Department of Diagnostic Imaging (Fenet, Conchou), Emergency and Critical Care (Aumann, Gaillard), Anaesthesia-Analgesia (Polo Paredes, Jourdan), and Internal Medicine (Diquelou) Université de Toulouse ENVT, INSERM, INRAE, UPS, École Nationale Vétérinaire de Toulouse, 23 chemin des capelles, 31076 Toulouse, France.
Can Vet J. 2022 Aug;63(8):830-834.
A dog was examined because of acute onset of respiratory distress following a cervical dog bite. Physical examination revealed a deep ventral cervical bite wound associated with localized mild subcutaneous emphysema. Thoracic radiographs showed moderate pneumomediastinum. Medical management consisting of oxygen therapy, antibiotics, and anti-inflammatories was initiated. After 2 days, respiratory distress suddenly worsened. Tracheoscopy showed a discontinuity between the tracheal rings of the cervical trachea; however, the inner tracheal wall appeared intact. Computed tomography scan revealed a ~3-cm complete rupture of all layers of the trachea. Surgical resection and anastomosis of the trachea were performed successfully. Follow-up 15 days after surgery showed complete resolution of respiratory signs, as well as subcutaneous emphysema. A mild ventral angulation of the trachea at the surgical site was noticed on thoracic radiographs. This is the first case report of a pseudotrachea in a dog. Persistence of a pseudotrachea may initially result in only minor clinical signs responsive to medical therapy despite tracheal rupture. In the presence of a pseudotrachea, tracheal rupture may be difficult to identify with tracheoscopy alone. Therefore, CT scan should be proposed in every patient with suspected tracheal trauma. Key clinical message: This case report highlights the importance of including a tracheal rupture in the differential diagnosis of cervical subcutaneous emphysema, even if the amount is small and not associated with significant respiratory signs. The presence of a pseudotrachea may result in less severe clinical signs than expected based on the actual degree of tracheal injury; however, the clinical status may rapidly deteriorate and become life-threatening. This case report also underlines the importance of a CT scan as a complement to tracheoscopy, which may not be sufficient to identify a tracheal rupture in the presence of a pseudotrachea.
一只狗因颈部狗咬伤后急性呼吸窘迫而接受检查。体格检查发现有一个深的腹侧颈部咬伤伤口，伴有局部轻度皮下气肿。胸部 X 光片显示中等度纵隔气肿。开始进行氧疗、抗生素和消炎药的医疗管理。两天后，呼吸窘迫突然恶化。气管镜检查显示颈气管的气管环之间有不连续，但内气管壁似乎完整。计算机断层扫描显示气管的所有层都有~3 厘米的完全破裂。成功地进行了气管切除术和吻合术。手术后 15 天的随访显示呼吸症状以及皮下气肿完全缓解。胸部 X 光片上注意到在手术部位的气管有轻微的腹侧弯曲。这是首例犬假性气管的病例报告。尽管存在气管破裂，但假性气管的持续存在最初可能仅导致对医疗治疗有反应的轻微临床症状。在存在假性气管的情况下，仅通过气管镜检查可能难以识别气管破裂。因此，建议对疑似气管创伤的每个患者进行 CT 扫描。关键临床信息：本病例报告强调了即使气管破裂量小且与明显的呼吸症状无关，也应将其纳入颈部皮下气肿的鉴别诊断中。假性气管的存在可能导致比根据实际气管损伤程度预期的更轻微的临床症状；然而，临床状况可能迅速恶化并危及生命。本病例报告还强调了 CT 扫描作为气管镜检查的补充的重要性，在存在假性气管的情况下，气管镜检查可能不足以识别气管破裂。
