Pneumomediastinum, pneumothorax and pneumoretroperitoneum following endoscopic retrieval of a tracheal foreign body from a cat : clinical communication

Abstract

A 6-year-old entire male cat was presented with a 1-week history of severe dyspnoea without coughing. Upon auscultation, an inspiratory and particularly pronounced expiratory wheeze was noted, with severe dyspnoea. The minimum database was normal. Plain thoracic radiographs showed signs of a mural or intraluminal intrathoracic (T1-T4) tracheal narrowing. A dynamic collapsing trachea was ruled out using fluoroscopy. Bronchoscopy was performed and a dark green and brown spiculated foreign object was found just cranial to the carina. Following removal, the cat rapidly developed extensive truncal subcutaneous emphysema and oxygen-responsive dyspnoea and cyanosis. Follow-up radiographs demonstrated unilateral pneumothorax and lung collapse, marked pneumomediastinum and dissection of air through the tracheal wall. A thoracic drain was placed and the pneumothorax resolved rapidly. Follow-up radiographs demonstrated resolution of pneumothorax and development of extensive retroperitoneal air. The cat made an uneventful recovery. The foreign object was the calyx and stem of a flower. This article emphasises the importance of diagnostic imaging in the dyspnoeic patient, both for confirming initial suspicions of respiratory tract disease, and in managing and charting post-therapy resolution or complications.

Intrathoracic Emergency Tracheotomy for Treatment of Tracheal Foreign Body in a Young Cat

“…Several objects are described as needles, wood mulch, grass, tooth, gravel, bone, endotracheal tube fragment, bullet (Tivers & Moore, 2006;Zambelli, 2006). Several less invasive techniques are described in literature to remove the tracheal foreign bodies, like bronchoscopy, aid with Foley catheter and fluoroscopy, endoscopy via pre-sternal tracheostomy (Goodnight et al, 2010;Tivers & Moore, 2006;Nutt et al, 2014).…”

“…In a study about etiology of secondary pneumomediastinum in cats, only 6% of the cases (2/31) presented tracheal foreign body (Thomas & Syring, 2013). There is a case report of pneumodiastinum, unilateral pneumothorax, subcutaneous emphysema and pneumoperitoneum after endoscopic removal of tracheal foreign body located immediately cranial to carina in a cat (Zambelli, 2006).…”

“…Inhalation of foreign objects to the distal airway can cause different levels of coughing, dyspnea, stridor, panic and cyanosis (Zambelli, 2006). One must make differential diagnosis with pneumomediastinum in cats, although it represents another unfrequently condition, mostly related to general anesthesia and endotracheal intubation with positive ventilation and less frequently, as a spontaneous presentation (Thomas & Syring, 2013).…”

“…Surgical treatment, including pre-sternal tracheotomy and endoscopy through the tracheostomy site, sometimes with a thoracotomy approach, has been described when the less invasive methods of removal failed (Nutt et al, 2014). Besides, bronchoscopy was related to promote pneumomediastinum, subcutaneous emphysema, oxygen irresponsive dyspnea and cyanosis, just after the removal of a calyx and stem fragments of a flower, cranial to the carina in a cat (Zambelli, 2006). Endoscopic retrieval of tracheal foreign body is one of the etiologies of pneumomediastinum in cats (Thomas & Syring, 2013).…”

Corpo estranho traqueal em cão

“…Podem ser observados corrimento nasal purulento ou sanguinolento, engasgo, dispneia, cianose e vômito (Zambelli, 2006). Sibilos podem ser auscultados se o objeto estiver obstruindo parcialmente as vias aéreas (Nelson, 1998).…”