1 / 16

Tracheal Collapse

Tracheal Collapse. James Montgomery, DVM September 21, 2009. General Conger Acc #114830. 8 yo MC Yorkshire Terrier Chronic cough Collapsing trachea – acute episode night prior to presentation at NCSU. General Conger Acc # 115060. Fluoroscopy. Link to movie. Tracheal Collapse. Two types

aletta
Download Presentation

Tracheal Collapse

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Tracheal Collapse James Montgomery, DVM September 21, 2009

  2. General Conger Acc #114830 • 8 yo MC • Yorkshire Terrier • Chronic cough • Collapsing trachea – acute episode night prior to presentation at NCSU

  3. General Conger Acc # 115060 • Fluoroscopy Link to movie

  4. Tracheal Collapse • Two types • Dorsoventral – often associated with a pendulous redundant dorsal tracheal membrane • Lateral – very unusual (rarely occurs spontaneously) • Obstruction of the trachea • Intrinsic weakness of the tracheal cartilage rings • Laxity of the dorsal tracheal membrane

  5. Signalment • With rare exception, toy and miniature breed dogs • Yorkshire terrier: 1/3 – 2/3 of all reported cases • Chihuahuas • Pomeranians • Toy poodles • Shih Tzus • Lhasa apsos • Usually middle-aged and older dogs • No sex predisposition

  6. Clinical Signs • Coughing is a sign consistently present • Chronic “honking” cough • Cough elicited with tracheal pressure at thoracic inlet (by palpation or pulling on leash), excitement, drinking water or eating food • Acute episodes: Respiratory distress +/- cyanosis • Physical exam usually normal otherwise

  7. Pathophysiology • Frequently affects the entire trachea, though cervical or thoracic tracheal may be involved alone • Inspiration: • Negative intrapleural pressures expand the intrathoracic airway lumen, while luminal pressure at the cervical level becomes negative cervical trachea collapses on inspiration • Expiration: • Intrapleural pressure increases, becoming positive – once intrapleural pressure exceeds the airway opening pressure, the thoracic trachea collapses

  8. Pathophysiology • Vicious cycle: • Collapsed trachea initiates coughing • Coughing and enforced respiration increase intrathoracic pressure causing opposing epithelial linings to come into contact  mucosal injury • Chronic epithelial injury causes inflammation and epithelial desquamation which disrupts mucociliary clearance

  9. Pathophysiology • With chronicity, mucous gland hyperplasia can occur causing increased respiratory secretion • Secretions accumulate in the trachea, as mucociliary clearance has been disrupted  further aggravates cough and tracheal collapse • A progressive disorder

  10. Treatment Options • Medical Management • Surgical • Chondrotomy • Plication of the dorsal tracheal membrane • Extraluminal prostheses • Endotracheal Stents

  11. Medical Management • Treatment of choice initially • Important to identify and manage any triggering event  break the pathologic vicious cycle • Allergies • Obesity • Deleterious effects on cardiopulmonary system, decreased lung expansion, and increased breathing effort • Treatment of existing infectious or inflammatory lung disease • Management of congestive heart failure

  12. Medical Management • Antitussives • Hydrocodone and butorphanol • Reduce chronic irritation or damage to the tracheal epithelium • Antisecretory drugs • Atropine • Decrease excessive accumulation of mucus in the respiratory tract • Bronchodilators • Methylxanthine • Theoretically reduce spasm of the smaller airways, reducing intrathoracic pressures and decreases tendency of larger airways to collapse

  13. Surgical treatment • Primary goal is to restore normal tracheal diameter without disrupting the mucociliary flow. • Tracheal Ring Chondrotomy and Plication of the dorsal tracheal membrane • Lead to reduction in tracheal diameter – techniques out of favor

  14. Surgical treatment • Extraluminal prostheses • C-shaped polypropylene • Improvement of clinical signs in 75-85% of patients • Mainly limited to cervical trachea • Difficult procedure • Invasive • Severe complications: • Laryngeal paralysis, tracheal necrosis (decreased tracheal blood flow), loosening or failure of the implant

  15. Surgical treatment • Intraluminal stents • Promising technique – still looking for optimal stent material • Fluoroscopic guidance • Self-expanding biliary Wallstents most common • Uncovered, metallic stent – epithelialization permanent • Relatively easy to deploy – orotracheal route • Less invasive • Shorter recovery time • Expensive - $1500 • Complications: stent migration, granulation tissue, tracheal perforation

  16. References • Ettinger SJ, Dantrowitz B. Diseases of the Trachea. In Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine, 6thed (St. Louis, MO: Elsevier Saunders, 2005) pp. 1217-32. • Moritz A, et al. Management of advanced tracheal collapse in dogs using intraluminal self-expanding biliary Wallstents. Journal of Veterinary Internal Medicine 18 (2004) pp. 31-42. • Sun F, et al. Endotrachealstenting therapy in dogs with tracheal collapse. The Veterinary Journal 175 (2008) pp. 186-93.

More Related