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Inoue T, Yamamoto T. Tracheal Deviation and Airway Management: Clinical Considerations From a Cadaver. Cureus 2024; 16:e55546. [PMID: 38576701 PMCID: PMC10993300 DOI: 10.7759/cureus.55546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/06/2024] Open
Abstract
Severe tracheal deviation detected on preoperative chest radiographs is one of the risk factors for difficult tracheal intubation and difficulty in ventilation using an endotracheal tube after tracheal intubation when managing the airway through tracheal intubation under general anesthesia. In this report, we describe the cadaver of an 81-year-old woman with marked tracheal deviation due to meandering multiple aortas. This report details the importance of anatomical knowledge in developing a detailed airway management plan. The deviated trachea was removed from the cadaver and the tracheal tube was inserted at the glottis to the proximal end of the glottal marker. The tube tip was in contact with the tracheal wall, suggesting ventilation difficulty during intubation. The tortuous brachiocephalic artery passed in front of the trachea, which posed a risk of massive aortic hemorrhage and postoperative trachea-brachiocephalic artery fistula during percutaneous tracheostomy for emergency airway management. The anatomical location of the trachea and carotid artery must be confirmed before surgery/anesthesia to ensure safe airway management.
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Affiliation(s)
- Takutoshi Inoue
- Department of Anatomy, Teikyo University School of Medicine, Tokyo, JPN
| | - Toru Yamamoto
- Division of Dental Anesthesiology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, JPN
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2
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The tortuous airway: Anatomical variability requiring off centre tracheostomy. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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3
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Tracheal diverticulum accidently found during bronchoscopy in a patient scheduled for thoracoscopic lobectomy: To perform the operation or not? Asian J Surg 2020; 43:961-962. [PMID: 32532679 DOI: 10.1016/j.asjsur.2020.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/21/2022] Open
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4
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Yamagata K, Kawamura A, Kasai S, Akazawa M, Takeda M, Tachibana K. Anesthetic management of a child with Kagami-Ogata syndrome complicated with marked tracheal deviation: a case report. JA Clin Rep 2018; 4:62. [PMID: 32025889 PMCID: PMC6967188 DOI: 10.1186/s40981-018-0199-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/23/2018] [Indexed: 11/17/2022] Open
Abstract
Background Kagami-Ogata syndrome (KOS) is a rare congenital imprinting disorder. The problems related to the anesthetic management of patients with KOS are respiratory distress and difficult endotracheal intubation. Case presentation A 2-year-old male was scheduled to undergo orchiopexy for bilateral cryptorchidism. Although he had a history of severe respiratory distress immediately after birth, his preoperative respiratory condition was stable. He also had marked tracheal deviation. General anesthesia was induced with nitrous oxide and sevoflurane in oxygen. A laryngeal mask airway (LMA) was inserted following rocuronium administration. Anesthesia was maintained with sevoflurane and simultaneous caudal anesthesia. His postoperative course was uneventful. Conclusions Patients with KOS should preferably undergo elective surgery only after infancy because their respiratory status is more stable as they grow older. Thorough preoperative evaluation of the respiratory tract is important even in KOS patients with a stable respiratory condition.
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Affiliation(s)
- Kazuaki Yamagata
- Department of Dental Anesthesiology, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima, 890-8544, Japan
| | - Atsushi Kawamura
- Department of Anesthesiology, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi-shi, Osaka, 594-1101, Japan.
| | - Satomi Kasai
- Department of Anesthesiology, Osaka Minami Medical Center, 2-1 Kidohigashi-machi, Kawachinagano-shi, Osaka, 586-8521, Japan
| | - Mai Akazawa
- Department of Anesthesiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu-shi, Shiga, 520-2134, Japan
| | - Michiru Takeda
- Department of Anesthesiology, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi-shi, Osaka, 594-1101, Japan
| | - Kazuya Tachibana
- Department of Anesthesiology, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi-shi, Osaka, 594-1101, Japan
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Kim HJ, Choi YS, Park SH, Jo JH. Difficult endotracheal intubation secondary to tracheal deviation and stenosis in a patient with severe kyphoscoliosis: a case report. Korean J Anesthesiol 2016; 69:386-9. [PMID: 27482317 PMCID: PMC4967635 DOI: 10.4097/kjae.2016.69.4.386] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/17/2015] [Accepted: 08/18/2015] [Indexed: 11/11/2022] Open
Abstract
We report on a case of difficult endotracheal intubation in a patient with marked tracheal deviation at an angle of 90 degrees combined with stenosis due to kyphoscoliosis with vertebral body fusion. After induction of general anesthesia, a proper laryngeal view was easily obtained using a videolaryngoscope. But a tracheal tube could not be advanced more than 3 cm beyond the vocal cords due to resistance, despite various attempts, including the use of small size tubes, full rotation of the tube tip, and fiberoptic bronchoscopy. Ultimately, the airway was successfully secured by placing a tube tip above the area of resistance and by additionally packing saline-soaked gauzes around the tracheal inlet to minimize gas leakage and to fasten the tube in the trachea.
