Tracheal collapse syndrome is a debilitating condition common in small breed dogs. 13-year-old Woh Woh had a 6-year history of chronic coughing. The cough worsened with episodes of syncope (fainting) despite medical management and exercise restriction. Intraluminal tracheal stenting is a minimally invasive procedure that can improve the quality of life for dogs with severe TCS.
JANUARY 2017: WOH WOH WAS REFERRED TO vet specialist dr patrick maguire at mount pleasant vet centre (gelenggang)
During physical examination, Woh Woh was cyanotic* and observed to have the classical ‘honking’ cough. On thoracic auscultation, a left-sided heart murmur was detected.
* When there is not enough oxygen being carried to the body by red blood cells, the skin and mucous membranes can turn a bluish or purplish colour. This condition is known as cyanosis.
what is tracheal collapse?
The trachea, or windpipe, is a tube that delivers air to and from the lungs during respiration. There are small rings of cartilage along the tracheal wall to maintain the tube shape and keep the airway open. If the cartilage becomes weak, the tracheal rings flatten, making it difficult for air to get to the lungs. Signs of tracheal collapse include coughing, noisy breathing, exercise intolerance. Some dogs like Woh Woh can turn cyanotic when stressed or excited.
FEBRUARY 2017: further diagnostic evaluation and tracheal stent placement BY vet specialist DR NATHALEE PRAKASH AND DR ANTHONY GOH
Due to Woh Woh’s compromised condition, concurrent conditions that exacerbate coughing were investigated during stent placement. Echocardiography performed revealed mitral valve disease. There was no indication of pulmonary hypertension that could have contributed to the fainting episodes on the echocardiography. Other concurrent findings include elevation of liver enzymes and hypothyroidism. These conditions had been managed by the referring vet with medications and a hepatic diet.
In addition to his on-going medication, post-procedural medication included a broad-spectrum antibiotic, corticosteroid, anti-tussive and bronchodilator therapy. The bronchoalveolar lavage results showed a very low grade, mixed inflammation and bacterial culture was negative. Antibiotics were subsequently discontinued and Woh Woh was discharged two days after stent placement.
Intraluminal tracheal stent placement is a palliative, minimally invasive procedure to restore an obstructed or narrowed tracheal lumen.
- TCS is common in small breed dogs. These patients usually present with a distinctive honking cough and may show signs of breathing difficulty, cyanosis and fainting episodes during stress.
- Diagnosis of TCS can be made by chest radiographs but as the collapse is dynamic, fluoroscopy and endoscopic examination may be required in some cases.
- Management of TCS consists of weight loss, use of harnesses instead of collars to reduce tracheal pressure, limiting exposure to respiratory irritants (e.g. smoke, dust).
- The stent reduces but does not resolve coughing completely. Concurrent conditions such as bronchial collapse, chronic bronchitis and congestive heart failure should be evaluated and managed to optimise success post-stenting.
- Intraluminal tracheal stenting can result in rapid and significant improvement of clinical signs in patients with severe TCS. However, it should be considered as a palliative procedure and reserved for dogs who do not respond to medical management.
Medical write-up by Dr Jeenise Ng and Dr Anthony Goh, Mount Pleasant Vet Centre (Gelenggang) with contributions from Angeline Poh.