Survey of the large animal diplomates of the American College of Veterinary Internal Medicine regarding percutaneous lung biopsy in the horse.

Abstract

A survey designed to obtain information on the indications, contraindications, complications, and methodology of percutaneous lung biopsy in the horse was sent to large animal diplomates of the American College of Veterinary Internal Medicine. Sixty-five of 190 diplomates returned the survey (response rate: 34%) and 59 of these 65 respondents (91%) indicated that they worked with horses. Forty-four diplomates had performed a percutaneous lung biopsy in 1 or more horses (i.e. 75% of those diplomates working with horses and 68% of total respondents). Clinical and radiologic diagnoses that prompted diplomates to perform percutaneous lung biopsy in the horse included a pulmonary miliary pattern (93%), suspicion of pulmonary infiltrative disease (91%), suspicion of pulmonary neoplasia (91%), suspicion of chronic obstructive pulmonary disease (COPD) (20%), and suspicion of exercise-induced pulmonary hemorrhage (EIPH) (7%). Only one of the respondents reported the use of percutaneous lung biopsy in the diagnostic workup if pneumonia was suspected, but 11% of respondents reported that suspicion of pulmonary abscessation would prompt them to perform a percutaneous lung biopsy. In contrast, a variable percentage of respondents felt there were contraindications to performance of this technique, which included neonatal septicemia (68%), pulmonary abscessation (65%), pleuropneumonia (55%) and pneumonia (42%), EIPH (41%), and COPD (26%). No respondent indicated that suspicion of neoplasia was a contraindication to percutaneous biopsy. Most common complications observed by respondents were epistaxis (68% of respondents), putative pulmonary hemorrhage (52%), tachypnea (39%), and respiratory distress (32%). Ten of 44 respondents (23%) had not seen any complications with percutaneous lung biopsy. Forty-two of 44 respondents (96%) warned owners about possible complications before performing percutaneous lung biopsy. All respondents to this question reported that they would perform percutaneous lung biopsies in horses in the future, but 4 of 41 would use the procedure only as a last resort.