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- Do imaging findings of EMPF correlate with survival?
Clinical findings and outcome predictors for multinodular pulmonary fibrosis in horses: 46 cases (2009-2019)
Amanda Craven, Amy Todd-Donato, Tracy Stokol, Rachel Liepman, Ilana Glasberg, Pamela Wilkins, Daniela Luethy, David Wong, Angelika Schoster, Astrid J. van den Brom - Spierenburg, Joy E. Tomlinson
Background
Equine multinodular pulmonary fibrosis (EMPF) is characterized by interstitial fibrosis in horses, often associated with equine herpesvirus-5 (EHV-5). This study aimed to identify clinical signs and prognostic indicators for EMPF based on retrospective data from 46 adult horses treated from 2009 to 2019.
Methods
The study involved a retrospective review of medical records, imaging studies, and bronchoalveolar lavage fluid (BALF) cytology across multiple centers. Radiographic and ultrasonographic studies were independently reviewed, and the associations between predictor variables and survival outcomes were analyzed using statistical tests including Fisher’s exact and Wilcoxon rank sum tests.
Results
The most common clinical signs observed were weight loss (78%), increased respiratory effort (72%), tachypnea (70%), and fever (39%). EMPF was associated with higher rates of EHV-5 detection and hyperfibrinogenemia. Imaging findings did not correlate strongly with survival outcomes. However, specific BALF cytology features such as lymphocyte-to-neutrophil ratios and macrophage atypia were indicative of prognosis. The overall prognosis for EMPF was poor, with only 24% of horses surviving beyond three months post-discharge.
Limitations
The study's retrospective design may introduce biases, especially in the accuracy and consistency of historical medical records. Additionally, the diagnostic criteria for EMPF were not uniformly applied across all cases, potentially affecting the study's findings.
Conclusions
The study emphasizes that fever is not a reliable indicator of EMPF. Diagnostic efforts should focus on horses showing signs like increased respiratory rates and weight loss. Despite the poor prognosis associated with EMPF, identifying specific BALF cytology features can help in prognostication and management decisions. Further research is needed to explore the implications of EHV-5 and other potential etiological factors in EMPF.
Examples of radiographic patterns observed in 20 horses with equine multinodular pulmonary fibrosis. A, Moderate interstitial pulmonary pattern in the caudodorsal lung field, with a mild bronchial component and a few, small, poorly discerned soft tissue opaque nodules. B, Moderate caudodorsal bronchial pulmonary pattern with a mild interstitial component. C, Severe caudoventral alveolar pulmonary pattern. D, Severe interstitial pattern with a micronodular (miliary) component. E, Innumerable, small to medium, poorly circumscribed, soft tissue opaque nodules with mild to moderate interstitial and mild bronchial patterns. F, Random innumerable, small to medium, well-circumscribed, soft tissue opaque nodules distributed diffusely through the lung field.
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