Tracheal diverticulum

Last revised by Daniel J Bell on 19 Apr 2023

Tracheal diverticula, also known as tracheoceles, are usually an incidental finding. Occasionally it may mimic pneumomediastinum, so-called pseudopneumomediastinum.

There is an overlap in the use and description of the terms paratracheal air cyst and a tracheal diverticulum in the literature such that they often seem to be synonyms for the same entity 1,5

Tracheal diverticula are typically asymptomatic but can occasionally present with chronic cough, stridor, dyspnea, or recurrent infection 5

Tracheal diverticula can be 5:

  • congenital

  • acquired

    • prolonged increased intraluminal pressure, e.g. chronic cough, COPD

    • tracheomalacia

    • iatrogenic, e.g. post-surgical

A tracheal diverticulum projects posteriorly where the cartilage rings of the trachea are deficient and usually lies to the right where there is no esophagus supporting the paratracheal tissue 6. The vast majority (97%) are located at the right posterolateral aspect of the trachea, approximately at the level of the thoracic inlet 5. A direct connection with the trachea may not always be appreciable on CT 5.  

Although usually asymptomatic, tracheal diverticula may accumulate respiratory secretions that become infected (and potentially abscess-forming) and lead to coughing or tracheobronchitis

In 1838, Rokitansky described three cases of tracheal diverticula for the first time 7.

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 2: coronal
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  • Case 2: axial
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  • Case 3: CT of tracheal diverticulum
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  • Case 4
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  • Case 5
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  • Case 6
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  • Case 7
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