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
(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.
(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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