A case of suspected tracheal rupture in a 12-year-old domestic shorthair cat
This report describes the case of a cat suspected of developing an iatrogenic tracheal rupture following a dental procedure. The patient, a 12-year-old male castrated domestic shorthair cat, was presented to the Dentistry and Oral Surgery Service at the Cornell University Hospital for Animals on January 16, 2013 for evaluation of chronic stomatitis. The patient began exhibiting oral signs (blood-tinged saliva and difficulty chewing) a few months prior to presentation. Previous treatments included oral antibiotics, oral anti-inflammatories, oral laser ablation therapy, and a change in diet since the onset of clinical signs. The treatments either had no effect on clinical signs or only resolved them temporarily for a few weeks. Due to the patient's potential inappetence of 24 hour duration, treatment with oral analgesics was implemented by the primary care veterinarian the day prior to presentation. On presentation, the patient was quiet, alert, and responsive with normal vital parameters. There were no significant findings on general physical examination. A limited oral examination revealed severe pain, erythematous gingiva and buccal mucosa, and halitosis. Chronic stomatitis was diagnosed based on the medical history, physical examination findings, and oral examination findings. Routine clinicopathologic testing (complete blood count, serum biochemistry panel, and urinalysis) were performed. Relevant abnormalities included mild hypernatremia likely due to dehydration, mild hypokalemia likely due to anorexia, and hyperproteinemia characterized by hyperglobulinemia, likely the result of severe chronic oral inflammation and stimulation of the immune system. The cat was admitted to the hospital for oral surgery to be performed the next day. The patient was placed under general anesthesia and full-mouth digital radiographs were obtained. Based on history, clinical signs, and diagnostic test results, full-mouth extractions and placement of an esophageal feeding tube after oral surgery were performed. Thoracic radiographs were obtained postoperatively to confirm proper placement of the feeding tube. Pneumothorax, pneumomediastinum, and subcutaneous emphysema were noted, suggestive of tracheal rupture. Immediate thoracocentesis and thoracostomy tube placement were performed. The patient was placed in an oxygen cage and monitored overnight. Thoracic radiographs performed the next day showed almost complete resolution of the pneumothorax. Many factors leading to tracheal ruptures in cats have been discussed in the veterinary medical literature. The two most common causes include overinflation of the endotracheal tube cuff and excessive manipulation of the endotracheal tube. This report reviews the most common etiologies of the condition, as well as the diagnosis, clinical signs, and management of tracheal ruptures in cats. The imaging modality of choice for diagnosis is computed tomography. Treatment depends on the severity of respiratory signs, but the prognosis is typically good for cats with this condition that have no other concurrent complications.
Senior seminar paperSeminar SF601.1 2013
Cats -- Diseases -- Case studies