Exercise Induced Pulmonary Hemorrhage - Diagnosis - Endoscopy

Endoscopy

EIPH is most commonly diagnosed by endoscopic examination of the trachea following exercise although a small proportion of horses will have blood at the nostrils (epistaxis) during or following intense exercise. Sometimes epistaxis may not be apparent until the horse has lowered its head, aiding drainage of the blood. In severe cases blood may be visible in the trachea immediately upon endoscopic examination soon after exercise. The most common current practice is to perform endoscopy of the trachea around 30–60 minutes after exercise. As the hemorrhage most commonly originates in the dorsal caudal (top-back) part of the lung it may not appear in the trachea immediately. With time it may travel to the trachea under the influence of mucociliary clearance, gravity and ventilation. Blood may be visible in the trachea for several days following a bout of intense exercise and moderate to severe EIPH. The amount of blood visible in the trachea at the time of examination is most commonly graded on a 0 (no blood) to 4 (airways awash with blood) scale.