Management of apposing,full‐thickness tracheal perforations in two horses

Two horses, one 15‐year‐old Arabian gelding and one 10‐year‐old Quarter Horse gelding, presented with a history of marked subcutaneous emphysema. The first case exhibited no external wound, although there was a depression noted on the ventral neck. The second case had a laceration on the ventral aspect of the neck over the trachea. Endoscopic examination revealed both horses to have concurrent dorsal and ventral perforations of the trachea. The horses were managed by placing a short, cuffed, J‐shaped tracheostomy tube in the ventral perforation, while the dorsal perforation healed. The dorsal perforation in the first horse was allowed to heal by second intention, whereas sutures were placed in the dorsal perforation in the second case to reduce the healing time. Both horses were maintained on oral antimicrobial and nonsteroidal anti‐inflammatory medications throughout treatment. The dorsal perforation healed after 13 days in the first horse, and 22 days in the second horse. The ventral perforation healed in both horses by second intention following tracheostomy removal, giving a cosmetically acceptable result. In addition to facilitating tracheal healing, the tracheostomy tubes prevented the progression of subcutaneous emphysema, and promoted its resolution.     

Morphological study of tracheal shape in donkeys with and without tracheal obstruction

Reason for performing study: There is limited information on the gross tracheal morphology of donkeys with or without tracheal abnormalities. Objectives: To: 1) examine the morphology of tracheas of donkeys with and without clinical and/or post mortem evidence of tracheal obstruction; 2) record the cross‐sectional dimensions and shapes of tracheal rings at fixed sites; and 3) document prevalence, sites and characteristics of detected tracheal abnormalities. Methods: The tracheas of 75, predominantly aged (median age 30 years, range 7–48 years) donkeys that died or were subjected to euthanasia on humane grounds were examined. Five had severe dyspnoea due to tracheal obstruction (with intercurrent lung disease in 3), while 7 had post mortem evidence of severe tracheal airway obstruction. Every 5th tracheal ring was dissected free and the inner and outer vertical and transverse dimensions and cross sectional areas were measured. Each dissected ring was photographed and the shape of the trachea was classified as normal or, in one of 6 abnormal grades, according to the type and degree of structural abnormality present. Results: The tracheas had a mean of 43 (range 34–50) tracheal rings that tended to be more oval in shape in the distal cervical region. Only 31.2% of rings examined had a circular to oval shape. Dorso‐ventral flattening was present in 0.9% of tracheal rings, dorsal ligament separation in 24.4%, slight cartilage deformity in 26.0%, moderate cartilage deformity in 10.4%, marked cartilage deformity in 1.9% and miscellaneous other abnormalities in 4.9% of tracheal rings. The 12 donkeys with ante or post mortem evidence of tracheal obstruction had significantly increased tracheal abnormality grade in comparison to the remaining donkeys. Conclusions and potential relevance: Structural tracheal abnormalities are present in most old donkeys, but generally do not cause clinical problems in these sedentary animals unless intercurrent pulmonary disease is present.     

Experimental rabies in skunks: oral, nasal, tracheal and intestinal exposure.

Striped skunks (Mephitis mephitis) were exposed to challenge virus standard rabies virus by feeding infected mouse brain in suspension or as intact brain free choice, by forced feeding of suspension, and by intranasal, intratracheal and intraintestinal instillation of suspension. All of five skunks exposed intranasally, two of five exposed intratracheally and two of ten exposed by forced feeding developed rabies. None of the skunks exposed to challenge virus standard virus, by other methods, became rabid. Most of the survivors, when challenged intramuscularly with street rabies virus at six months, developed rabies. The results indicate that the skunk is much more susceptible to challenge virus standard rabies virus given intranasally than by the other methods used. When disease occurs following oral administration, infection may be associated with prolonged contact with buccal mucosa or accidental contact with nasal mucosa. Survivors had little or no protection when challenged intramuscularly with street rabies virus.     

