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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 dogs with complete avulsion, the mediastinal tissues can help to maintain the airways.
The following signs may occur immediately after injury or up to a week later:
Penetrating cervical (neck) wounds:
Perforation by a veterinarian (iatrogenic):
Blunt trauma can cause intrathoracic tracheal avulsion:
Your veterinarian will perform a thorough physical exam on your dog, taking into account the background history of symptoms and possible incidents that might have led to this condition. A complete blood profile will be conducted, including a chemical blood profile, a complete blood count, a urinalysis and an electrolyte panel. An arterial blood gas analysis may also be done to check oxygenation of blood. A pulse oximetry measurement may show less than normal (or even low) oxygen saturation.
Side view X-rays of the neck and chest are essential for diagnosis. Air pockets under the skin, air collection in the mediastinum, free air in the chest cavity, and potentially air in the sac around the heart will be seen with tracheal perforation. In cases of tracheal avulsion, the site of disruption may be visible. Abdominal X-rays may show a pneumoretroperitoneum -- air that has escaped into the space behind the lining of the stomach (peritoneum).
An examination of the interior walls of the trachea can be done by tracheoscopy to confirm the diagnosis of tracheal perforation and to estimate its severity. False-negative examinations can sometimes occur.
Your veterinarian will schedule follow-up appointments to monitor healing of the surgical incisions if surgery was indicated. Dogs that suffer from an avulsed trachea (one that has been torn away) and do not receive surgery may suffer sudden death. In fact, even with surgery, an animal with a repaired avulsed trachea have a guarded prognosis.
Call your veterinarian immediately if signs of redness, oozing or swelling are noted at the surgical incision site. The veterinarian should also be called immediately, on an emergency basis, if your dog begins to have difficulty breathing.
The prediction of a disease’s outcome in advance
The puncturing of a hole in the wall of the chest as a means of drawing out fluid or air
An in-depth examination of the properties of urine; used to determine the presence or absence of illness
A medical condition in which gas or air collects in the pleural space
The windpipe; it carries air from the bronchi to the mouth
The membrane that covers the wall of the abdomen and pelvic area
The tearing or breaking away of a part.
Anything that is created through a method of treatment
The area in the thorax between the two lungs, where the heart, esophagus, aorta, bronchials, and thymus are located.
The space in the abdomen that holds the major digestive organs in an animal. Normally referred to as the area between the diaphragm and the pelvis. Also referred to as the peritoneal cavity.