Presentation
Presented to ED with shortness of breath and dyspnea on exertion.
Patient Data
No discrete focal pneumonia, effusion or pneumothorax. The heart and central pulmonary vascularity are normal and stable. No acute osseous findings. No free air in the upper abdomen.
Small focal lucency is noted to the right of midline just below the thoracic inlet in this patient with known tracheal diverticulum.
Case Discussion
A tracheal diverticulum (TD) is a rare abnormal pouch or sac that develops in the trachea, or windpipe. It is usually found in the posterior wall of the trachea, near the bifurcation into the bronchi1. This needs to be distinguished from Zenker diverticulum, which occurs in the upper portion of the esophagus2.
Tracheal diverticula can be congenital or acquired and are generally asymptomatic, but can cause symptoms such as shortness of breath, coughing, and dyspnea on exertion if they become infected or obstructed1.
In this case, the patient presented to the emergency department with shortness of breath and dyspnea on exertion. Upon further evaluation, a chest X-ray and CT scan revealed the presence of a tracheal diverticulum. Multidetector computed tomography (MDCT) is the best imaging method to demonstrate TD, able to evaluate location, size, contour, wall thickness and communication with the trachea3. The presence of a tracheal diverticulum likely contributed to the patient's symptoms of shortness of breath and dyspnea on exertion.
Tracheal diverticulum is a rare condition that requires evaluation and management by a specialist, such as a pulmonologist or thoracic surgeon. The treatment of tracheal diverticulum may vary depending on the size and location of the diverticulum, as well as the presence of any associated symptoms or complications. In many cases, prevention of infection is the standard of care, especially in those with multiple of wide-based TDs4. In more severe cases, often congenital, surgical intervention may be necessary to remove the diverticulum1.
This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Health Sciences Clinical Professor,
Department of Radiological Sciences,
David Geffen School of Medicine at UCLA.
Attending Radiologist,
Olive View - UCLA Medical Center.