Presentation
We present the case of a 77-year-old woman with a large acquired tracheal diverticulum who presented many difficulties for orotracheal intubation and hemoptysis. [archbronconeumol.org]
There is male predominance, and patients usually present in adult life. [lungindia.com]
A 53-year-old smoker presented with a history of recurrent lower respiratory tract infections. A diagnosis of Tracheal Diverticulosis due to Tracheobronchomegaly (Mounier-Kuhn Syndrome) was made. [ncbi.nlm.nih.gov]
Clinical Case We present the case of a 63-year-old, non-smoker with one week of odynophagia and right cervicalgia, associated with signs of local and systemic infection. Complementary imaging studies were taken. Chest x-ray was normal. [elynspublishing.com]
Entire Body System
- Weakness
It has been proposed that the cause of this difference is the relative weakness presented by the right paratracheal region compared with the left due to the presence of the aortic arch and the esophagus, which provide structural support to the tracheal [archbronconeumol.org]
Usually due to weakness in the posterior wall with pulmonary functions abnormality. Lined by respiratory epithileum. [sumerdoc.blogspot.com]
It results from a congenital or acquired weakness of the tracheal wall. Most tracheoceles cause few symptoms and are well tolerated. Diagnosis is often based on computerized tomography (CT) scan findings. [elsevier.es]
Acquired diverticula has been associated with persistent chronic cough by increasing intraluminal pressure in the trachea, resulting in a mucosal herniation through a weakness area of the tracheal muscular wall. [epos.myesr.org]
- Swelling
[Crossref] Edmiston R, Hariri A, Karagama Y (2015) The trumpet player with a swelling in the neck. Case Reports [Internet]1:bcr2015209487-bcr2015209487. [oatext.com]
Discussion Tracheal diverticula have been reported to be associated with chronic cough, recurrent nerve paralysis, and/or cervical neck swelling. (2,4,5) They have also been reported to cause difficult endotracheal intubation with associated pneumomediastinum [thefreelibrary.com]
There was no history of fever, wheezing, hemoptysis, chest pain, shortness of breath, leg swelling, loss of weight or appetite, and associated nasal symptoms. [journals.lww.com]
Tracheal diverticulum could present clinically with foreign body sensation, neck or cervical swelling, recurrent laryngeal nerve palsy, bloody sputum and dysphagia. [ijri.org]
It was not associated with any predisposing factors and except for the swelling in the neck the patient was asymptomatic. It was excised completely through the cervical approach and there has been no recurrence in two years follow-up. [cambridge.org]
- Recurrent Infection
Tracheal diverticula are typically asymptomatic but can occasionally present with chronic cough, stridor, dyspnea or recurrent infection 5. [radiopaedia.org]
AMYLOIDOSIS • rare • Symptoms - hoarseness, stridor, dyspnea, cough, hemoptysis, and recurrent infections. • Primary tracheobronchial amyloidosis - usually confined to the airways, with no evidence of concurrent parenchymal disease. • Deposits are multifocal [slideshare.net]
These are usually incidental findings at CT, although less commonly they may be associated with recurrent infection. [appliedradiology.com]
- Weight Loss
He denied fever, wheezes, chest pain, dyspnea, or weight loss. No other respiratory illness was present. His parents and siblings were normal. He works as a security officer. He has never smoked and denies regular alcohol intake. [journal.chestnet.org]
loss Bad breath (halitosis) Some people may experience a gurgling sound as air passes through the diverticulum. [my.clevelandclinic.org]
There was no history of fever, wheeze, chest pain, or weight loss. No other associated comorbid conditions were present (diabetes, hypertension, hyperlipidemia, or immunosuppresion). [lungindia.com]
- Leg Swelling
There was no history of fever, wheezing, hemoptysis, chest pain, shortness of breath, leg swelling, loss of weight or appetite, and associated nasal symptoms. [journals.lww.com]
Respiratoric
- Chronic Cough
Similarly, case 2, a 68-year-old woman, complained of sputum and throat discomfort, case 3, a 73-year-old woman, complained of chronic cough and sputum and case 4, a 62-year-old man, complained of hoarseness. [jstage.jst.go.jp]
Tracheal diverticula are typically asymptomatic but can occasionally present with chronic cough, stridor, dyspnea or recurrent infection 5. [radiopaedia.org]
Nevertheless, it can act as a cavity full of secretions and manifest clinically with chronic cough, repeated episodes of respiratory infections, haemoptysis, stridor or dyspnoea. [casesjournal.biomedcentral.com]
It was felt that pooling of secretions in the acquired pouch was a contributing factor in the exacerbation of the patient's chronic cough. [thefreelibrary.com]
- Sputum
