Sinusitis is a common finding in a variety of avian species, however presents unique treatment challenges in ratites.1 A 6-yr-old male greater rhea (Rhea americana) presented acutely with right periorbital swelling. Examination revealed chemosis and infraorbital sinus swelling. He was treated with oral antibiotics based on multiple cultures for the next 14 wk with variable improvement, however no resolution of clinical signs. Mycoplasma, mycobacterial, and fungal culture results were negative. Due to inability to resolve clinical signs, advanced imaging with a CT scan of the sinuses was performed which revealed a mixed density mass associated with extensive destruction of the right nasal bone, hard palate, maxilla and frontal bone. CT guidance was used to perform a fine needle aspirate of the mass through a frontal bone defect for aerobic, anaerobic, fungal, and mycobacterial culture and cytology. The sinus mass culture grew an E. coli which was only susceptible to imipenem and amikacin. Based on these results, surgical resection of the affected tissue was performed. A dorsal midline incision was made to access the right infraorbital sinus and nasal cavity. The mass was removed and submitted for culture and histopathology. Gentamicin was applied topically and amikacin was administered parenterally. Histopathology of the mass was consistent with inspissated necrotic tissue. Five months post-surgery, no further clinical signs have been noted. Advanced imaging and surgical therapy were considered instrumental in eventual resolution of this resistant bacterial sinusitis in a species that is not typically amenable to frequent handling and restraint.
The authors thank Dr. Jeff Steurer and Dr. Dennis Keith for their assistance with this case, as well as the bird management and keeper staff at the Phoenix Zoo.
1. Donaley B. Management of captive ratites. In: Harrison GJ, Lightfoot TL, eds. Clinical Avian Medicine. Palm Beach, FL: Spix Publishing, Inc.; 2005.