Surgery of the intrathoracic trachea and mainstem bronchi

image of Surgery of the intrathoracic trachea and mainstem bronchi
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Surgical diseases of the intrathoracic trachea are uncommon in both dogs and cats. Surgical intervention, when required, is best performed by a trained surgical specialist. This chapter covers intrathoracic tracheal avulsion injury, left principal bronchus avulsion/rupture, iatrogenic tracheal rupture, intrathoracic tracheal laceration or penetration, tracheal and bronchial foreign bodies, and neoplasia of the trachea.

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13.1 Tracheal avulsion: lateral thoracic radiograph of a cat taken on the day that it was hit by a car. The separated ends of the trachea are seen (arrowheads) along with a pseudotracheal membrane (black arrows) and evidence of leakage of air: subcutaneous emphysema (white arrows), pneumomediastinum and mild pneumothorax.
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13.2 Tracheal avulsion: lateral thoracic radiograph of a cat taken 3 weeks after it was hit by a car. The stenotic ends of the separated trachea can be seen (white arrows) and the pseudotracheal membrane is obvious (black arrows).
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13.3 Tracheal avulsion: view of the bulging pseudotracheal membrane (black arrows) through a right third intercostal thoracotomy. The cranial vena cava is seen ventral to the trachea (white arrow).
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13.4 (a) The tracheal avulsion is exposed through a right lateral thoracotomy and a sterile endotracheal tube is used to secure the airway whilst the sutures are preplaced through the ends of the trachea. (b) Preplaced sutures are tied following removal of the endotracheal tube.
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13.5 Cervical and intrathoracic tracheal tear caused by overinflation of an endotracheal tube cuff. (a) The tear is exposed via a ventral neck and sternotomy approach. The endotracheal tube can be seen through the tracheal defect (arrowed). (b) Closure of the defect with simple interrupted sutures of fine polydioxanone.
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13.6 Tracheal foreign body in a young adult cat. (a) A radiodense 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.
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13.7 Intrathoracic tracheal apocrine gland carcinoma in a 9-year-old Domestic Shorthaired cat. (a) A lateral thoracic radiograph shows a soft tissue density within the tracheal lumen between ribs 4 and 5 (arrowed). (b) A computed tomographic image of the same case showing a mass lesion arising from the left dorsolateral aspect of the caudal tracheal wall and causing almost complete occlusion of the tracheal lumen (arrowed).
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13.8 Intraoperative views of the tracheal apocrine gland carcinoma shown in Figure 13.7 seen through a right fifth intercostal thoracotomy following transection of the azygos vein. (a) The distal trachea has been sectioned and a sterile endotracheal tube placed in the carina to maintain the cat’s airway. The tracheal mass can be seen inside the cut end of the trachea (arrowed). The proximal tracheal incision is being made to allow the section of trachea containing the mass to be removed. (b) Sutures of fine polypropylene are placed in each end of the sectioned trachea, with the sterile endotracheal tube still positioned in the carina, to align the cut ends of the trachea. (c) The preplaced sutures of fine polypropylene are tied to complete the end-to-end anastomosis of the trachea.
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