Intrathoracic Emergency Tracheotomy for Treatment of Tracheal Foreign Body in a Young Cat

Abstract

-Tracheal foreign bodies are rare emergency events. Several noninvasive methods are described for removal, such as bronchoscopy combined with appropriate grasping equipment or Foley catheter and forceps guided by fluoroscopy. However, complications can occur like pneumothorax, pneumomediastinum and irresponsive dyspnea as well as failure. Thus, pre-sternal tracheotomy combined with endoscopy or thoracotomy are attempted. Female cat, 1 year old, 1.6 kg had diagnosis of foreign body (0.7 x 0.5cm) with morphology of bird cervical vertebra at carina area, presenting one week of dyspnea, worsening with radiographic exam. It was performed emergency thoracotomy at left fifth intercostal space, followed by tracheotomy between the tracheal rings immediately cranial to the carina, allowing forceps removal. No foreign body was observed at radiograph after eight days and the patient was clinically well. Although, less invasive methods are preferable, they are not always available and they are not free from failures, leading to emergency tracheotomy as described in the present case report.Keywords: thoracotomy; dyspnea; feline.RESUMO -Corpos estranhos traqueais são eventos raros e emergenciais. Vários métodos não invasivos são descritos para a sua remoção, como broncoscopia combinada com equipamento apropriado de preensão ou cateter de Foley e pinça guiados por fluoroscopia. Entretanto, complicações como pneumotórax, pneumomediastino e dispneia irresponsiva assim como insucessos podem ocorrer. Portanto, traqueotomia preesternal combinada com endoscopia ou toracotomia são tentativas viáveis. Gata, 1 ano, 1.6kg teve diagnóstico de corpo estranho (0.7 x 0.5 cm) com morfologia de vértebra cervical de ave na região da carina. Apresentava há uma semana, dispnéia, piorando durante exame radiográfico. Foi realizado toracotomia de emergência no quinto espaço intercostal esquerdo, seguida de traqueotomia entre os anéis traqueais imediatamente cranial à carina, permitindo remoção por fórceps. Após oito dias, foi realizada radiografia controle e o paciente apresentava-se clinicamente bem. Embora, métodos menos invasivos sejam preferidos, não são isentos de falhas, necessitando toracotomia emergencial como a descrita no presente relato.Palavras-Chave: toracotomia; dispneia; felino.* Autor para correspondência.

Emergency Removal of a Proximal Tracheal Foreign Body by Tracheotomy in a Dog and a Cat

“…In dogs and cats, most reported cases were FBs in the distal trachea or bronchi [4][5][6][7][8][9][10][11][12]. Only a few cases of proximal tracheal FBs have been reported; a small segment of pine cone was diagnosed at a chronic stage and removed endoscopically [13], and a large roundish stone was urgently removed by tracheotomy [14].…”

“…These FBs were commonly found near the carina, with a history of coughing or breathing problems for several days, and were not necessarily an emergency condition [4][5][6]. For distal tracheal FBs, removal through the mouth with endoscopy [4,5] or a balloon catheter [7,8] is preferred, and if these are not feasible, thoracotomy is performed [9][10][11].…”