American Federation for Medical Research

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Tracheal Diverticulae
Theo D. Trandafirescu. Medicine, Mount Sinai Services, Queens Hospital Center, Flushing, New York, United States

Purpose of Study Tracheal diverticulae (TD) are a rare finding on chest imaging, often seen incidentally in asymptomatic patients with underlying lung disease. Congenital and acquired types exist and have characteristic features on CT imaging and histopathologic exam.
Methods Used 63 m with history of treated tuberculosis, bladder cancer, obstructive lung disease,hypertension and hypothyroidism presented with cough associated with chest pain,SOB.He is an ex-smoker (35 yrs.pack) with occupation as a chef.PFTs showed mild obstructive defect with positive BD response.Chest CT revealed biapical pleural thickening with parenchymal nodularity and focal air density along the right posterolateral margin of the trachea consistent with tracheal air cyst or tracheal diverticulum.
Summary of Results TD are rare findings on imaging defined as a benign out-pouching of the tracheal wall.TD are congenital or acquired. Congenital TD represent a malformation of the supernumerary branches of the trachea and usually occur above the carina with small neck openings. Acquired TD are typically larger, can occur at any level of the tracheobronchial tree and result from increased intraluminal pressure such as chronic cough or weakening of structures after surgical procedures.Differential diagnoses of TD include laryngocele, pharyngocele, esophageal diverticulum, apical herniation of the lung, apical bullae, tracheocele, lymphoepithelial cysts and bronchogenic cysts. CT can be used to distinguish congential and acquired diverticulae, the former occurring more often proximal to the carina with smaller outpouching necks and the latter occurring at any part of the tracheobronchial tree with larger sizes of both neck and diverticulae. Bronchoscopy is an optional test for direct visualization of the TD, but if small with narrow necks or if without tracheal communication, can lead to missed diagnosis.Management is usually conservative (antibiotics, mucolytics, physiotherapy) while surgical management (resection, fulguration or endoscopic cauterization ) is considered more in young, symptomatic patients.
Conclusions TD are a rare and often asymptomatic manifestation of either congenital or acquired causes. Diagnosis is made by chest CT and histopathological examination, with or without bronchoscopic evaluation. Management is usually conservative, though surgical options are available in select patients.


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