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Affiliation(s)
- Hyun Jung Kim
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Yun Suk Choi
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Hyun Park
- Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Jun-Ho Jo
- Department of Anesthesiology and Pain Medicine, Veterans Health Medical Center, Seoul, Korea
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6
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Mehta AC, Thaniyavarn T, Ghobrial M, Khemasuwan D. Common Congenital Anomalies of the Central Airways in Adults. Chest 2015; 148:274-287. [PMID: 25811532 DOI: 10.1378/chest.14-1788] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The knowledge of airway anatomy is the most fundamental requirement of every bronchoscopist. There are numerous and frequent anatomic variations of the central airways making the examination unique for every individual. It is imperative for every bronchoscopist to be fully cognizant of the common congenital anomalies involving the central airways. Proper identification and reporting of these findings are a matter of the utmost importance, especially when surgical options in a patient with lung cancer or lung transplantation is under consideration. This article focuses on the congenital anomalies of central airway encountered among adults. Each of these anatomic variations has a characteristic appearance, yet requires bronchoscopic acumen for their identification. This review provides a comprehensive description of these anomalies and highlights their clinical implications.
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Affiliation(s)
- Atul C Mehta
- Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH.
| | - Tany Thaniyavarn
- Department of Pulmonary, Allergy, and Critical Care Medicine, Emory University, Atlanta, GA
| | - Michael Ghobrial
- Internal Medicine Department, Fairview Hospital, a Cleveland Clinic Hospital, Cleveland, OH
| | - Danai Khemasuwan
- Interventional Pulmonary Medicine, Henry Ford Hospital, Detroit, MI
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7
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Wooten C, Patel S, Cassidy L, Watanabe K, Matusz P, Tubbs RS, Loukas M. Variations of the tracheobronchial tree: Anatomical and clinical significance. Clin Anat 2014; 27:1223-33. [PMID: 24453071 DOI: 10.1002/ca.22351] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 10/29/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Candace Wooten
- St. George's University School of Medicine; St. George's Grenada West Indies
| | - Swetal Patel
- St. George's University School of Medicine; St. George's Grenada West Indies
| | - Lindsey Cassidy
- St. George's University School of Medicine; St. George's Grenada West Indies
| | - Koichi Watanabe
- Pediatric Neurosurgery; Children's Hospital; Birmingham Alabama
| | - Petru Matusz
- Department of Anatomy; “Victor Babes” University of Medicine and Pharmacy; Timisoara Romania
| | - R. Shane Tubbs
- St. George's University School of Medicine; St. George's Grenada West Indies
- Pediatric Neurosurgery; Children's Hospital; Birmingham Alabama
| | - Marios Loukas
- St. George's University School of Medicine; St. George's Grenada West Indies
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8
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Polat AV, Elmali M, Aydin R, Ozbay A, Celenk C, Murat N. Paratracheal air cysts: Prevalence and correlation with lung diseases using multi-detector CT. J Med Imaging Radiat Oncol 2013; 58:144-8. [DOI: 10.1111/1754-9485.12095] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/12/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmet Veysel Polat
- Department of Radiology; Faculty of Medicine; Ondokuz Mayis University; Samsun Turkey
| | - Muzaffer Elmali
- Department of Radiology; Faculty of Medicine; Ondokuz Mayis University; Samsun Turkey
| | - Ramazan Aydin
- Department of Radiology; Faculty of Medicine; Ondokuz Mayis University; Samsun Turkey
| | - Adile Ozbay
- Department of Radiology; Faculty of Medicine; Ondokuz Mayis University; Samsun Turkey
| | - Cetin Celenk
- Department of Radiology; Faculty of Medicine; Ondokuz Mayis University; Samsun Turkey
| | - Naci Murat
- Department of Statistics; Ondokuz Mayis University; Samsun Turkey
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9
