Clinical Signs:
At presentation, the horse had severe respiratory distress and generalized subcutaneous emphysema without any visible injury. Subcutaneous emphysema is the medical term for air becoming trapped in tissues beneath the skin. The subcutaneous emphysema was so severe that his eyes were not visible.
Diagnosis:
A tracheoscopy (endoscopy of the trachea) revealed a tear located 100cm from the tip of the nostril. Dr. Castro found two injuries, one located dorsally and one ventrally. The definitive diagnosis was a tracheal tear or rupture, with secondary subcutaneous emphysema.
BEFORE
Assessment and Management:
Dr. Castro performed a tracheotomy under sedation and local anesthetics. The incision was made over the site of the trauma in order to divert air flow so it did not continue to build up under the skin. Some air located in the subcutaneous tissue was also massaged out. Conservative management was indicated for this case. Therapy consisted of: anti-ulcer medications, non-steroidal anti-inflammatories, broad spectrum antimicrobials, strict stall rest, constant monitoring and re-evaluation of the injuries. After 17 days, a final tracheoscopy showed healed tracheal tissue and notably reduced subcutaneous emphysema. The tracheostomy was also healing beautifully.
AFTER
The more you know:
TRACHEAL RUPTURES/TEARS
These injuries are uncommon and often result from blunt trauma, like kicks or injury by sharp objects. In this case a very strong hit against a door was enough to tear the tissue.
Shoutout to Dr. Escudero (2022 intern) and visiting externs, Diego Cevallos and Kathrina Torres, who helped Dr. Castro with this challenging and surprising case.
If you ever experience an emergency, don’t hesitate to contact us.
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