Infected tracheal diverticulum: a rare association with alpha-1 antitrypsin deficiency

Tracheal diverticula in advanced cystic fibrosis: Prevalence, features, and outcomes after lung transplantation

BACKGROUND

Tracheal diverticula (TD) are rare anomalies that may harbor infected secretions, posing potential risk to patients with lung disease. In an end-stage cystic fibrosis (CF) cohort, we describe the characteristics and associated post-lung transplant (LTx) outcomes of TD.

METHODS

Pre-transplant computed tomography (CT)'s were reviewed in CF patients undergoing LTx. TD were characterized radiographically and on autopsy when available. Pre-transplant clinical variables and post-transplant outcomes were compared by TD status.

RESULTS

Of 93 patients, 35 (37.6%) had TD. 58% of TD had fat-stranding, and post-mortem TD examinations revealed histology carrying intense submucosal inflammation, and purulent contents that cultured identical species to sputum. There was no difference in post-LTx survival [HR 1.77 (0.82-3.82), p=0.147], bacterial re-colonization, or rejection in patients with TD compared to those without. Patients with TD were more likely to die from infection, but the result was not statistically significant [HR 2.02 (0.62-6.63), p=0.245].

CONCLUSIONS

We found a high prevalence of TD in end-stage CF, where diverticula may represent a large-airway bacterial reservoir. TD were not associated with differences in post-LTx outcomes, but given the infectious concerns further investigation is necessary.

The diseases of airway-tracheal diverticulum: a review of the literature

Tracheal diverticulum (DV) is a type of paratracheal air cyst (PTAC) that is often asymptomatic and usually detected incidentally by imaging methods. Tracheal DV are divided into two subgroups: congenital and acquired. Dysphagia, odynophagia, neck pain, hoarseness, hemoptysis, choking, and recurrent episodes of hiccups and burping can also be seen in symptomatic patients. Thin-section multidetector computed tomography (MDCT) is useful for diagnosis of tracheal diverticulum. The relationship between DV and tracheal lumen can be demonstrated by axial, coronal, and sagittal reformat multiplanar images. Bronchoscopy can also be used in diagnosis for tracheal DV. However, the connection between DV and tracheal lumen can not be shown easily with bronchoscopy. Conservative treatment is the preferred treatment in asymptomatic patients. Surgical or conservative treatment can be performed for symptomatic patients, depending on patient age and physical condition.