Page 187 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

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

The mass is usually large and the disease process
advanced at the time of diagnosis: at least 50% of the
VetBooks.ir be recognized.
tracheal lumen must be obstructed for clinical signs to

Clinical signs
Dogs and cats with tracheal tumours are usually presented
with worsening dyspnoea, a progressive cough and exer-
cise intolerance.

Diagnosis
Radiography (Figure 13.7a), CT (Figure 13.7b) and broncho-
scopy can all be used to visualize a mass. Bron choscopy is
(a) useful for identification and biopsy and even for debulking
the tumour to improve clinical signs in the short term. In
some cases surgery is performed without a histological
diagnosis and is considered an excisional biopsy.

Treatment
For the majority of tracheal tumours surgical resection is
recommended for definitive diagnosis, treatment and/or
palliation of clinical signs. Surgical resection of tumours
affecting the intrathoracic trachea is extremely challenging
from both surgical and anaesthetic perspectives (Figure
13.8). Such surgery should only be attempted by trained
anaesthesia and surgical personnel. Un fortunately, survival

(b)
Tracheal foreign body in a young adult cat. (a) A radiodense
13.6 foreign body (pebble) is lodged at the tracheal bifurcation.
(b) Removal of the foreign body was easily achieved by gentle use of
grasping forceps under fluoroscopic guidance. The forceps may be
placed through the larynx either via the endotracheal tube or under
direct laryngoscopic visualization.

during removal can also occur, particularly with plant
matter. Where these removal methods fail, which tends
to be more common if the foreign body is within a bron-
chus, a more invasive approach with a thoracotomy and (a)
removal via a tracheotomy or bronchotomy is needed.
Foreign bodies wedged further into the smaller airways,
or those that have caused significant lung pathology, may
require a lung lobectomy for removal and resolution of
the problem. In general, successful removal of foreign
bodies has a good long-term outcome.

Neoplasia of the trachea
Although tracheal neoplasms are rare in both the dog
and the cat, many different tumour types have been
seen, including lymphoma (the most common tracheal
tumour in cats), plasmacytoma, chondrosarcoma, adeno-
carcinoma, mast cell tumour, squamous cell carcinoma,
basal cell carcinoma and neuroendocrine tumour. Benign
neoplasms such as leiomyoma and osteochondroma have
also been reported. Not all tracheal masses are neo plastic,
with more exotic parasitic lesions causing tracheal granu- (b)
lomas and obstruction being reported outside the UK, and
even more unusually, a haematoma involving the dorsal 13.7 Intrathoracic tracheal apocrine gland carcinoma in a
tracheal membrane has been reported to cause an 9-year-old Domestic Shorthaired cat. (a) A lateral thoracic
radiograph shows a soft tissue density within the tracheal lumen
obstructive mass after a dog bite. Inflammatory masses between ribs 4 and 5 (arrowed). (b) A computed tomographic image of
and polyps of the feline trachea are less common than the same case showing a mass lesion arising from the left dorsolateral
neoplastic masses, and the underlying aetiology for these aspect of the caudal tracheal wall and causing almost complete
is currently not clear. occlusion of the tracheal lumen (arrowed).

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