Presentation

A 5 year old male neutered Yorkshire Terrier presented for evaluation of tracheal collapse. The patient was experiencing severe episodes of dyspnea and tachypnea at night accompanied with mild to moderate coughing and gagging as well as labored respirations. He had been previously treated with cough suppressants, corticosteroids, antihistamines, and antibiotics intermittently for several years prior to presentation with variable response.

---

Thoracic Radiographs

Marked tracheal collapse in the caudal cervical region. The intrathoracic structures are normal. Obesity

---

Tracheal Fluoroscopy

There is severe almost complete collapse of the caudal cervical trachea to the level of the thoracic inlet. There is no collapse of the intrathoracic trachea or main stem bronchi.

---

Diagnosis

Tracheal collapse – severe (Grade III); Obesity – mild

---

Treatment

The patient was discharged on prednisone, Theophylline, Azithyromycin and Hydrocodone. He was also started on a weight loss plan.

---

Re-Evaluation

The patient initially improved with medical therapy and weight loss but the nocturnal respiratory distress returned and he represented for tracheal stent placement.

---

General Information on Tracheal Stenting

For stent placement, the patient is placed under general anesthesia, tracheal measurements are made, and an appropriately sized stent is placed through an endotracheal tube and deployed during direct visualization using fluoroscopy. The stenting procedure is fairly short and the patients are typically discharged from the hospital the following day. Medical management with corticosteroids and cough suppressants continues initially and most dogs will need continued cough suppressants for life. Those with concurrent lower-airway disease will often benefit from continued corticosteroid therapy as well. Stenting is not a cure, it is a palliative procedure, and the vast majority of patients will require continued medical therapy for a good long-term outcome.

---

Re-Evaluation Following Stent Placement

The nocturnal episodes have resolved but the patient continues to have marked coughing 4 weeks following the procedure. The coughing is expected to gradually improve over the next several weeks.

Figure 1: Lateral thoracic radiographs taken on initial presentation (A) and following tracheal stent placement (B).In Figure 1A. Note the severe collapse of the caudal cervical trachea (black arrows).

Figure 2: Tracheoscopy view of severe tracheal collapse (A) and correction with an intra luminal tracheal stent (B).