Effect of tracheal mucus and tracheal cytology on racing performance in Thoroughbred racehorses

REASON FOR PERFORMING STUDY: Accumulations of mucus within the trachea are often found during endoscopic examinations of the airways of poorly performing racehorses, but the clinical importance of this finding is unknown. OBJECTIVES: To determine the effect of tracheal mucus, pharyngeal lymphoid hyperplasia (PLH) and cytological indices of tracheal aspirate on racing performance in Thoroughbred horses assessed by race place and whether the horse was raced. METHODS: Endoscopic examination of the nasopharynx, larynx and trachea was performed, and a tracheal aspirate obtained monthly at Thistledown racetrack from April to December, 2002 and 2003. Horses received a score of 0-4 for the degree of PLH and 0-4 for the amount of mucus visible in the trachea. The tracheal aspirate was assessed for turbidity, and total and differential cell counts. Generalised estimating equations models were used as repeated measures models for each risk factor and the level of association assessed through the risk factor's P value in the model. RESULTS: Moderate to severe tracheal mucus (2-4) was a risk factor for poor racing performance. There was no association between degree of PLH, cell counts or turbidity of tracheal wash fluid and racing performance. However, horses that raced had higher total neutrophil counts in tracheal wash aspirates than horses that did not race. CONCLUSIONS: Grades 2-4 tracheal mucus should be considered a potential cause of poor racing performance in Thoroughbred horses. CLINICAL RELEVANCE: Because moderate to severe tracheal mucus accumulation, and not increased tracheal neutrophils, was a risk factor for poor racing performance, functionally significant airway inflammation may best be confirmed by the presence of mucus rather than increased number of neutrophils in the trachea.     

Intraluminal tracheal stenting for treatment of tracheal narrowing in three cats

OBJECTIVE: To describe the use of intraluminal tracheal stenting in 3 cats with either benign or malignant tracheal obstruction. STUDY DESIGN: Retrospective clinical study. ANIMALS: Three client-owned cats. METHODS: Medical records were reviewed and information regarding signalment, clinical signs, physical examination findings, diagnostic tests performed, treatment, outcome and follow-up were retrieved. Intraluminal tracheal stent placement was performed as previously described in the literature. RESULTS: Three cats received intraluminal tracheal stents for the treatment of tracheal obstruction due to 3 different underlying causes: stricture secondary to traumatic endotracheal intubation, stricture secondary to a previous tracheotomy, and neoplasia. Self-expanding metallic stents of varying sizes were placed, and all cats recovered uneventfully from the procedures. The cat with tracheal neoplasia was euthanized because of pulmonary metastatic disease 6 weeks post-stent placement. The two cats with tracheal obstructions secondary to benign strictures are currently 39 months and 32 weeks post-stent placement, respectively. No complications were noted during the post-stent period in any of the 3 cats. CONCLUSIONS: Intraluminal tracheal stenting was easily, safely, and rapidly performed without complications and resulted in immediate improvement in clinical signs in all three cases. None of the cats in this study developed significant stent-associated complications during the study period. CLINICAL RELEVANCE: Intraluminal tracheal stenting has the potential to be a viable option for the treatment of tracheal obstruction in cats and perhaps for similar disease processes in other veterinary patients.     

Structural considerations in tracheal disease

Examinations were made of three sections of trachea obtained from eight dogs. The sections examined were at the regions of the second ring caudal to the larynx, the thoracic inlet, and the origin of the brachiocephalic trunk. Measurements were made of the lateral and ventrodorsal diameters, the lumen area of the trachea, the width and thickness of the tracheal cartilages, and the thickness of the trachealis muscle. Cell counts-per-square-micrometer of the cartilage and trachealis muscle were made. The results of these measurements were subjected to statistical analyses by means of one-way and two-way analyses of variance. The tracheal diameters, cartialge thickness, muscle thickness, and tracheal lumen area had significantly different measurements among the areas compared with both statistical methods. Ventrodorsal tracheal diameter and lumen area were not found to have significantly different measurements between the levels of the thoracic inlet and the brachiocephalic trunk. The cell counts did not have significantly different values among the areas considered when body weight was not a factor, but the values were significant when weight was a factor.     

Laryngeal, laryngotracheal, and tracheal masses in cats: 27 cases (1998-2003)

Medical records of 27 cats with masses of the larynx and trachea were examined. Six cats had inflammatory masses, and 21 cats had neoplastic lesions. A definitive diagnosis was reached in 22 cats with a single biopsy. The median age of the cats was 12.0 years (range 6 to 20 years). Dyspnea was the most common clinical sign. Accurate diagnoses were best obtained through direct laryngeal or tracheal examination combined with histological examination of tissue biopsies. Kaplan-Meier survival data for all inflammatory and neoplastic lesions showed a median survival of 5 days, with 7.4% of cats alive at 1 year.     