His symptoms at the time were fever, shortness of breath, cough, and purulent sputum. There was a history, extending over many years, of persistent cough and purulent sputum, with progressive shortness of breath. [pubs.rsna.org]
Similarly, case 2, a 68-year-old woman, complained of sputum and throat discomfort, case 3, a 73-year-old woman, complained of chronic cough and sputum and case 4, a 62-year-old man, complained of hoarseness. [jstage.jst.go.jp]
During the last 15 years, he had experienced an increased expectoration of mucoid sputum that became purulent during infectious exacerbations, sometimes with bloody sputum. He denied fever, wheezes, chest pain, dyspnea, or weight loss. [journal.chestnet.org]
- Hemoptysis
Key words: Tracheal diverticulum, Paratracheal air cyst, Hemoptysis [scopemed.org]
Excessive sputum production with occasional hemoptysis occurs and patients may develop dyspnea and respiratory failure as the lungs become progressively damaged. [the-medical-dictionary.com]
The clinical manifestations of these diseases are frequently protean, including symptoms such as cough, hemoptysis, dyspnea and wheezing. [appliedradiology.com]
We present the case of a 77-year-old woman with a large acquired tracheal diverticulum who presented many difficulties for orotracheal intubation and hemoptysis. [archbronconeumol.org]
Patients may present clinically with chronic cough, dyspnea, hemoptysis, stridor, dysphagia, hoarseness, or repeated episodes of tracheobronchitis. [rsnj.org]
- Dyspnea
A tracheal diverticulum may act as a reservoir for secretions that may spill over into the tracheobronchial tree, predisposing affected patients to cough, dyspnea, stridor, and chronic chest infection. [entjournal.com]
Tracheal diverticula are typically asymptomatic but can occasionally present with chronic cough, stridor, dyspnea or recurrent infection 5. [radiopaedia.org]
Excessive sputum production with occasional hemoptysis occurs and patients may develop dyspnea and respiratory failure as the lungs become progressively damaged. [the-medical-dictionary.com]
- Hoarseness
Similarly, case 2, a 68-year-old woman, complained of sputum and throat discomfort, case 3, a 73-year-old woman, complained of chronic cough and sputum and case 4, a 62-year-old man, complained of hoarseness. [jstage.jst.go.jp]
Patients may present clinically with chronic cough, dyspnea, hemoptysis, stridor, dysphagia, hoarseness, or repeated episodes of tracheobronchitis. [rsnj.org]
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. [ijri.org]
Dysphagia, odynophagia, neck pain, hoarsness, hemoptysis, choking, recurrent episodes of hiccups and/or burping have also been described [9]. Compression of the laryngeal nerves can lead to dysphonia. [ghrnet.org]
Cardiovascular
- Chest Pain
We report a case of a 69-year-old woman who was hospitalized after presenting with fever, fatigue, pleuritic chest pain, and a right neck mass complicated by dysphagia. [ncbi.nlm.nih.gov]
He denied fever, wheezes, chest pain, dyspnea, or weight loss. No other respiratory illness was present. His parents and siblings were normal. He works as a security officer. He has never smoked and denies regular alcohol intake. [journal.chestnet.org]
There was no history of fever, wheezing, hemoptysis, chest pain, shortness of breath, leg swelling, loss of weight or appetite, and associated nasal symptoms. [journals.lww.com]
There was no history of fever, wheeze, chest pain, or weight loss. No other associated comorbid conditions were present (diabetes, hypertension, hyperlipidemia, or immunosuppresion). [lungindia.com]
Musculoskeletal
- Neck Pain
[…] when swallowing Cough Neck pain Weight loss Bad breath (halitosis) Some people may experience a gurgling sound as air passes through the diverticulum. [my.clevelandclinic.org]
Dysphagia, odynophagia, neck pain, hoarsness, hemoptysis, choking, recurrent episodes of hiccups and/or burping have also been described [9]. Compression of the laryngeal nerves can lead to dysphonia. [ghrnet.org]
Face, Head & Neck
- Neck Mass
We report a case of a 69-year-old woman who was hospitalized after presenting with fever, fatigue, pleuritic chest pain, and a right neck mass complicated by dysphagia. [ncbi.nlm.nih.gov]
mass, choking sensation, etc. [journals.lww.com]
Psychiatrical
- Suggestibility
It suggests the uncommon tracheal diverticulum. Teaching points by Dr MGK Murthy: Paratracheal air cyst is a nonspecific term used for collection of air parallel to the trachea. [sumerdoc.blogspot.com]
The cause of tracheobronchomegaly is not entirely known although a genetic link has been suggested with findings of radiographic abnormalities in the siblings. [jacpjournal.org]
In addition, the average age of the patients with cysts was 37 years, which suggests that air cysts are unrelated to chronic obstructive pulmonary disease. [ajnr.org]
Some authors distinguish tracheoceles from diverticula by size (diameter > 2 cm), while others suggest that a tracheocele is a diverticulum that has become dilated and air-filled. [rsnj.org]
