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Tracheal Perforation in Cats

Tracheal perforation is a loss of the integrity of the tracheal wall, in the form of a hole or rip, allowing leakage of air into the surrounding tissues and creating air pockets under the skin, air collection in the mediastinum (in between the lungs), and potentially air in the sac around the heart, free air in the chest cavity, and air in the most posterior part of the abdominal cavity (pneumoretroperitoneum). This loss of integrity can be caused by a penetrating trauma, trauma from inside the trachea, or blunt neck or chest trauma.

The severity of tracheal perforation ranges from a small perforation to complete tracheal avulsion (tearing away of the trachea). In cats with complete avulsion, the mediastinal tissues can help to maintain the airways.

Symptoms and Types

 The following signs may occur immediately after injury or up to a week later:

• Pockets of air collected under the skin
• Respiratory distress
• Lack of appetite (anorexia)
• Lack of energy
• Gagging
• Excessive salivation (ptyalism)
• Vomiting
• Coughing
• Harsh crowing sound as animal breathes in
• Shock             

Causes

Penetrating cervical (neck) wounds:

• Bite wounds
• Missiles (e.g., gunshots, arrows)

Perforation by a veterinarian (iatrogenic):

• During a transtracheal wash (a saline wash and collection of tissue and fluid through [trans] the trachea when evaluating for respiratory diseases)
• Inadvertent puncture while drawing blood, or during neck surgery
• Anesthesia and intubation procedures (to maintain an airway during anesthesia)

Blunt trauma can cause intrathoracic tracheal avulsion:

• Motor vehicle accident
• Falling from great heights