Tracheal Collapse


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Key Points

Tracheal collapse is commonly seen in small breed dogs such as Yorkshire terriers, Poodles, and Pomeranians to name a few

Tracheal collapse is caused by a progressive weakening of the the tracheal rings

When medical treatment is not effective surgery is a good option

Prognosis is good following surgery

 

Anatomy

  • The trachea, commonly known as the windpipe, is a tube that allows passage of air from the back of the throat to the lungs
  • There are two regions of the trachea:  cervical which is located in the neck and the thoracic trachea which is located in the chest
  • The trachea is made of many “C”-shaped cartilage rings and a dorsal tracheal ligament which connects the “C” to form a complete tube
  • Each of the cartilages is connected together by fibrous tissue
  • The voice box or larynx is the gateway of the trachea and prevents food and water from getting into the trachea
  • Two delicate nerves located on each side of the trachea, called the recurrent laryngeal nerves, control the muscles that open the doors of the voice box; damage to these nerves causes laryngeal paralysis
  • Below is a section of a normal trachea illustrating the dorsal tracheal ligament that is on the top side of the trachea and the cartilage rings that maintain the structure of the trachea

 

 

Cause of tracheal collapse

  • Tracheal collapse is commonly seen in small breed dogs such as Yorkshire terriers, Poodles, and Pomeranians to name a few
  • Tracheal collapse is caused by a progressive weakening of the the tracheal rings
  • One study showed that dogs with tracheal collapse have less chondroitin sulfate in their tracheal rings
  • Cushing’s disease (adrenal gland produces too much steroid) can weaken the cartilages
  • Below is an illustration showing about 50% collapse of the trachea, as the cartilage rings become progressively weaker, the trachea continues to collapse

Clinical signs

  • Goose honking cough is the classic sign of this disease
  • Coughing frequently is worsened by hot weather, exercise and excitement
  • Fainting spells due to lack of oxygen
  • Exercise intolerance

 

Diagnostic testing

  • Complete blood cell count
  • Chemistry profile
  • Testing for Cushing’s disease if clinical signs are present
  • Urinalysis
  • Fluoroscopy – movie type of x-ray (real time) that allows evaluation of the airway during inspiration and expiration
  • Scoping the airways
  • Chest radiographs below demonstrates a severely collapsed trachea (dark grey thin stripe labeled as trachea) in a dog; both the trachea in the neck and in the chest are collapsed

 

Treatment

  • Medical therapy
    • Cough suppressants
    • Antibiotics if indicated
    • Short course of steroids
    • Bronchodilators
    • Weight loss
    • Use harness instead of neck collar
    • Limit excitement
    • Keep out of hot environment
  • Surgery
    • Indicated if collapse is advanced
    • Indicated if collapse is not responsive to medical therapy
    • Surgery involves suturing the collapsed trachea to plastic rings which are placed around the trachea (see illustration); in the photo below, two clear plastic rings have been sutured to the trachea; an instrument has been passed beneath the trachea in order to pass the third plastic ring

 

 

Aftercare

  • Cough suppressants are needed while the trachea is healing – excessive cough can break the repair down
  • Pain medication
  • Antibiotics
  • Exercise restriction for 4 month
  • Use harness instead of neck collars
  • Weight reduction

 

Potential complications

  • Laryngeal paralysis
  • Swelling of the airway
  • Necrosis of the trachea
  • Recurrence
  • Anesthetic death
  • Pneumonia
  • Infection of surgical site

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