Page 121 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery

with important neighbouring neurovascular structures,
com plete excision may not be safely possible. Endoluminal
VetBooks.ir patent airway in these patients in a palliative setting or to
tracheal stenting has been effective in re-establishing a
stabilize them prior to more definitive treatments such as
radiation therapy (Figure 8.15).
Chemotherapy and/or radiation therapy are the most
appropriate treatments for lymphoma. Squamous cell
carcinoma, mast cell tumours and lymphoma are radio-
sen sitive, and radiotherapy can therefore be considered
for management of these lesions.
(a)

(a)

(b) (c)

(b)
Lateral radiographs of a patient with a narrowed tracheal
8.15 lumen due to malignant obstruction (arrowed). (a) Before and
(d) (b) following palliative tracheal stent placement.
eries of radiographic images of an - eek-old puppy ith a
8.14 tracheobronchial foreign body (a bead). (a) Bead (arrowhead)
located at the carina, resulting in nearly complete airway obstruction.
(b) Ventrodorsal radiograph with the bead (arrowhead) in the left Segmental tracheal stenosis
mainstem bronchus and a 0.035-inch guidewire (arrowed) passed
beyond the bead into the left bronchus. (c) Ventrodorsal radiograph Segmental stenosis of the trachea is a rare congenital
with stone basket (arrowed) adjacent to the bead (arrowhead) bronchial condition associated with congenital cartilage deformities
foreign body. (d) Final lateral thoracic radiographic image demonstrating (Mawby et al., 2006) and may also be acquired following
completed removal of the foreign body. trauma, including endotracheal tube injury associated with
anaes thesia for dental prophylaxis or tracheostomy (Culp
A diagnosis is achieved by diagnostic imaging of et al., 2007). Extensive tracheal narrowing has been treated
the neck and thoracic cavity. Radiography may reveal the using intra uminal self-expanding nitinol stents (Culp et al.,
l
location of a mass, due to deviation or narrowing of 2007). Focal segmental tracheal stenosis may be managed
the air-filled trachea or due to mineralization of the mass. by performing a tracheal resection and anastomosis
Computed tomography may provide further information (Figure 8.16).
regarding the mass and its association with adjacent
structures. Tracheoscopy allows a definitive diagnosis to
be achieved by visualization of the mass and obtaining
brush cytology or grab biopsy samples. Additionally, laser Tracheal resection and
ablation or instrument-assisted debulking can be per-
formed under endoscopic guidance. anastomosis
For lesions confined to the trachea and affecting a
defined segment, surgical management is the treatment of Indications for tracheal resection and
choice. Benign neoplasms are readily cured if adequate anastomosis
margins are achieved, and the survival times for malignant
neoplasms are also favourable following surgical resection. • Focal tracheal neoplasm.
If surgical excision is not feasible and the mass is in • Congenital tracheal stenosis.
the cranial cervical trachea, a permanent tracheostomy • Acquired tracheal stenosis following trauma.
may give temporary relief. As these tumours are not • Resection of a traumatized section of trachea that is
uncommonly extensive, diffuse and/or closely associated not amenable to primary repair.

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