Tracheal Perforation in Dogs

A tear or hole in the trachea is known more commonly as tracheal perforation or tracheal tear. This condition, at its worst, allows for air to get trapped in pockets under the skin, in the chest cavity and abdominal cavity, between the lungs, and in the sac around the heart. In those instances, surgery is more likely to occur. In more benign cases, small punctures and tears require very little attention from your dog’s medical staff, though it’s always a good idea to have your animal companion checked by a medical profession.

Since tracheal perforation is caused by injury, any of the following symptoms may become apparent immediately following trauma and up to 14 days later:

• Pockets of palpable air under the skin
• Shortness of breath, difficulty breathing or wheezing
• Signs of external trauma or holes in the neck region
• Malaise
• Vomiting
• Anorexia (lack of appetite)
• Gagging
• Unusual salivation
• Coughing
• Shock

Types

• Penetration or puncture wound
• Perforation

There are a number of things that can cause a hole in the trachea in dogs, including:

• Punctures from bite wounds, hunting accidents, sticks, etc. These type of punctures will appear as small or medium-sized holes in the neck of the dog.
• Accidental perforation can occur during medical procedures. The most common causes include perforation during intubation, transtracheal saline washes, during the administration of anesthesia, and during dental procedures. In these cases, you will not notice any physical signs of damage to your dog’s neck, though you may see small pockets of air forming in your dogs skin.
• Blunt trauma, such as being struck by a car or object., falling down the stairs or from a point of high elevation. There are obvious signs of injury and distress here, and this is considered a medical emergency.

The path to diagnosis begins with a physical examination during which your veterinarian will look for tenderness in the neck region of your dog and any visible wounds. Your doctor will also listen to your dog’s lungs and heart, and check for air pockets under your dog’s coat if a hole in the trachea is suspected.

A variety of medical tests are used to confirm diagnosis, such as:

• Complete blood count (CBC) to rule out inflammation and infection
• Biochemistry profile to check kidney, liver and pancreas function
• Urinalysis to gauge kidney function and look for signs of dehydration
• Arterial blood gas analysis to measure blood oxygenation
• Pulse oximetry to check for low oxygen saturation
• X-rays of neck and chest to confirm air pockets under the skin, free air in the chest cavity and/or air in the area around the heart
• Abdominal X-rays may be used to see air that has been trapped in the abdominal cavity
• Tracheoscopy, a procedure that allows doctors to view the inside of the trachea and lower airways, may be performed to confirm tracheal tears, rips or holes.

A positive diagnosis is generally confirmed with a combination of X-rays and, if needed, tracheoscopy, though the latter is less common as it can cause further injury and inflammation to the trachea.

Treatment varies widely, of course, depending on the extent of the injury and general health of the dog. Possible treatments include:

• Tracheal perforation with signs of oxygen deficiency generally requires hospitalization, during which your dog may receive oxygen therapy and rest.
• Small tears and perforations caused by medical procedures usually heal on their own and rarely require hospitalization or treatment, with the exception of mild painkillers.
• Blunt force trauma injuries will need to be evaluated extensively. Dogs that are physically unstable, have difficulty breathing, or are leaking large amounts of air under their skin rapidly will require immediate surgery to close deep wounds, repair tracheal damage, and remove air pockets.

Most dogs will be given a prescription strength pain medication and, if an infection is present, a course of antibiotics. Most trapped air under the skin will be reabsorbed without intervention though large pockets of air or those that do not heal on their own may require a tubal drain system to be implanted under the skin.

Follow-up appointments are a requirement for this type of injury if your dog has had a surgical procedure performed. Your doctor will want to see your dog several times post-surgery to watch for signs of infection and monitor healing.

Dogs with minor injuries that heal on their own may require one follow-up visit though your veterinarian will decide that your dog’s course of treatment.

Dogs should be prohibited from exercising for at least 7 to 10 days following treatment.

Since the severity of this condition varies widely and, in many cases, spontaneously heals on its own, the costs associated with treatment vary widely. Average costs run from $78 to $3,880, including office visits, medications, and surgery.