ISSN 2398-2950      

Trachea: avulsion

ffelis

Synonym(s): Tracheal rupture


Introduction

  • Definition: complete severance of the intrathoracic trachea.
  • Cause: generally a sequelae to road traffic accident.
  • Signs: initial presentation:
    • Initial signs of shock and non-specific trauma.
    • Recover well with conservative management.
Often representation at 2 weeks due to progressive tracheal stenosis.
  • Dyspnea, increased respiratory effort and prolonged inspiratory phase.
  • Wheezing evident on tracheal auscultation.
  • Diagnosis: radiographs show classic bullous lesion in thoracic trachea 1-4cm cranial to tracheal bifurcation . Atypical patterns of rupture have also been reported (involvement of the carina or one of the principal bronchi).
  • Treatment:
    • Initial stabilization of shock.
    • Surgical repair via a right 4th/5th intercostal thoracotomy.
  • Prognosis: excellent with appropiate treatment.

Pathogenesis

Etiology

  • Blunt cervical or thoracic trauma - usually road traffic accident.

Pathophysiology

  • Traumatic incident leading to intrathoracic complete avulsion of the trachea.
  • Two possible pathologies have been proposed.
    • Blunt cervical or thoracic trauma and extension of the neck  →  Fixation of the cervical trachea  →  shearing force between the fixed cervical tracheal segment and relatively mobile thoracic tracheal segment as lungs and carina still mobile  →  avulsion of the trachea at the point of maximal shearing force (1-4 cm cranial to the carina).
    • Cervical or thoracic trauma  →  hyperextension of the neck  →  direct traction of the thoracic trachea at the thoracic inlet  →  avulsion 1-4 cm cranial to the carina.
  • In both instances the severed ends of the tracheal segments become stenotic over the following 2 week period due to fibrosis and granulation tissue formation at the severed ends.

Timecourse

  • 2 phases of the disease are seen:
    • Initial acute phase - distinguished by shock following the initial traumatic evens.
    • Representation 2 weeks after the initial trauma - representation due to the stenosis of the transected ends of the trachea.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Schmierer P A, Schwarz A, Bass D A et al (2014) Novel avulsion pattern of the left principal bronchus with involvement of the carina and caudal thoracic trachea in a cat. J Fel Med Surg 16 (8), 695-698 PubMed.
  • White R N & Oakley M R (2001) Left principal bronchus rupture in a cat. JSAP 42 (10), 495-498 PubMed.
  • White R N & Burton C A (2000) Surgical management of intrathoracic tracheal avulsion in cats: long-term results in 9 consecutive cases. Vet Surg 29 (5), 430-435 PubMed.
  • Griffiths L G, Sullivan M & Lerche P (1998) Intrathoracic tracheal avulsion and pseudodiverticulum following pneumomediastinum in a cat. Vet Rec 142 (25), 693-6 PubMed.
  • White R N & Milner H R (1995) Intrathoracic tracheal avulsion in three cats. JSAP 36 (8), 343-347 PubMed.
  • Whitfield J. B, Graves G M, Lappin M R et al (1989) Anesthetic and surgical management of intrathoracic segmental tracheal stenosis utilizing high-frequency jet ventilation. JAAHA 25 (4), 443-6 VetMedResource.

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