Tracheal Diverculum: A Rare Entity Diagnosed in the Context of Blunt Thoracic Trauma Report of A Case

Abstract

(PTACs) from which TD should be differentiated in consideration of the similar basic pattern of "paratracheal air collection". Diagnosis of TD is difficult because of its rarity, lack of symptomatology or specific symptomatology and low sensibility of the diagnostic tools available to date (chest CT and bronchoscopy). Apart from its intrinsic rarity, the case of TD we present here has the peculiarity of being diagnosed, differently from usual, by direct bronchoscopic visualization. The blunt thoracic trauma of which the patient was victim, gives more exemplarity to the diagnostic pathway of this entity. Indeed the detection of a para tracheal air collection on CT images could have been interpreted as a traumatic rupture of the trachea rather than a TD, leading to an unjustified surgical treatment. It was only clinical judgment combined with the use of the diagnostic imaging and bronchoscopy that conducted to the correct diagnosis.

Incidental Tracheocele as an Unusual Presentation of Pneumomediastinum in the Trauma Setting

“…There is very limited documentation of tracheocele diagnosis in the setting of traumatic injuries, but Naritmasu et al and Clemente et al described similar events in which high-impact blunt thoracic injuries due to a motor vehicle accident and a fall, respectively, led to the diagnosis [ 9 , 15 ]. Similar to these 2 cases, no evidence of traumatic injury within the tracheal lumen on bronchoscopic evaluation was observed in our case.…”

“…Nevertheless, Haddad et al suggested that multiple tracheal wall dilations (trachieactasis) can lead to further invagination of the mucosa. Hence, it is well known that an association exists between a weak tracheal wall and increased intraluminal pressure leading to a tracheal wall herniation [ 5 – 9 ].…”

Tracheal Diverticulum Diagnosed Following Blunt Thoracic Trauma

“…Although many TD are clinically silent, symptoms can include recurrent respiratory tract infections/ tracheobronchitis, chronic cough, dyspnea, dysphagia, hemoptysis, or stridor. 3 Most tracheal diverticulum respond well to conservative management with antibiotics, expectorants, and mucolytic therapies. Treatment options for those that do not respond to conservative measures include endoscopic fulguration/cauterization or surgical resection via mediastinoscopy, thoracoscopy, or thoracotomy approaches.…”