Posterior tracheal diverticulum: a case report

BACKGROUND

Tracheal diverticulum is a rare condition often linked to other malformations. This case study highlights the posterior tracheal diverticulum, covering its causes, symptoms, diagnosis, treatment, and prognosis. The report is significant due to the rarity of tracheal diverticulum and potential for misdiagnosis, which can result in complications such as respiratory infections. The case offers novel insights into the presentation and management of tracheal diverticulum, helping to guide future diagnosis and treatment.

CASE PRESENTATION

A 73-year-old Iranian man with a history of cardiac surgery 15 years ago was admitted to the Loghman Hakim Hospital in Tehran, Iran, for retrosternal chest pain, shoulder radiation, and a persistent cough lasting 4 months. The patient underwent cardiac tests and a lung computed tomography scan, which showed a 16 × 18 mm air-filled outpouching connected to the trachea's right posterolateral side, leading to a diagnosis of tracheal diverticulum. The patient was treated with bronchodilators and antibiotics.

CONCLUSIONS

Tracheal diverticulum is typically asymptomatic but can present with respiratory difficulties, dysphagia, and hoarseness. Diagnosis relies on imaging, and treatment ranges from conservative management to surgical intervention, particularly in symptomatic cases or those with complications. Recognizing tracheal diverticulum in surgical and anesthesia planning is crucial to prevent severe risks such as airway obstruction or trauma. This case report highlights the importance of early detection and personalized management, potentially improving patient outcomes and guiding clinical decision-making in similar cases.

Track your trach: Removal of a fractured tracheostomy tube using a flexible fibreoptic bronchoscope in a patient with severe head injury

Tracheostomy is a common airway procedure for life support in critically ill patients with head injuries. This procedure is safe but also associated with early and late complications. Tube fracture and dislodgement into the tracheobronchial tree leading to airway obstruction is a rare but life-threatening complication after prolonged tracheostomy tube placement. There are very few published reports of tracheostomy tube fracture and dislodgement into tracheobronchial tree in a neurologically injured patient. We report a case of a fractured tracheostomy tube which got impacted in the left main bronchus, in a 41-year-old male patient who had been on prolonged tracheostomy tube after craniotomy and evacuation of subdural hematoma. The distal part of the tracheostomy tube fractured and impacted in the left main bronchus. Fibreoptic bronchoscopy was performed through the oral cavity to extract it, and the anaesthetic management during the period is discussed.

[Submucosal tunneling endoscopic resection for large esophageal leiomyoma: technical aspects and risk of complications]

We analyzed the technical aspects and risk of possible complications after submucosal tunneling endoscopic resection for large esophageal leiomyoma. A patient with a 4-cm non-epithelial esophageal tumor underwent STER procedure in June 2018. Surgery time was 130 min. There were no intraoperative complications. Postoperative period was complicated with mediastinitis with reactive pneumonia and pleural effusion accompanied by episodes of hyperthermia up to 38°C for 5 days. The patient was discharged in 12 days after complete resolution of pneumonia confirmed by chest X-ray. Contrast-enhanced examination after 3 postoperative days revealed no contrast agent leakage outside the esophagus. The previously applied clips were visualized. Endoscopic examination in 3 months after surgery visualized postoperative scar without signs of deformation and narrowing of the esophagus. No complaints were observed throughout 3.5-year follow-up period.

CONCLUSION

This report demonstrates the advantages of tunnel dissection ensuring organ-sparing procedure with the best functional result. However, intra- and postoperative complications are possible after STER. The risk of complications and complexity of surgery depend on transverse size (>3.5 cm), shape and localization of tumor. Larger neoplasm is accompanied by more difficult surgery and higher risk of complications. Therefore, adequate selection of patients for STER is essential.

Anesthetic management of thoracoscopic pulmonary wedge resection with a giant tracheal diverticulum in the carina: a case report and review of the literature

A tracheal diverticulum (TD) is a rare disease that is usually diagnosed as an incidental finding on thoracic computed tomography or bronchoscopy. TDs can be classified as congenital or acquired. In patients undergoing surgery, TDs can result in difficult intubation, difficult ventilation, pneumothorax, and other complications. We herein report a case of anesthetic management of thoracoscopic pulmonary wedge resection in a patient with a giant TD in the carina. Intraoperative double-lumen intubation and single-lung ventilation were challenging to perform. Fiberoptic-guided intubation was helpful, and intraoperative management was tailored to avoid diverticulum rupture. In this report, we also review complications related to TD in surgical patients undergoing mechanical ventilation. Ventilation is one of the most prominent anesthetic challenges. The close collaboration of the entire medical team was a key factor in the successful management of this rare case.

