Hole in the Trachea in Cats

Tracheal perforation most often occurs due to external trauma or an internal injury and can range from a small tear to complete avulsion, in which case the trachea tears away.

The trachea, also known as the windpipe, is a tube made of cartilage that allows air to pass from the throat to the larynx to the bronchi in the lungs. When the trachea becomes perforated via a small hole or tear in the cartilage, the air that normally passes into the lungs goes into the surrounding tissues. This creates pockets of air under the skin, in the mediastinum (the area between the lungs), around the heart, in the chest cavity and in the posterior portion of the abdominal cavity.

Symptoms typically appear immediately or within seven days of the injury or trauma. These symptoms include:

• Visible tissue damage to the neck and/or trachea
• Respiratory distress
• Breathing difficulties
• Rapid breathing
• Visible pockets of air under the skin
• "Crackling" sound when stroking cat's neck and back
• "Crowing" noise as the cat intakes air
• Loss of appetite (anorexia)
• Weight loss
• Weakness
• Lethargy
• Aversion to exercise
• Gagging
• Vomiting
• Dehydration
• Excessive salivation
• Coughing
• Shock

Perforation of the trachea can either be caused by an internal injury or external trauma. Internal injuries most often happen during a separate medical procedure by the veterinarian (iatrogenic). These causes include:

• Accidental puncture while drawing blood
• Accidental puncture during neck surgery
• Traumatic intubation during use of a tracheostomy tube
• Administration of anesthesia
• During a transtracheal wash

External trauma to the trachea normally occurs as the result of an accident. These accidents include:

• Penetrating trauma from an arrow, gunshot
• Blunt trauma from a thrown rock or object
• Bite wounds
• Falling from a great height
• Vehicle accident

The veterinarian will ask for the cat's health history, a list of noticeable symptoms, any recent accidents that occurred and a date when the symptoms first began. The veterinarian will physically examine the cat, feeling for air pockets and listening to the cat's breathing. Labs, which will include a complete blood count, a biochemical profile, an electrolyte panel and a urinalysis, will be taken. These tests will help the veterinarian eliminate other conditions that could be causing the respiratory problems. An arterial blood gas analysis may also be performed. This test looks at the levels of oxygen and carbon dioxide in the blood. A pulse oximetry test will also be performed. Both tests will typically show low amounts of oxygen saturation.

Radiography is the best way to confirm a tracheal perforation. A side view X-ray of the chest and neck will show the air pockets and air collection under the skin, around the heart, in the chest cavity and in the mediastinum. An abdominal X-ray may show free air in the abdominal cavity. The trachea may appear narrowed and the site of the tear or hole may be visible.

A tracheoscopy may also be performed to visualize the trachea. During this procedure, the cat will be placed under general anesthesia while a small tube with an attached camera (endoscope) is placed into the cat's mouth and into the trachea. The tracheoscopy can help the veterinarian determine the extent of damage and the best course of treatment. As this procedure does carry the risk of furthering injuring the trachea, however, it is only recommended in some cases.

Oxygen Therapy

The cat will need to be hospitalized and given oxygen via a nasal cannula or a face mask to increase its oxygen saturation levels. Oxygen therapy will be continued while other medical therapies are provided to the cat until the cat can get enough oxygen through its own breathing.

Fluid Therapy

Cats who are dehydrated will need to receive fluids intravenously in the hospital. The veterinarian will monitor the cat's fluid levels and its effects on the cat's heart to ensure it isn't being overly taxed.

Medication

The veterinarian will prescribe pain medications to keep the cat comfortable while it heals. An antibiotic may also be prescribed if a traumatic injury poses the risk of infection or as a preventive measure if surgery occurred.

Surgery

For external trauma or tracheal avulsion, surgery may need to occur. This is normally indicated if the cat's heart isn't able to maintain adequate circulation or if the cat isn't stabilized. During the surgery, part of the trachea will be removed and the trachea will be resected. The surgery poses the risk of infection. Because tracheal avulsion is a medical emergency that could result in sudden death, surgery must be done as soon as possible after the injury has occurred.

With prompt diagnosis and treatment, most cats recover completely after a minor tracheal perforation. Tracheal avulsions have a guarded prognosis. The cat will need to remain in a quiet, stress-free environment without young children or other animals while it recovers. The cat will need to follow up with the veterinarian to monitor healing with X-ray and physical exams.