Gal is a 3.5 year old intact male Yorkshire Terrier which presented to Miami Veterinary Specialists for evaluation and treatment of collapsing trachea. He had originally been presented to his primary care veterinarian with the complaint of difficulty breathing, coughing and exercise intolerance at the age of one year. He was diagnosed with collapsing trachea based on thoracic radiographs, and was being treated with antitussives (butorphanol and hydrocodone at varying doses) and bronchodilators (aminophyline 10 mg/kg up to BID). His condition had been deteriorating, and had reached the point where he could no longer carry on any activity without being short of breath and coughing uncontrollably.

On exam, he was in good body condition. Vital signs were normal. On thoracic auscultation there were loud referred upper respiratory sounds, but no murmurs, crackles or wheezes. Direct palpation of the cervical trachea elicited a deep, loud honking cough. The rest of his physical examination was unremarkable.

Cervical and thoracic radiographs taken without sedation showed severe collapse of the trachea, beginning at the mid-cervical area, extending through the thoracic inlet and into the intra-thoracic area. The heart and lung parenchyma appeared unremarkable, no evidence of heart disease.

Due to the involvement of the intrathoracic trachea, together with the severity of his disease, the decision was made to support his trachea using an endotracheal stent.

He was anesthetized using hydromorphone as a premed and propofol for induction. His trachea was intubated normally and anesthesia was maintained using isoflurane in oxygen. A guide wire was placed into his esophagus and a measuring catheter passed over the guide wire so that it was at the same level as the trachea, but not in its lumen. Using fluoroscopic and digital radiographic control, the diameters of the trachea were measured during both positive and negative endotracheal pressure. Using these measurements, an appropriate sized endotracheal stent was chosen. It was introduced using a catheter placed through the endotracheal tube, and deployed using fluoroscopic control. The entire procedure took less than 40 minutes.

Gal recovered from anesthesia uneventfully, and went home later that evening. Because of the initial irritation of the placement procedure, antitussive medications were continued (hydrocodone and prednisone). After about 1.5 months, the antitussives were discontinued, and Gal was able to have vigorous activity without loss of breath or coughing. Today Gal continues to lead a near-normal life, with only an occasional cough.

Traditionally, collapsing trachea that was unresponsive to medical management was treated with external support rings. These implants required an open approach, and were not well suited for treatment of intrathoracic collapse. This case study illustrates the potential of using a minimally invasive intervention to treat a disease that previously was found to be very frustrating, if not impossible, to treat successfully using conventional open techniques.