TRACHEAL DIVERTICULUM: DIAGNOSIS AND TREATMENT OPTIONS

Abstract

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Tracheal Diverticulum is a rare and often incidental diagnosis found on chest imaging in an asymptomatic patient with underlying lung disease. Management includes conservative and possible surgical treatment depending on age and symptoms. CASE PRESENTATION: 72 yom presents with dyspnea and chronic cough. He is a nonsmoker and has a history of asthma, chronic sinusitis and right lung lobectomy after mva. Chest CT revealed pockets of air in superior mediastinum along the right posterior tracheal wall suggestive of tracheal diverticulum. Patient was medically managed with symptomatic improvement. DISCUSSION: Tracheal diverticulum (TD) is a benign and often incidental finding on chest imaging as an out pouching of the tracheal wall. According to their location, size and histopathology TD can be classified in either congenital or acquired. Acquired TD has a wide opening, can be found at any level in the thoracic cavity and occurs as a result of herniation of the weakened tracheal wall due to increased luminal pressure in the trachea. Congenital TD is thought to represent a malformation of the supernumerary branches of the trachea and usually occurs above the carina with small neck openings. The histopathological difference between them is the presence of smooth muscle and cartilage in congenital TD while acquired TD lacks these structures. Medical management of TD include physiotherapy, mucolytic and antibiotics in some cases. When symptomatic, patients may present with cough, hemoptysis and recurrent respiratory infections due to either the compression of adjacent organs or secondary bacterial infections. In symptomatic patients (cough, hemoptysis and recurrent respiratory infections) surgical treatment and endoscopic laser cauterization have been reported to be effective and safe. There is a lack of consensus regarding indications for treatment due to the rarity of this cases CONCLUSIONS: Tracheal diverticulum (TD) is defined as a benign out-pouching of the tracheal wall due to structural weakness that can be congenital or acquired in origin. Most cases are found incidentally since majority of patients are asymptomatic. Uncomplicated TDs are usually asymptomatic and when symptoms have occurred, they usually present with non-specific symptoms like pharyngeal discomfort, cough, dyspnea, and recurrent respiratory infection. Asymptomatic TDs usually require no treatment and managed conservatively while surgical excision is indicated in cases of recurrent infections or compression of adjacent organs. Reference #1: .Lee S-Y, Joo S, Lee GD, Ham SJ, Park CH, Lee S. A Case of Symptomatic Tracheal Diverticulum and Surgical Resection as a Treatment Modality. The Korean Journal of Thoracic and Cardiovascular Surgery. 2016;49(5):405-407. https://doi.org/10.5090/kjtcs.2016.49.5.405 Reference #2: Tanaka H, Mori Y, Kurokawa K, Abe S. Paratracheal air cysts communicating with the trachea: CT findings. J Thorac Imaging. 1997;12:38–40. https://doi.org/10.1097/00005382-199701000-00005. [PubMed][Cross Ref] Reference #3: Collin JD, Batchelor T, Hughes CW. Transcervical repair of tracheal diverticulum. Ann Thorac Surg. 2014;98:1490–2. https://doi.org/10.1016/j.athoracsur.2014.02.081. [PubMed] [Cross Ref DISCLOSURES: No relevant relationships by Anastasia Novikov, source=Web Response No relevant relationships by Theo Trandafirescu, source=Web Response