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Hole in the Trachea in Dogs

Tracheal Perforation in Dogs

Tracheal perforation in dogs refers to a condition where the tracheal wall loses its integrity, resulting in a hole or tear. This breach allows air to escape into the surrounding tissues, leading to the formation of air pockets beneath the skin. Additionally, air may accumulate in the mediastinum, the space between the lungs, and potentially spread to other areas such as around the heart or in the chest and abdominal cavities.

Various factors can lead to tracheal perforation in dogs, including penetrating trauma, internal trauma within the trachea itself, or blunt trauma to the neck or chest. The severity of the perforation can vary, ranging from a small hole to complete tearing of the trachea (avulsion). In cases of complete avulsion, the presence of mediastinal tissues may aid in maintaining the airways.

Symptoms and Types

After sustaining an injury, dogs may exhibit the following signs either immediately or within a week:

  • Formation of air pockets beneath the skin
  • Difficulty breathing (respiratory distress)
  • Loss of appetite (anorexia)
  • Lethargy
  • Gagging
  • Increased salivation (ptyalism)
  • Vomiting
  • Coughing
  • Producing a harsh crowing sound while inhaling
  • Shock

Causes

Tracheal perforation in dogs can result from various factors, including:

  • Penetrating wounds to the neck, such as bites or injuries caused by projectiles like gunshots or arrows
  • Iatrogenic causes, which include perforation during medical procedures conducted by a veterinarian, such as transtracheal washes, inadvertent punctures while drawing blood, or during neck surgeries, as well as complications during anesthesia and intubation to maintain the airway
  • Blunt trauma, which may lead to intrathoracic tracheal avulsion, commonly seen in incidents such as motor vehicle accidents or falls from significant heights.

Diagnosis

To diagnose tracheal perforation in your dog, your veterinarian will conduct a comprehensive physical examination, considering the history of symptoms and potential incidents that may have caused the condition. Various tests will be performed, including a complete blood profile consisting of a chemical blood profile, complete blood count, urinalysis, and electrolyte panel. Additionally, an arterial blood gas analysis may be conducted to assess blood oxygen levels, while pulse oximetry can reveal lower-than-normal oxygen saturation.

Side-view X-rays of the neck and chest are crucial for diagnosis. These images can reveal air pockets under the skin, air accumulation in the mediastinum, free air in the chest cavity, and potential air around the heart in cases of tracheal perforation. In instances of tracheal avulsion, the site of disruption may also be visible. Abdominal X-rays may show pneumoretroperitoneum, indicating air leakage into the space behind the stomach lining.

Tracheoscopy, an examination of the tracheal interior, may be performed to confirm the diagnosis and assess the severity of the perforation. However, it’s important to note that false-negative results can occur in some cases.

Treatment

Dogs diagnosed with tracheal perforation typically require hospitalization for oxygen therapy. It’s important to maintain a low-stress environment with minimal stimuli.

In cases of iatrogenic perforation, spontaneous healing can occur with appropriate medical and supportive therapy. If pneumothorax develops, interventions such as thoracocentesis or placement of thoracostomy tubes may be necessary.

Surgery is recommended if the patient fails to stabilize or if there’s decompensation, characterized by the heart’s inability to maintain adequate blood circulation. Additionally, surgical intervention is warranted if the tracheal rupture is a result of blunt trauma or a penetrating wound.

In severe cases of tracheal damage or avulsion, tracheal cutting and rejoining to a healthy section of the trachea may be necessary.

Living and Management

After treatment, your veterinarian will schedule follow-up appointments to monitor the healing process, especially if surgery was performed. It’s crucial to adhere to these appointments.

For dogs with an avulsed trachea, surgical intervention is imperative to prevent sudden death. However, even with surgery, the prognosis remains guarded.

Keep a close eye on the surgical incision site for any signs of redness, oozing, or swelling. If you notice any of these symptoms, contact your veterinarian immediately. Additionally, if your dog experiences difficulty breathing, seek veterinary assistance promptly as it may indicate a serious issue.

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