A paratracheal cystic lesion in a patient with potential high-energy trauma

Abstract

59-year-old man with potential high-energy trauma aused by a traffic crash was transferred to our emerency department (ED) for treatment of suspected injuies of the lower limbs and other organs. On admission, he patient was in mild shock (blood pressure, 88/53 mm g; heart rate, 111 beats/min), but other vital signs were ithin normal ranges. Neurological and respiratory findngs were normal. Fluid resuscitation was immediately erformed, and the patient soon recovered from circulaory shock. A systemic examination for trauma, including echography FAST) and plain radiography, did not indicate any cranial, horacic, abdominal or pelvic trauma, but did reveal closed ractures of the lower legs. Because the damage to the car riven by the patient was significant, whole body computed omography (CT) scanning was performed. Plain CT scan evealed an air-filled cystic lesion in the upper mediastinum hat seemed to extend to the posterior tracheal wall (Figure 1). owever, the characteristics of the wall of the cystic lesion ould not be determined on plain CT images. Reconstructed mages from 3-dimensional CT scanning (3-D CT) revealed hat the cystic lesion was a tracheocele communicating to the osterior tracheal wall (2.3 4.1 3.6 mm in diameter, igure 2). Bronchoscopy revealed that the aperture of the racheocele was located at the posterior wall of the trachea acing upward. The inner wall of the tracheocele was covered ith mucosa that smoothly continued to the tracheal mucosa.