Bruges, a 10-year-old Hanoverian gelding, was participating in a local dressage clinic with owner Karen Anderson, of Garrett Park, Maryland, in the saddle when he took off across the arena, bucking aggressively. Totally out of character for this normally cooperative horse, this behavior abruptly ended Karen’s participation in the dressage clinic hosted by Grand Prix dressage rider Jim Koford. 

Cricket Russillo at Virginia Equine Imaging completed a bone scan and radiographs of Bruges, which revealed impingement of the spinal processes in the saddle area. Although these findings explained the gelding’s sudden pain and reactive bucking, a suspicious mass discovered in his right sinus was a complete surprise. Russilo recommended that Karen contact James Brown, clinical associate professor of equine surgery at the Equine Medical Center and a specialist in equine dental and sinus issues.

During his examination of Bruges, Brown noted no nasal discharge from either nostril and no unusual odor from the mouth or nose; moreover, the gelding did not appear to have any difficulty breathing through the right nostril.

Standing computed tomography of Bruges’ head revealed a rounded, soft tissue density within the right rostral maxillary sinus, extending into the maxillary septal bulla, from which Brown removed a sample for microbial DNA diagnostic testing. An endoscopic examination of the maxillary septal bulla revealed a brown-colored, lobulated mass in the rostral maxillary sinus, in close proximity to the infraorbital canal.

While Bruges was sedated and standing, Brown removed the mass under endoscopic guidance. Samples obtained during the surgery were submitted for histopathology, which revealed an ethmoid hematoma. The sinus was thoroughly lavaged, and an antibiotic solution was instilled into the affected sinus area.


Karen has owned Bruges since he was 4 years old and is working on second-third level dressage under the supervision of  Fédération Equestre Internationale (FEI) rider/trainer Cathy Echternach. 

“Before Bruges’ appointment, Dr. Brown explained the possible diagnoses and said the CT scan would be fairly quick and the results available immediately. Dr. Brown was factual and reassuring,” said Karen.

“On the day of the appointment, Dr. Brown came out to the trailer parking area, due to COVID-19 precautions, to tell me that the scan had been completed and that Bruges did not have cancer! After surgery, Dr. Brown came out again and said that the mass proved to be an ethmoid hematoma and that the horse was doing well, but they would like to keep him overnight for observation. When I came to pick him up the following day, Bruges looked rested and relaxed, but refused to load onto the trailer for the journey home!” 

Once home (after a little loading assistance), Bruges’ recovery from surgery went well. Not wanting to be the perfect patient, the gelding managed to remove his carefully applied head bandage on the second day of his rehabilitation!

Two weeks later, Karen’s primary care veterinarian removed Bruges’ stitches. After the kissing spine condition was treated, Bruge returned to full work and is feeling great, according to Karen. 

“And here is the other surprise,” Karen shared. “Bruges, who had been a difficult horse to load onto the trailer, now self-loads. He confidently marches up the ramp and munches his alfalfa with no sign of wanting to back off. Dr. Brown hinted to me that this might happen, and apparently it has!” 

Written by Sharon Peart for the Virginia-Maryland College of Veterinary Medicine.