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Year : 2004  |  Volume : 14  |  Issue : 2  |  Page : 197-198
Tracheal diverticula-report of 2 cases


Department of Radiology, Bharati Hospital, Dhankawadi, Pune 411043, India

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Keywords: Tracheal Anomalies, CT of cystic lesions in Neck, Tracheal Diverticulum

How to cite this article:
Rahalkar M D, Lakhkar D L, Joshi S W, Gundawar S. Tracheal diverticula-report of 2 cases. Indian J Radiol Imaging 2004;14:197-8

How to cite this URL:
Rahalkar M D, Lakhkar D L, Joshi S W, Gundawar S. Tracheal diverticula-report of 2 cases. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Nov 22];14:197-8. Available from: http://www.ijri.org/text.asp?2004/14/2/197/28588
This report describes two cases of tracheal diverticula, a rare anomaly. One was in an infant and so of congenital origin and the other was in an adult with severe cough, and hence of acquired type. A tracheal diverticulum arising from the right wall of trachea was detected in both of our cases incidentally during CT study of neck.

Case No. 1

A one and a half year old male child was referred for CT of larynx for investigation of stridor with intermittent complaints of respiratory distress and violent cough. A laryngeal cause was suspected on clinical examination. CT study detected a 28 x 6mm. in size, air-filled cystic lesion parallel to right tracheal wall, communicating with trachea through a small aperture.[Figure - 1] a&b. It was thought that fluid or secretions collecting in this diverticulum and spilling into tracheal lumen could be the cause of respiratory distress.

Case No. 2

A 47year old woman presented with complaints of severe, chronic cough and hoarseness of voice with no positive findings on ENT examination. CT study revealed a 22x12mms in size, right para-tracheal, air-filled cystic lesion and a small communicating tract was demonstrated on re-constructed oblique coronal images.[Figure - 2]a & b.


   Discussion Top


There are several causes of air-filled cystic lesions in the neck, eg pharyngocele, laryngocele, Zenker's diverticulum, apical herniations of lung, apical para-septal bullae or tracheal diverticulum.

Tracheal diverticulum is extremely rare and hardly accounts for 2% of cases, although Goo J M et al [1] reported in their single series perhaps the largest number of 64 proven cases. Tracheal diverticulum has been variously described as para-tracheal diverticulum, air-cyst, bronchogenic cyst, tracheocele, lymphoepithelial cyst, etc. in previous literature. The diverticulum is lined by ciliated columnar epithelium and has communication with tracheal lumen. These lesions arise from right postero-lateral wall of trachea and are seen at cervico-dorsal junction nearly in all cases described hitherto. The communication of the diverticulum with trachea could be visualized in both our cases, although in the series of 64 cases reported by Goo J M et al [1], the communication was seen in only 5 cases.

Congenital tracheal diverticula are very rare and thought to be due to malformed supernumerary branches of trachea [2]. There are interesting circumstances reported in the literature, under which such diverticula were detected. In one instance an endotracheal tube had entered into the diverticulum blocking the distal trachea [2] and in another accidental perforation of an unsuspected tracheocele by an endotracheal tube led to pneumomediastinum.

In an adult increased trans-luminal pressure in trachea such as in chronic cough, obstructive lung disease with emphysema can cause mucosal herniation through a weak point in trachea, resulting in formation of a tracheal diverticulum. There is also a well-known association of tracheal diverticulum with tracheobronchomalacia (Mounier-Kuhn Syndrome)[3], with few reports mentioning it as a sequel of tracheostomy [4].

Tracheal diverticulum could present clinically with foreign body sensation, neck or cervical swelling, recurrent laryngeal nerve palsy, bloody sputum and dysphagia.

The diagnosis of this rare entity is made by CT scan of trachea (preferably Spiral/Helical CT) and re-construction in varying angles in coronal plane to visualize communication with tracheal wall. There are also reports confirming the diagnosis of an unsuspected tracheal diverticulum at surgery or autopsy [4]. Excellent results have been reported after surgical excision.

Both our patients highlight the typical CT appearances of a tracheal diverticulum, with congenital and acquired cause for their formation.

This probably could be first report in Indian Radiological Literature, wherein congenital and acquired causes for tracheal diverticula have been mentioned together and could guide radiologists in interpretation of air-filled cystic lesions in neck.

 
   References Top

1.Right Para-tracheal Air Cysts in the Thoracic Inlet: Clinical and Radiologic Significance. Goo J M, Im JG, Ahn JM, Moon W K, Chung J W, Park J H, Seo J B, Hand M C. AJR 1999 ; 173(1): 65-70.   Back to cited text no. 1    
2.Congenital tracheal diverticulum : A case report. Frenkiel S, Assimes I K, Rosales J K. Ann Otol Rhinol Laryngol 1980 ; 89 : 406-8.  Back to cited text no. 2    
3.Tracheal diverticula and tracheobronchomegaly. Surprenant EL, O'Loughlin BJ. Dis Chest1966; 49:345-51.  Back to cited text no. 3    
4.Tracheocoele after routine tracheostomy. Henderson CG. Otolaryngol Head Neck Surg 1995; 113: 489.   Back to cited text no. 4    

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Correspondence Address:
S W Joshi
Medivision Diagnostic Centre, Patil Palza, Near saras Baug, Opp Mitra Mandal Chowk, Pune-411 009
India
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Source of Support: None, Conflict of Interest: None


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    Figures

[Figure - 1], [Figure - 2]

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