Giant Esophageal Leiomyoma: Diagnostic and Therapeutic Challenges

BACKGROUND Leiomyoma is a rare, benign, esophageal tumor that does not often measure >10 cm. Here, we report a case of giant esophageal leiomyoma in a 24-year-old man. CASE REPORT A 24-year-old man who smoked and had primary hypertension and glucose-6-phosphate dehydrogenase deficiency presented with a history of shortness of breath and productive cough with yellowish sputum, a long history of dysphagia to solid food, and a weight loss of 7 kg over 2 months. A chest X-ray revealed a mediastinum with a width >8 cm. Computed tomography of the patient's chest revealed a multilobulated mass that originated from the upper and middle thoracic esophagus, caused severe narrowing of his esophageal lumen, and was compressing his trachea and right main bronchus. Resection of the tumor was performed and, because of the large defect after the surgery and the mucosal necrosis, the patient underwent an Ivor-Lewis esophagectomy. His postoperative course was uneventful. He had no symptoms when he was seen in the outpatient clinic for follow-up and fully recovered. CONCLUSIONS Giant esophageal leiomyoma (GEL) is a rare oncological entity that presents several diagnostic and therapeutic challenges because of the scarcity of information in the medical literature on surgical management. The descriptions of techniques for surgical resection of GEL do not include ways to effectively perform subsequent reconstruction. The aim of the present paper was to contribute to this scant information by reporting our experience with performing an Ivor-Lewis esophagectomy to manage a case of GEL.

Adult with mass burnt lime aspiration: A case report and literature review

BACKGROUND

Foreign body aspiration mainly occurs in children, which can cause a severe concurrent syndrome and even death without timely treatment. As a rare foreign body, aspiration of lime is seldom reported, and most cases involve a small amount of hydrated lime. Although the symptoms are usually severe, the prognosis is good after suitable treatment. Experience of treatment for lime aspiration is lacking, and this report provides novel evidence for treatment of mass burnt lime aspiration using bronchoscopy.

CASE SUMMARY

We report an adult with a large amount of burnt lime aspiration. Because of delay in clearance of the inhaled lime in the trachea and bronchus at the local hospital, he suffered several severe complications, including complete occlusion of the right primary bronchus, aeropleura, aerodermectasia, pneumomediastinum, secondary infection and hypoxemia at 4 d after injury. After transferring to our department, bronchoscopy was immediately carried out to clear the lime in the major airway, using foreign body forceps, biopsy forceps, puncture needle, and hairbrush. The patient’s condition recovered rapidly and at 3-months’ follow-up, he demonstrated good recovery of the bronchus and lung parenchyma.

CONCLUSION

After mass lime aspiration, flexible fiberoptic bronchoscopy is suggested as early as possible, using clamping, flushing or cryotherapy.

Complete laparoscopic-transhiatal removal of duplex benign oesophageal tumour: case report and review of literature

BACKGROUND

Leiomyoma is the most common benign oesophageal tumour. Half of all leiomyoma patients have oesophagus-associated complaints, such as dysphagia and epigastric pain, and the other 50% are asymptomatic with a diagnosis made on incidental discovery. Endoscopic ultrasonography is essential for an accurate preoperative workup and can enable guided-tissue acquisition for immunohistochemistry in certain cases. Smaller tumours are amenable to traditional and novel endoscopic removal in specialized centres, but some complex cases require surgical enucleation with a minimally invasive approach.

CASE PRESENTATION

An asymptomatic 60-year-old woman was accidentally diagnosed with a bifocal oesophageal mass, which was discovered by chest computed tomography. We report a rare case of a duplicated lower-third oesophageal leiomyoma, which was completely removed via the laparoscopic transhiatal approach. The patient has recovered successfully from the surgery. She has been followed up for six months with a normal oesophagram, adequate oesophageal function and no complaints observed. Pathological examination confirmed the diagnosis of leiomyoma in both lesions.