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Mazul-Sunko B, Zdenčar D, Kožul I, Špiček-Macan J, Stančić-Rokotov D. Pneumomediastinum related to distal tracheal diverticulum. Anaesthesia 2013; 68:432-3. [DOI: 10.1111/anae.12193] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - D. Zdenčar
- University Hospital Sveti Duh; Zagreb Croatia
| | - I. Kožul
- University Hospital Sveti Duh; Zagreb Croatia
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10
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Bae HJ, Kang EY, Yong HS, Kim YK, Woo OH, Oh YW, Doo KW. Paratracheal air cysts on thoracic multidetector CT: incidence, morphological characteristics and relevance to pulmonary emphysema. Br J Radiol 2013; 86:20120218. [PMID: 23255540 DOI: 10.1259/bjr.20120218] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the incidence, morphological characteristics and relevance of paratracheal air cysts (PTACs) with pulmonary emphysema, as seen on thoracic multidetector CT (MDCT). METHODS The CT images of 854 consecutive patients who underwent thoracic MDCT during a period of 2 months at our institution were reviewed. 538 of the patients were male and 316 were female. The incidence, size and shape of the PTACs and their relation to pulmonary emphysema were retrospectively analysed. RESULTS Among the 854 patients, 69 (8.1%) had PTACs. 37 (6.9%) of the 538 male patients and 32 (10.1%) of the 316 female patients had PTACs. The highest prevalence of PTACs (25 patients, 11.2%) was found in those who were in the sixth decade of life. 48 (69.6%) PTACs measured 3-10 mm at the longest diameter and 33 (47.8%) were elongated on the coronal section images. 12 (17.4%) patients with PTACs had underlying gross morphological emphysema. The relationship between the presence of PTACs and the presence of emphysema and the relationship between the presence of PTACs and the severity of emphysema were not statistically significant. The size of PTACs showed an inverse relation to the severity of emphysema. CONCLUSION The incidence of PTACs was estimated to be much higher than that of previous studies. There was a slight female predilection for PTACs, most commonly found in the sixth decade of life; PTACs mostly measured 3-10 mm and were elongated in shape. The relation of PTACs to gross morphological emphysema was low. ADVANCES IN KNOWLEDGE PTACs are not correlated with the presence of emphysema on MDCT.
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Affiliation(s)
- H-J Bae
- Department of Radiology, Korea University College of Medicine, Seoul, Republic of Korea
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11
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Koudounarakis E, Karatzanis A, Velegrakis S, Fountoulakis E, Velegrakis G. A case of acquired tracheal diverticulum presenting with globus pharyngeus. Am J Otolaryngol 2013; 34:82-4. [PMID: 23084429 DOI: 10.1016/j.amjoto.2012.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 08/24/2012] [Indexed: 11/17/2022]
Abstract
Acquired tracheal diverticulum is a rare pathology that has been associated with chronic cough and lung emphysema. A 72 year-old woman was referred to a tertiary Otorhinolaryngology Department for evaluation of chronic cough and globus pharyngeus. Computed tomography of the neck and chest revealed a diverticulum of the right posterolateral wall of the trachea. The patient underwent surgical excision of the diverticulum via a transcervical approach. Symptoms subsided after surgical treatment.
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12
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Salhotra R, Sharma C, Tyagi A, Kumar S, Sethi A, Bhatt S. An unanticipated difficult airway in Lesch-Nyhan syndrome. J Anaesthesiol Clin Pharmacol 2012; 28:239-41. [PMID: 22557752 PMCID: PMC3339734 DOI: 10.4103/0970-9185.94909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An 11-year-old boy with Lesch–Nyhan syndrome presented to the emergency for fixation of a fractured femur. During induction of general anesthesia, unexpected difficult intubation was encountered with a 6.5-mm ID endotracheal tube and successively smaller tubes, also failing to pass 1 cm beyond the vocal cords. Intubation was finally achieved with a 4.5-mm ID tube. The surgery was completed uneventfully. A tracheal diverticulum was found in the computerized tomography (CT) scan performed postoperatively to account for this unexpected difficult intubation. This case highlights the anesthetic concerns in Lesch-Nyhan syndrome and also reports the rare occurrence of a tracheal diverticulum associated with it.
