Recurrent Obstructive Fibrinous Tracheal Pseudomembranes in a Young English Bulldog

Abstract

Endotracheal intubation is a common procedure, rarely associated with life‐threatening complications (e.g., tracheal rupture, necrosis, foreign body). A 1.5‐year‐old English Bulldog was presented for respiratory distress, with increased respiratory efforts and stridor, 2 days after endotracheal intubation. Cervical and thoracic radiographs disclosed a severe narrowing of the tracheal lumen associated with an intraluminal soft‐tissue structure at the thoracic inlet. Tracheoscopy confirmed the presence of an obstructive fibrinous tracheal pseudomembrane (OFTP) creating a 1‐way valve obstruction. Removal of the OFTP dramatically improved the dog's respiratory function, but the lesion reformed twice despite corticosteroid and antibiotic therapy PO, warranting repeated endoscopic removal of the OFTP. No additional recurrences were observed after treatment with inhaled heparin and N‐acetylcysteine q4h. No respiratory signs were reported 9 months after discharge. Postintubation OFTP has been reported rarely in humans and never described in dogs. Unexplained signs of upper airway obstruction shortly after endotracheal intubation should prompt consideration of OFTP in dogs, even if intubation was uneventful. Unlike its counterpart in humans, OFTP in dogs can reoccur after endoscopic removal, warranting repeated endoscopic extraction. A combination of corticosteroid therapy PO and heparin and N‐acetylcysteine inhalation q4h may be attempted if recurrence is observed.

Obstructive fibrinous tracheal pseudomembrane in a cat

“…11 The single case report of a dog with OFTP was unusual owing to its recurring nature. 4 In the present case, as in humans, clinical signs immediately resolved after removal of the OFTP and have not recurred during the following 1 year.…”

“…Firstly, the cat had undergone ET intubation 5 weeks prior to presentation. In humans and in 1 case report in a dog, 4,6 clinical signs often present shortly after extubation, although rarely can present as long as 2 weeks postprocedurally. 6 The present case is therefore unique in the Secondly, the cat was forcefully administered 2 antibiotics, which had previously been associated with esophageal stricture, and of which doxycycline in particular is known to cause esophageal mucosal irritation.…”

“…It is essentially a desiccated mucus plug that forms circumferentially in the trachea, without adhering to the adjacent tracheal wall. 1 It has previously been reported in humans [1][2][3] and in 1 dog, 4 but has yet to be described in cats. In humans, OFTP formation invariably follows TI, with the exception of a single case report of a silicone stent-induced OFTP.…”

Tracheal pseudomembrane secondary to aspiration pneumonia in a 6-year-old Ragdoll

“… 1 , 2 In the veterinary literature, there has been a previous case report of a recurrent tracheal pseudomembrane in a British Bulldog secondary to endotracheal intubation. 3 It has also been reported in foals secondary to equine herpesvirus. 4 The present case report is the first to describe a tracheal pseudomembrane in a cat, which was suspected to be secondary to aspiration pneumonia.…”

A systematic review and meta‐analysis of prevalence of complications after tracheal stenting in dogs

“…4,7,14,15,21,22,[26][27][28][29][30][31] Most studies did not aim to report the prevalence of these complications, which is largely unknown. 4,7,15,18,[21][22][23][24][25][32][33][34][35][36][37][38][39][40] Given the expense of tracheal stents and the debilitating consequences of some complications on the dog's quality of life, 7 the prevalence of these complications must be explained to owners to allow them to make an informed decision about tracheal stent placement in their pets. Meta-analysis is the statistical combination of results of multiple studies addressing the same subject.…”