Workup
The congenital form was found incidentally in 3 asymptomatic middle-aged women, and the acquired case (a tracheobronchial diverticulum) was discovered during a workup for chronic cough and fever in a young man. [entjournal.com]
The gold standard for diagnosis is flexible bronchoscopy; however, because patients present with nonspecific symptoms ranging from cough to complete airway obstruction, imaging is often obtained as part of the initial workup. 18 The CT appearance of papillomatosis [appliedradiology.com]
X-Ray
- Pericardial Effusion
effusion 168 Case 64 Pericardial cysts 170 Case 65 Partial or complete absence of the pericardium 172 Case 66 Pleural lipoma 176 Case 67 Prominent subpleural fat with chronic pleural disease 178 Case 68 Benign fibrous tumor of the pleura + pedicles 180 [books.google.com]
There was no lung parenchymal abnormality, mediastinal lymph nodal enlargement, or pleural/pericardial effusion. Flexible bronchoscopy was performed. [journals.lww.com]
Pleura
- Pleural Effusion
The CT scan of the chest showed pleural effusion and a tubular air-filled structure, which was adjacent to the posterolateral wall of the trachea at the level of thoracic inlet. [erj.ersjournals.com]
Treatment
Treatment options of tracheal diverticulum include surgical resection and conservative management. Treatment options change depending on the patient's symptoms, age and physical state. [erj.ersjournals.com]
So, they do not use any antibiotic treatment. [elynspublishing.com]
She underwent treatment with three months of FOLFIRI-bevacizumab followed by a two-month treatment holiday, and presented to our clinic again with decreased right paratracheal lymphadenopathy and no new metastatic disease. [cureus.com]
The clinical history, diagnosis and treatment options are discussed. [ncbi.nlm.nih.gov]
Multidisciplinary contributions on medical treatment, radiation oncology, and surgery and anesthesia are included. Highlights include new material on minimally invasive procedures and thoroughly updated diagnostic and treatment information. [books.google.com]
Prognosis
Treatment and prognosis Although usually asymptomatic, Tracheal diverticula may accumulate respiratory secretions that become infected (and potentially abscess-forming) and lead to coughing or tracheobronchitis. [radiopaedia.org]
COLLAPSUS TRACHEOBRONCHIQUE CHIRURGIE PRONOSTIC ETIOPATHOGENIE DIAGNOSTIC TRACHEE PATHOLOGIE MALFORMATION BRONCHE VIEILLARD ADULTE HOMME ORL STOMATOLOGIE PNEUMOLOGIE Keyword (en) TRACHEOBRONCHOMEGALIA DIVERTICULUM TRACHEA TRACHEOBRONCHIAL COLLAPSE SURGERY PROGNOSIS [pascal-francis.inist.fr]
They are generally small, do not metastasize to regional lymph nodes, and are associated with an excellent prognosis, with surgical resection resulting in a cure in most cases. [appliedradiology.com]
Etiology
Laryngology. 1998, vol. 107, no. 4, p. 362-4 Keywords Aged — Diverticulum/complications/diagnosis — Endoscopy — Female — Humans — Recurrent Laryngeal Nerve — Tomography, X-Ray Computed — Tracheal Diseases/complications/diagnosis — Vocal Cord Paralysis/etiology [archive-ouverte.unige.ch]
The most common etiology is COPD. [appliedradiology.com]
While the precise etiology is unknown, they have been associated with obstructive lung disease, inflammation, tracheal mucus impaction and increased intrathoracic pressures as possible causes. [elynspublishing.com]
[…] of the trachea and main bronchi, sometimes with tracheal diverticulosis, bronchiectasis, and recurrent lower respiratory tract infection.[1,2] The clinical and endoscopic features of tracheobronchomegaly were described by Mounier-Kuhn in 1932.[3] The etiology [the-medical-dictionary.com]
Pathophysiology
Newborn Surgery, Third Edition provides a comprehensive compendium of the pathophysiology, investigation and management of neonatal disorders. [books.google.com]
Although the cause and pathophysiology of the PTACs are still unknown, they are mostly considered as tracheal DV. In previous studies, the incidence of PTACs was 2% according to Goo et al [3] and 3.7% according to Buterbaugh and Erly [5]. [article.sapub.org]
Prevention
Medical Sciences, Tehran, Iran 3 Nursing and Respiratory Health Management Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran 4 Department of Medicine, Tobacco Prevention [zjrms.com]
Usually found in pairs on opposite sides of the bladder, bladder diverticula are often surgically removed to prevent infection, rupture, or even cancer. [en.wikipedia.org]
However, surgical treatment has been reported to be effective and safe for symptomatic tracheal diverticula to prevent the recurrence [15]. [elynspublishing.com]
We consulted our thoracic surgery colleagues who performed a serratus muscle flap repair of the tracheal diverticulum to prevent progression to tracheovascular fistula, as we were concerned the defect was extending toward the superior vena cava. [cureus.com]