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Affiliation(s)
- Rashmi Salhotra
- Department of Anaesthesiology and Critical Care, UCMS and GTBH, Dilshad Garden, Delhi, India
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13
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Monroe MM, McLean M, Gross ND. Infected tracheal diverticulum presenting as a cervical abscess. Otolaryngol Head Neck Surg 2011; 145:513-4. [PMID: 21493282 DOI: 10.1177/0194599811402307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marcus M Monroe
- Department of Otolaryngology, Oregon Healthand Science University, Portland, Oregon, USA
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14
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Infected tracheocoele (acquired tracheal diverticulum): case report and literature review. The Journal of Laryngology & Otology 2011; 125:540-5. [PMID: 21310098 DOI: 10.1017/s0022215110003026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Paratracheal air-filled cysts are rare. Tracheocoele or acquired tracheal diverticulum is the term given to these acquired abnormalities, which usually arise in adults. The majority is asymptomatic, being discovered as incidental findings on radiological imaging. METHODS We report the case of a 72-year-old man with a previously identified tracheocoele which became symptomatic following an upper respiratory tract infection. A literature is presented and nomenclature is discussed. RESULTS The clinical presentation, differential diagnosis and management of paratracheal air-filled cysts are discussed. CONCLUSION While most of these rare abnormalities are discovered incidentally, this case illustrates the fact that significant symptoms can develop; excision should therefore be considered.
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15
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Endoscopic treatment of tracheocele in pediatric patients. Am J Otolaryngol 2010; 31:272-5. [PMID: 20015760 DOI: 10.1016/j.amjoto.2009.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Revised: 02/15/2009] [Accepted: 02/22/2009] [Indexed: 11/23/2022]
Abstract
Acquired tracheal pouch known also as tracheocele is a rare air-filled diverticulum of tracheal pars membranacea. This disease may be due to esophageal or tracheal surgery, orotracheal intubation, or increased intralunimal pressure through a weak area of tracheal wall. When symptomatic and medical therapy is insufficient, this disorder must be treated surgically. Several surgical methods ranging from open neck or thoracic surgery to endoscopic managements have been reported. We report the case history of a 7-year-old boy affected by recurrent pneumonia due to tracheal pouch. The patient underwent successful brushing of tracheocele plus fibrin glue application by rigid tracheobroncoscopy. Furthermore, particular emphasis on endoscopic treatments of tracheal diverticulum is also presented.
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16
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Danielson GP, Jedlovszky V, Landrigan GP. Tracheal Diverticulum: A Rare Finding in a Patient with Worsening Chronic Cough. EAR, NOSE & THROAT JOURNAL 2008. [DOI: 10.1177/014556130808700815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acquired tracheal diverticulum is a rare clinical entity with only limited reports in the literature. We report a case of a tracheal diverticulum that was identified as part of a work-up for a worsening cough. In this case the diverticulum was observed 2 years after surgical management of a retropharyngeal abscess. It was felt that pooling of secretions in the acquired pouch was a contributing factor in the exacerbation of the patient's chronic cough. Because of the patient's extensive comorbidities, observation and serial computed tomography scans were recommended.
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Affiliation(s)
- Gregory P. Danielson
- From the Division of Otoloaryngology–Head and Neck Surgery, Department of Surgery, University of Vermont College of Medicine, Burlington
| | | | - Gary P. Landrigan
- From the Division of Otoloaryngology–Head and Neck Surgery, Department of Surgery, University of Vermont College of Medicine, Burlington
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17
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Buterbaugh JE, Erly WK. Paratracheal air cysts: a common finding on routine CT examinations of the cervical spine and neck that may mimic pneumomediastinum in patients with traumatic injuries. AJNR Am J Neuroradiol 2008; 29:1218-21. [PMID: 18544671 DOI: 10.3174/ajnr.a1058] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Collections of extraluminal paratracheal gas may be present on CT images of the neck and cervical spine and the radiologist may question whether this is related to a pathologic process. This study is designed to demonstrate the appearance, clinical presentation, and prevalence of paratracheal air cysts, which, on CT examinations of the neck, can mimic abnormal extraluminal air. MATERIALS AND METHODS From January 1, 2005, through May 22, 2005, a total of 702 CT examinations of the cervical spine or soft tissue of the neck were reviewed. All examinations were at 2- to 5-mm thickness. Sagittal and coronal reconstructions were available for review, if necessary. Paratracheal air cysts were evaluated for size; the presence of visible communication with the trachea; association with pneumothorax, pneumomediastinum, or subcutaneous emphysema; and association with findings of emphysematous changes in the lung apices. Patient demographics of age, sex, and whether the patient had sustained a traumatic injury were also collected. RESULTS Of the 702 patients evaluated, 26 (3.7%) had paratracheal air cysts, all of which were found on the right, at the level of the thoracic inlet. Ages of the patients ranged from 15 to 74 years. In 9 (34.6%) of the patients, a direct communication with the trachea was seen. Sizes of the paratracheal air cysts ranged from 1 x 2 mm to 10 x 15 mm. No association was found with CT findings of emphysema in the lung apices, abnormal soft tissue air, or trauma. CONCLUSION Right paratracheal air cysts are a common CT finding that occur in a predictable location. In the setting of trauma, these characteristic structures can mimic pneumomediastinum and are seen in approximately 3% to 4% of the US population. The cause is unclear but may be either congenital or an acquired phenomenon, given that they are often seen in both children and adults. We found no association with either trauma or the presence of emphysematous changes in the lung apices.
