SESSION TYPE: Airway Cases I
PRESENTED ON: Monday, October 22, 2012 at 01:45 PM - 03:00 PM
INTRODUCTION: Tracheal diverticulum is a rare typically benign condition characterized by invaginations of the tracheal wall resulting in paratracheal air cysts. We report a fairly symptomatic patient with such a condition.
CASE PRESENTATION: 50 year-old woman with a history of recurrent lung adenocarcinoma s/p right middle and lower lobectomy was hospitalized for worsening of dyspnea and foreign body sensation in her neck since surgery. She initially had a dry cough, but later developed hemoptysis. She was evaluated by indirect laryngoscopy and two bronchoscopies which were reportedly normal. Her vital signs were normal. She had inspiratory stridor over her neck and bilateral lung inspiratory and expiratory wheezing. PFT’s revealed flattening of expiratory flow volume loop and normal inspiratory limb consistent with variable intra-thoracic obstruction. A neck CT scan with 3- dimensional reconstruction revealed a circumscribed gas density structure adjacent to and apparently communicating with the right postero-lateral trachea consistent with tracheal diverticulum. She was treated medically with systemic antibiotics and discharged home. Unfortunately, she died a month later due to respiratory failure.
DISCUSSION: Although rarely reported in clinical practice, the incidence may be as high as 1-2%.(1) Tracheal diverticulum can be either congenital or acquired. Congenital tracheal diverticulum is typically smaller and located 4-5 cm below vocal cords. The acquired form may appear at any level, but commonly in the postero-lateral region. They may be due to increased intraluminal pressure caused by cough or COPD combined with a weakened trachea wall.(2) Most are asymptomatic and incidentally discovered on radiological imaging. It can retain secretions and manifest with chronic cough, recurrent respiratory infections, hemoptysis, stridor or rarely dyspnea. CT scan with 3-dimensional reconstructions are typically diagnostic. Diverticula with a narrow opening can be missed on bronchoscopy. Treatment options are typically conservative management although surgical intervention has been reported in symptomatic patients. (3)
CONCLUSIONS: The diagnosis of tracheal diverticulum is often challenging and delayed due to insidious clinical course and non-specific presentation. Therefore, clinicians should consider tracheal diverticulum in the differential diagnosis of patients with chronic respiratory symptoms.
1) D. Pinot, D. Breen. An incidental finding in a 34-year-old male with hemoptysis. Eur Respir J 2009; 33:1227-1229.
2) Soto-Hurtado EJ, Penuela L.Tracheal diverticulum: a review of the literature. Lung 2006;184(6): 303-307.
3) I. Kokkonouzis, D. Haramis. Tracheal diverticulum in an asymptomatic male. Cases journal 2008. I:181
DISCLOSURE: The following authors have nothing to disclose: Luis Chug, Sowjanya Duthuluru, Damien Stevens, Joel Mermis
No Product/Research Disclosure InformationKansas University Medical Center, Kansas City, KS