Plasma and urinary concentrations of trimetoquinol by LC‐MS‐MS following intravenous and intra‐tracheal administration to horses with heaves

Trimetoquinol (TMQ) is a very potent and fast acting bronchodilator in horses with heaves. This study assessed the plasma and urinary concentrations of TMQ in horses with heaves following administration via the intravenous (IV, 0.2 μg/kg) and intra‐tracheal (IT, 2 μg/kg) routes. TMQ was administered to six horses affected with heaves (RAO – Recurrent Airway Obstruction, used interchangeably) by the above routes and plasma and urine samples collected and stored at ?20 °C until analyzed. Solid Phase Extraction (SPE) of TMQ was followed by highly sensitive ESI(+)‐LC‐MS‐MS (ElectroSpray Ionization, positive mode – Liquid Chromatography – Mass Spectrometry – Mass Spectrometry); with a Limit of Detection (LOD) estimated at 1 pg/mL. Following IV administration, TMQ plasma levels peaked at 1 min at 707 pg/mL, and at 9 min at 306 pg/mL following IT administration. Our results show that TMQ plasma concentrations decline rapidly following IV administration, which is consistent with the fast onset and short duration of TMQ effect that was observed in our previous studies. On the other hand, IT administration showed a very unique plasma concentration pattern. From a regulatory standpoint, the current available TMQ ELISA kit was also used in an attempt to detect TMQ from the plasma and urine samples. We report that the ELISA kit was unable to detect TMQ from any of the samples generated in these studies.     

Intrathoracic tracheal rupture

This paper reports five new cases of intrathoracic tracheal rupture in cats, and summarizes these cases in conjunction with 11 cases from the literature. Most cats had no obvious respiratory signs at the time of injury, and in half of them the tracheal rupture was the only injury. The interval from trauma to onset of dyspnoea ranged from 1 to 28 days (median 12.5 days). Radiographic findings include loss of continuity of the trachea, often with a gas-filled diverticulum present between separated tracheal rings. With careful attention to surgical technique and anaesthetic management the prognosis for these cats is excellent. All eight of the cats reported in the last 14 years having surgical correction survived and returned to normal. The surgical anatomy, approach and tracheal anastomosis technique is described and recommendations for anaesthetic management are made.     

Canine tracheal collapse

Tracheal collapse occurs most commonly in middle‐aged, small breed dogs. Clinical signs are usually proportional to the degree of collapse, ranging from mild airway irritation and paroxysmal coughing to respiratory distress and dyspnoea. Diagnosis is made by documenting dynamic airway collapse with radiographs, bronchoscopy or fluoroscopy. Most dogs respond well to medical management and treatment of any concurrent comorbidities. Surgical intervention may need to be considered in dogs that do not respond or have respiratory compromise. A variety of surgical techniques have been reported although extraluminal ring prostheses or intraluminal stenting are the most commonly used. Both techniques have numerous potential complications and require specialised training and experience but are associated with good short‐ and long‐term outcomes.     

Primary tracheal collapse in a cat

A 7-year-old, neutered male, domestic shorthair cat was presented for severe inspiratory dyspnea of 2 to 3 days' duration. Radiography and tracheobronchoscopy confirmed the diagnosis of primary extrathoracic tracheal collapse. The cat was treated with oxygen, dexamethasone, and terbutaline, but no improvement was seen. Surgical correction was performed using nine prosthetic tracheal ring implants. Clinical signs improved after surgery, and the cat continued to do well 11 months after surgery, despite development of unilateral laryngeal paralysis.     

Incomplete tracheal intussusception in a dog

An 18-year-old male miniature poodle had a chronic nonproductive cough. On radiographic examination, an opacification resembling a foreign body was noticed within the trachea at the level of the sixth cervical vertebra. When the trachea was examined endoscopically, a circumferential flap-like lesion was found. To differentiate the invagination from an annular mass, thoracic computed tomography (CT) of the trachea was performed. There was cranial displacement and invagination of a tracheal segment creating the flap-like lesion. Tracheal intussusception should be considered as a cause of an annular tracheal mass.     

Intrathoracic tracheal avulsion in three cats

The surgical repair of complete intrathoracic tracheal avulsion in three cats is described. The initial presenting signs included dyspnoea, exercise intolerance and exertional cyanosis. Diagnosis was based upon the clinical signs, survey radiography and tracheal endoscopy. The ruptures were repaired via a right lateral thoracotomy made at the third or fourth intercostal interspace. Abnormal trachea was resected and a standard tracheal anastomosis was performed. Surgical results were considered excellent in all cases.