Tracheal Collapse in dogs.

Signalment:

  • Middle aged miniature breeds
  • Yorkshire Terrier, Pomeranian, Min. Poodle
  • Coughing: from lower airway or bronchial collapse
  • Honking/Gagging: from tracheal collapse
  • Dyspnea (difficulty passing air): from airway collapse or pulmonary disease

Pathophysiology:

  • Narrowing of the trachea occurs typically via dorsoventral collapse, rarely lateral collapse and ventrodorsal with tracheal malformation or circumferential with stenoses
  • Typical TC is caused by cartilaginous defect causing laxicity of the tracheal rings and invagination/collapse of the dorsal membrane into the tracheal lumen
  • Collapse can be neck (cervical), chest (intrathoracic), focal or a combination
  • May also involve the bronchi (tracheobronchomalacia)
  • Coughing caused by airway, pulmonary, laryngeal dysfunction can cause further collapse lead to progression of disease

Diagnostics:

  • LISTEN and WATCH: are the signs inspiratory and/or expiratory
  • Thoracic Radiographs (chest X-rays): Perform 3-view with the whole neck in the picture. Laterals should highlight the thoracic inlet but having forelimbs pulled forward in 1 view and back in another.
  • Fluoroscopy: shows dynamic nature of collapse
  • Hepatomegaly (large liver) is often present, broken ribs may be obvious (old or healing), dog often obese

Medical Management-STOP the COUGH:

  • Hycodan (0.25-0.5mg/kg every 4-12 hours)
  • Butorphanol- can be used but quite sedative
  • Aminophylline/theophylline: for lower airway disease present
  • Terbutaline/Albuterol: reduce lower airway constriction
  • Prednisone: reduce inflammation (1mg/kg/day)
  • Flovent: locally delivered steroids
  • Trazadone: reduce anxiety (4mg/kg PRN or q8 hours).
  • WEIGHT loss, Harness ONLY, Environmental management for allergens/irritants, Avoid extreme heat and excessive exercise

Surgical Management:

  • Extraluminal ring placement: for cervical collapse only
  • Laryngeal tie-back

Minimally invasive interventions

  • Endoluminal Tracheal Stent Placement:
    • Effective fro collapse at any level of the airway
    • Effective for standard collapse, neoplasia, granulation tissue
    • Reduced morbidity
    • No post-operative mortality
    • Complications:
      • Can exacerbate bronchial collapse (as can extraluminal rings)
      • Stent fracture
      • Granulation tissue

Picture of the trachea (windpipe) collapsing

 

 

 

 

 

(Above) Picture of the trachea (windpipe) collapsing – area that is circled. The collapse does not allow air to flow into the lungs causing respiratory distress.
The tracheal stent is in place after a short procedure

 

 

 

 

 

(Above) The tracheal stent is in place after a short procedure and patient was discharge the following day passing air normally.

Follow-up:
1. Routine rechecks monthly post-stent for 3 months, then every 3 months
2. Radiographs if clinical signs altered
3. Grading of cough, honk, dyspnea (0/10) at each recheck
4. Radiographs: 3-views

For more information, please contact our Internal Medicine Department at (310) 558-6100.

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