches with sterile saline and antibacterial solutions
• Removal of chondroids if present, sometimes requiring minor surgery
• Systemic antibiotics and anti-inflammatories when indicated
• Strict biosecurity to prevent spreading the infection to other horses

Prognosis
With timely treatment, the prognosis is good and horses usually recover fully.
Untreated empyema can spread to the carotid arteries or cranial nerves, leading to life-threatening complications.