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Affiliation(s)
- J E Buterbaugh
- Department of Radiology, University of Arizona College of Medicine, Tucson, AZ 85724, USA
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18
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Johnson LB, Cotton RT, Rutter MJ. Management of symptomatic tracheal pouches. Int J Pediatr Otorhinolaryngol 2007; 71:527-31. [PMID: 17289165 DOI: 10.1016/j.ijporl.2006.10.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Revised: 10/27/2006] [Accepted: 10/29/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Acquired tracheal pouches arise following tracheoesophageal fistula (TEF) repair, but are usually asymptomatic. Symptomatic tracheal pouches are rare, and the optimal management strategy debated. The evolution of our management to this challenging problem is presented. DESIGN A case series over a 5-year period. SETTING A tertiary care pediatric hospital. PATIENTS Children with a past history of TEF repair in whom severity of pouch-related respiratory symptomatology warranted surgical intervention. MAIN OUTCOME MEASURES Symptomatology, bronchoscopic findings, number and type of surgical interventions required, complications, and outcomes. RESULTS Eleven patients required surgical intervention for a symptomatic tracheal pouch. Symptoms were due to stasis of secretions with associated pulmonary soiling in three children, severe tracheomalacia in six children, and respiratory obstruction related to the tip of a tracheotomy tube or endotracheal tube being displaced intermittently into the pouch in six children. Surgical management of the pouch included one fulguration with the CO(2) laser, one with microlaryngeal instruments, Bugbee cautery in two, open resection in one, and transcervical division in another. The final five children had endoscopic pouch division with Clickline biopsy forceps. All children have had resolution of their pouch-related symptoms, although two remain tracheotomy-dependent. CONCLUSIONS Symptomatic tracheal pouches are rare. Surgical intervention to divide the common party wall between the trachea and the pouch may alleviate associated respiratory symptomatology. The Clickline biopsy forceps is a safe, rapid, and effective method of dividing a tracheal pouch.
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Affiliation(s)
- Liane B Johnson
- Department of Otolaryngology/Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Soto-Hurtado EJ, Peñuela-Ruíz L, Rivera-Sánchez I, Torres-Jiménez J. Tracheal diverticulum: a review of the literature. Lung 2006; 184:303-7. [PMID: 17086467 DOI: 10.1007/s00408-006-0010-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2006] [Indexed: 10/24/2022]
Abstract
Tracheal diverticulum is a rarely encountered entity. It may be congenital or acquired, the difference residing mainly in the histologic features of the wall. Most cases are asymptomatic, but when symptoms are present they are usually nonspecific. Congenital diverticulum is not normally detected in infancy unless it is suggested by recurrent episodes of tracheobronchial infection or in associated with other malformations. Imaging techniques are useful for diagnosis because the point of communication with the trachea is difficult to detect with bronchoscopy. In the absence of symptoms, management should be conservative. We review the entity and report two new cases, one a casual finding in a 49-year-old man and the other in a 63-year-old woman who presented with occasional bloody sputum.
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Ching SLL, Chow MYH, Ng HN. Difficult lung isolation in a patient with an undiagnosed tracheal diverticulum. J Cardiothorac Vasc Anesth 2003; 17:355-6. [PMID: 12827586 DOI: 10.1016/s1053-0770(03)00063-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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