Tracheal Diverticulum

Abstract

SESSION TITLE: Imaging SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Tracheal diverticulae (TD) are a rare finding, often seen incidentally in asymptomatic patients with underlying obstructive lung disease. Congenital and acquired TD have characteristic features on CT and histopathologic exam. Management includes conservative and surgical measures depending on age and symptoms. CASE PRESENTATION: 63 YO Taiwanese male with a pmh of treated tuberculosis, COPD, bladder cancer, hypertension and hypothyroidism presented with cough and hemoptysis. Cough was associated with pleuritic type CP and SOB. He was an ex-smoker with occupation as a chef. PFTs showed mild obstructive defect. CXR showed prominent hilar markings and increased cardiac silhouette. CT showed biapical pleural thickening with parenchymal nodularity, two 4mm Rt lobe nodules and focal air density along the right posterolateral margin of the trachea consistent with tracheal air cyst or tracheal diverticulum. DISCUSSION: TD are rare findings defined as a benign out-pouching of the tracheal wall. Patients are often asymptomatic, though they can present with cough, recurrent respiratory infections, hemoptysis, SOB or stridor. TD are categorized as congenital or acquired. Congenital TD are thought to represent a malformation of the supernumerary branches of the trachea and usually occur above the carina with small neck outpouch Acquired TD are typically larger, can occur at any level of the tracheobronchial tree and result from increased intraluminal pressure such as cough or weakening of structures after surgical procedures, including difficult intubation or ventilation. Differential diagnoses of TD include laryngocele, pharyngocele, esophageal diverticulum, apical herniation of the lung, apical bullae, tracheocele, lymphoepithelial cysts and bronchogenic cysts. CT can 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 additional test for TD, but can lead to missed diagnosis. Management of TD is usually conservative, including antibiotics, mucolytics, physiotherapy, while surgical management (resection, fulguration or endoscopic cauterization) considered more in young,symptomatic patients. CONCLUSIONS: Tracheal diverticulae are a rare and often asymptomatic manifestation of either congenital or acquired causes. Diagnosis is made by CT and histopathological examination, with or without bronchoscopic evaluation. Management is usually conservative, though surgical options are available in select patients. Reference #1: Kurt A, Sayit AT, Ipek A, Tatar IG. Multidetector computed tomography survey of tracheal diverticulum. Eurasian J Med 2013. Reference #2: Sayit AT, Elmali M, Saglam D, Celenk C. The diseases of airwaytracheal diverticulum:review of the literature. J Thorac Dis 2016. Reference #3: Takhar RJ, Bunkar M, Jain S, Ghabale S Tracheal diverticulum:an unusual cause of chronic cough and recurrent respiratory infections Tuberk Toraks 2016. DISCLOSURE: The following authors have nothing to disclose: Theo Trandafirescu, Sherleen Gandham No Product/Research Disclosure Information.