CONCLUSIONS

To the best of our knowledge, this is the first reported case of duplex oesophageal leiomyomas removed laparoscopically. Using the minimally invasive abdominal technique, the lower oesophagus can be mobilised to the mediastinum without pleura injury and offers a good alternative to the thoracoscopic approach in patients with possible intrathoracic difficulties. At experienced centres, laparoscopic transhiatal enucleation of lower oesophageal leiomyomas and other benign tumours with a combination of intraoperative oesophagoscopy is a safe, fast and effective operation.

Anesthetic management of a patient with an unusual broken tracheostomy tube: a case report

Objective

This study was performed to investigate the management of general anesthesia in an unusual case involving a patient with a broken tracheostomy tube presenting as an airway foreign body.

Methods

We herein describe the anesthetic management of a patient with a broken tracheostomy tube. A 77-year-old Chinese man who had been involved in a car accident underwent a tracheostomy. One year later, he presented with cough and bleeding at the tracheostomy site. Preoperative evaluation revealed that the metal tracheostomy tube was lodged in his left main bronchus. General anesthesia was induced to maintain spontaneous breathing, and adequate topical anesthesia of the airway was administered.

Results

The metal tracheostomy tube was successful removed, and a new tracheal tube was put in place.

Conclusions

General anesthesia to maintain spontaneous breathing and adequate topical anesthesia of the airway can be safely used when removing broken tracheostomy tubes.

Minimally invasive surgery for giant esophageal leiomyoma: a case report & review of the literatures

Despite the rapid development of minimally invasive surgery, the treatment of esophageal lesions remains controversial. Giant esophageal leiomyoma could be removed once diagnosed, but its operative method is not quite the same as esophageal leiomyoma of small size. We report a case of giant esophageal leiomyoma and review published cases of giant leiomyomas in the past 10 years. A 29-year-old man was admitted to the clinic for the complaints of 2-month history of dysphagia and discomfort. Radiologic and endoscopic findings suggested esophageal lesion in the muscular layer. The VATS enucleation was performed to relieve the patient's symptoms. The patient started oral intake on the 1st postoperative day, with following solid meal. The postoperative course was uneventful, and the patient was discharged on the 8^th postoperative day.

Tracheal Diverticula

Extraluminal paratracheal air bubbles are occasionally seen on computed tomography (CT) studies that include the thoracic inlet (ie, CT of the neck, of the cervical spine, and of the chest). In most cases, these paratracheal air bubbles are tracheal diverticula (TD), sometimes also referred to as tracheal pouch, tracheocele, and tracheogenic cyst. TD are most commonly seen at the right posterolateral aspect of the upper trachea at the level T1-T3. Because of their typical location and appearance, they are easily recognized and should not be confused with pneumomediastinum or other causes of air bubbles in the same region. This article describes the prevalence, possible pathophysiology, and associated complications of TD and illustrates the spectrum of their appearance on CT.

Increased prevalence of tracheal diverticula in cystic fibrosis patients

OBJECTIVE

This investigation sought to evaluate the prevalence and imaging characteristics of tracheal diverticula (TD) among patients with cystic fibrosis (CF).

METHODS

A total of 113 patients with CF at our institution, with a median age of 29 years, had chest CT examinations between 2002 and 2014. These imaging studies were retrospectively reviewed to assess for the presence and characteristics of TD, including quantity, size and location. The severity of the CF disease was assessed using the Bhalla CT scoring system and pulmonary function tests.

RESULTS

Of the 113 cases reviewed, 20 (17.7%) patients were found to have 1 or more TD. The presence of TD was associated with more severe disease by imaging criteria, with a Bhalla CT score of 13.9 ± 4.3 in patients with TD and 11.5 ± 4.3 in patients without TD. For the pulmonary function tests, forced expiratory volume in 1 s (FEV1) and FEV1 percent predicted demonstrated a trend towards worsening function in patients with TD, although the difference was not statistically significant.

CONCLUSION

The prevalence of TD in our patient population with CF based on chest CT exams was 17.7%. In addition, the presence of TD was associated with more severe CF disease by imaging criteria.

ADVANCES IN KNOWLEDGE

TD appear to have a higher prevalence in patients with CF than in the general population, are associated with more severe CF pulmonary disease by CT criteria and are frequently underreported by radiologists.