Airbag diseases – how do they occur?

The air sacs of horses are part of the upper respiratory tract. They develop in foals as a mucous membrane protrusion on both sides of the Eustachian tube (the connection between the middle ear and the nasopharyngeal cavity), each with a capacity of approximately 300 ml. Air sacs are found exclusively in equines and some other odd-toed ungulates, making them a unique feature. There are various theories about the function of the air sacs. The most likely is that they serve to cool the brain. There is a connection between the horse's throat and the air sacs, which is why infections of the upper respiratory tract can also spread to the air sacs. The most important diseases of the air sacs are described below.

INHALT
Airbag inflammation and airbag empyema Air sac mycosis Air pocket
Airbag inflammation and airbag empyema

Inflammation of the air sacs often occurs as a result of a viral infection of the upper respiratory tract or bacterial throat infections such as strangles (see article on strangles). Injuries or the direct penetration of feed particles or fungi can also cause air sac inflammation. Purulent inflammation occurs very frequently, especially after the rupture of abscessed lymph nodes in the laryngeal folds in cases of strangles. This is followed by the accumulation of pus in the air sacs, sometimes in large quantities. This is referred to as air sac empyema.

The clinical picture can vary depending on the extent of the inflammation and the type of underlying disease. The general condition may be disturbed and the body temperature may be slightly elevated. Air sac inflammation is often accompanied by increased unilateral, intermittent nasal discharge with a foul odor. The affected air sac can swell significantly, leading to difficulty swallowing and breathing. In some horses, air sac swelling can also be felt from the outside.

The veterinarian can usually diagnose air sac inflammation based on the clinical symptoms and the patient's medical history. To confirm the diagnosis, further examination with an endoscope is always recommended. This allows the air sacs to be examined and treated very effectively. As the examination is not straightforward, it is advisable to have it carried out at a clinic.

To treat the condition, the veterinarian flushes the inflamed air sac with a catheter. In the case of bacterial infections, additional antibiotic therapy should be administered. If there is very solid inflammatory material in the air sac that cannot be flushed out, surgical intervention may be necessary. To allow any secretions to drain better, it is recommended to soak and feed the animal from the floor several times after starting treatment.

Schematic location of air sacs in horses
1 Upper jaw | 2 Lower jaw | 3 Air sac
Air sac mycosis

Air sac mycosis is an infection of the air sac with mold fungi and is one of the most feared fungal diseases in horses. The colonization with fungi can occur on one or both sides and remain symptom-free for a long time. However, once the fungal cells penetrate the mucous membrane, dangerous vascular damage or brain nerve paralysis can occur. Without any prior signs, this can suddenly lead to severe bleeding from one nostril, which can cause the horse to bleed to death if left untreated. Paralysis of the larynx and vocal cords is also possible.

However, diagnosing air sac mycosis is not always easy. The disease can only be diagnosed endoscopically once fungal deposits have formed inside the air sac. If vascular damage has already occurred, blood may also be detected. However, both of these symptoms may be absent despite infection, which makes diagnosis considerably more difficult.

Fungal infection of the air sac can generally be treated either with antifungal medication administered directly into the air sac via irrigation or surgically. Surgery includes conventional and minimally invasive procedures. An important step in the treatment of air sac mycosis has been achieved by ligating the main vessel that runs through the air sac. This prevents the fungus from entering the vessel and causing life-threatening bleeding. In addition, the fungus is deprived of its nutrient supply, preventing it from growing. Thanks to these modern treatment methods, the risks of a vessel rupture can now be significantly reduced.

Air pocket

Air sac tympany is a relatively rare condition that mainly affects foals and young horses. Air flows into the air sac but cannot escape, causing excessive air to accumulate in one or both air sacs. Air sac tympany is often associated with air sac empyema.

The cause and exact mechanism of development remain unclear. In foals, the condition is due to a malformation of the Eustachian tube. A hereditary predisposition to this malformation has been demonstrated in Arabians and warmbloods. The air sac expands to such an extent that the ganasche is clearly visible from the outside and the narrowing of the airways leads to severe breathing difficulties, coughing, and swallowing disorders, which can even result in aspiration pneumonia (= pneumonia).

The veterinarian can usually make a suspected diagnosis based on the typical clinical picture. The diagnosis can be confirmed with the help of a further endoscopic examination. At the same time, most of the air can be released during the endoscopy. In some cases, it may also be advisable to take X-rays. Air sac tympany can be treated successfully either by conventional surgery under general anesthesia or, more recently, by minimally invasive laser surgery on a standing horse, with a significantly better prognosis after laser surgery.