12 tracheal collapse

tracheal collapse

this is a form of tracheal obstruction caused by cartilage flaccidity and flattening

the cause is unknown and probably multifactorial

what is the problem with knowing the pathophysiology of tracheal collapse?

top down/bottom up aka dorsoventral direction (NOT SIDE TO SIDE)

in what way does the trachea collapse?

INSPIRATION: cervical and thoracic inlet collapse

EXPIRATION: intrathoracic collapses

what is tracheal collapse like on inspiration and expiration?

thoracic inlet

which part of the trachea is most susceptible to tracheal collapse?

COUGHING

what becomes an important tracheobronchial clearing mechanism with tracheal collapse?

typically TOY and mini dogs, though it CAN HAPPEN in large dogs (it is more associated with trauma/deformity/masses in them)

what is the signalment like for tracheal collapse?

Because tracheal collapse in large breed dogs should NOT BE EQUATED with tracheal collapse in toy breed dogs = consider what is causing it

In larger dogs, tracheal collapse is usually associated with trauma, deformity, and masses. Why do we care?

GOOSE HONK COUGH

What is the CLASSIC SYMPTOM for tracheal collapse?

Tracheal collapse

(though common differentials are kennel cough, laryngeal paralysis/collapse, etc)

A dog presents with flaccid tracheal cartilages with prominent lateral borders on palpation of the cervical trachea, though the dog breaks into paroxysmal coughing on palpation. What is your first thought?

1. obesity (50%)

2. laryngeal paralysis (20%)

3. systolic heart murmur (33%)

4. dental disease (40%)

Name some common concurrent problems with tracheal collapse:

Intrathoracic tracheal collapse

A patient with tracheal collapse shows soft end-expiratory snapping together of the tracheal wall. What is this?

Cervical trachea

which part of the trachea will collapse on inspiration?

thoracic (aka intrathoracic) trachea

which part of the trachea will collapse on expiration?

DIAGNOSTIC IMAGING (though it may require multiple modalities and bronchoscopy) = collapsed lumen, bronchiectasis or cardiopulmonary disease in some

what should you do to diagnose tracheal collapse? what will it look like?

tracheal collapse (which is not the same as "microtrachea", which will be a more "uniform" collapse throughout)

what is happening here?

do laryngoscopy at the same time as tracheoscopy because laryngeal paralysis is present in 30% of dogs with tracheal collapse

what should you do at the same time as tracheoscopy when evaluating a dog for tracheal collapse? why?

4

how many grades are there of tracheal collapse?

grade 1

which grade of tracheal collapse shows a relatively normal tracheal cartilage anatomy, with up to 1/4 luminal diameter collapse

grade 2

which grade of tracheal collapse shows mild to moderate flattening of the tracheal cartilages, with up to 1/2 luminal diameter collapse

grade 3

which grade of tracheal collapse shows severe flattening of the tracheal cartilages, with up to 3/4 loss of luminal diameter

grade 4

which grade of tracheal collapse shows complete obstruction, with 100% tracheal lumen collapse

1. kennel cough

2. brachycephalic syndrome

3. laryngeal collapse/paralysis

4. bronchitis

5. tracheobronchitis

6. allergies

7. heartworm disease

8. hypoplastic trachea

name a few differential diagnoses for tracheal collapse:

when there is less than 50% tracheal lumen collapse, aka grades I and II you can medically manage

when can you medically manage tracheal collapse (and should think about medically managing instead of jumping straight into surgery)?

weight loss, harness instead of collar, nonsmoking atmosphere, medicinally (antitussive aka cough suppressant)

name a few ways you can medically manage tracheal collapse

response to medical therapy is usually transient/temporary, and the disease typically progresses aka remind the owner the problem will progress and the patient will not remain stable forever

what do you need to remind the owner when medically managing tracheal collapse?

severe clinical signs, over 50% reduction of tracheal lumen (aka grade III and IV)

when should you jump to surgically treating tracheal collapse?

support tracheal cartilages and trachealis muscle while preserving as much of the segmental blood and nerve supply to the tracheal as possible

what is the goal of surgically treating tracheal collapse?

extraluminal ring prostheses and endoluminal stenting

name some surgical techniques for treating tracheal collapse:

surgical treatment of collapsing trachea (aka extraluminal ring protheses and endoluminal stenting)

which surgical procedure aims to support tracheal cartilages and trachealis muscle while preserving as much of the segmental blood and nerve supply to the tracheal as possible

FALSE: these are ADVANCED SURGICAL PROCEDURES and it is recommended to REFER

true or false: extraluminal ring prosthesis and endoluminal stent placement to surgically manage tracheal collapse should be done by general practitioners as the dog's condition is likely critical at that point.

extraluminal ring prosthesis

what is happening here, where you retract the sternohyoid and expose the trachea, pass the ring around the trachea and suture in place between holes and thru the cartilage?

endoluminal stent placement

what is happening in this minimally invasive procedure, where you place in a stent and let it expand?

under general anesthesia using tracheoscopy or fluoroscopy

how should you perform endoluminal stent placement to correct collapsing trachea?

because constant movement at that point often leads to early fracture of the stent

why should you be careful about placing an endoluminal stent near the thoracic inlet when correcting tracheal collapse?

nasal insufflation of O2, glucocorticoids, mucolytics, antibiotics, antitussives, bronchodilators, cage rest 3-7 days, tracheoscopy 1-2 months post op

name a few post-op things you can do to care for animals recovering from endoluminal stent or extraluminal ring prosthesis:

NOTHING: after surgery, the quality of life is improved for most patients, but neither SURGERY NOR STENTS CURE THE CONDITION

what cures tracheal collapse?

prognosis dependent on concurrent respiratory problems (laryngeal paralysis/collapse, bronchial disease) rather than the location or severity of tracheal collapse

what is the prognosis dependent on with tracheal collapse post surgery patients?

regardless of treatment type, the presence of mainstem bronchi collapse is associated with shorter survival times

regardless of treatment type, the presence of WHAT is associated with shorter survival times for post op tracheal collapse patients?