Infected tracheal diverticulum mimicking an aggressive mediastinal lesion on FDG PET/CT: an interesting case with review of the literature

Chronic Cough Revealing a Tracheal Diverticulum: A Case Report

Tracheal diverticulum (TD) is a rare entity in the literature. It is the consequence of a congenital or acquired weakness of the tracheal wall. The principal difference lies in the histological characteristics of the wall. Most cases are asymptomatic, but when symptoms are found, they are usually not specific. Therefore, the diagnosis is made based on the results of CT. We report a case of a 62-year-old female presenting with a chronic cough. A diagnosis of the TD was established on the basis of a thoracic CT scan.

The role of MRI in the diagnosis and management of tracheal diverticulum

Background

Multidetector CT is currently the best imaging method for detecting tracheal diverticulum (TD). Compared with CT, MRI is radiation-free and has higher resolution. However, the MRI characteristics of this disease have not been previously reported. The present retrospective study compared the MR and CT imaging features of TD, aiming to examine the role of MRI in TD diagnosis and management.

Methods

Imaging data were collected in 26 TD patients divided into two groups, including the uninfected and infected groups. The MR and CT imaging features (size/wall/channel) of uninfected patients were compared. The performances of MRI and CT in diagnosing and monitoring therapeutic efficacy in infected TD patients were comparatively assessed.

Results

The uninfected group comprised 25 cases with 25 lesions confirmed by CT, including 23 lesions (92%) detected by MRI, with an average diameter of 8.5 mm (range from 3 to 15 mm). Meanwhile, the average diameter was 7.8 mm as measured by CT (range from 2.8 mm to 14.7 mm). The lesion diameters of the two cases not detected by MRI were 2.3 mm and 2 mm. MRI detected walls of all the 23 lesions (23/23), while CT detected no wall (0/23). CT showed channels in 18 lesions (18/23) versus3 for MRI (3/23). The infected case presented with a paratracheal abscess; MRI clearly showed a relationship between the abscess and the trachea, while CT could not show the lesion source. MRI also sensitively showed the whole process of lesion absorption.

Conclusions

MRI can be used as a supplementary method for TD diagnosis, providing information about the wall that cannot be obtained by CT. MRI is superior to CT in diagnosing infected TD cases presenting with a paratracheal abscess, and in monitoring therapeutic efficacy in these patients.

The Role of MRI in Diagnosing and Managing Tracheal Diverticulum

RATIONALE AND OBJECTIVES

Multidetector CT is the best imaging method to diagnose tracheal diverticulum (TD) till now. MRI characteristics of this disease is not reported before. The study report 5 cases of TD, intend to discuss the role of MRI in diagnosing and managing tracheal diverticulum (TD).

MATERIALS AND METHODS

Five cases of TD (include 4 cases of uninfected TD and 1 case of infected TD) with complete CT and MR imaging data were collected and analyzed to compare MR and CT imaging features(location/size/wall/channel) of the disease. The role of MRI in monitoring therapeutic efficacy of infected TD was also discussed.

RESULTS

All cases were located in the right posterolateral region of the trachea at the level between the T1 and T3 vertebrae. MRI was better in showing the wall of TD, and inferior to showing the channel (between TD and the tracheal) than CT. The diameter measured in MR images was longer than measured in CT image. MRI had equal capacity with CT in accurately display the location of the disease. MRI sensitively showed the absorption of infected TD.

CONCLUSION

MRI is helpful in diagnosing TD, especially infected TD. The sign that local thickening and signal increasing of tracheal wall observed on MR images means that a paratracheal abscess may originate from TD. MRI plays an important role in monitoring therapeutic efficacy of infected TD.

Endotracheal, Endobronchial, and Vocal Cords Metastases From Lung Cancer Detected by 18F-FDG PET/CT

ABSTRACT

A 61-year-old man with a history of lung cancer initially treated 3 years prior presented with a new onset of cough for 1-month and 2-week hoarseness. FDG PET/CT revealed multiple hypermetabolic lesions in the endotracheal, endobronchial, and vocal cords. Subsequently, immunostaining confirmed that all lesions were metastatic squamous cell carcinomas originating from the patient's primary lung squamous cell carcinoma.

Thoracic Esophagus Cancer Revealing a Tracheal Diverticulum

Tracheal diverticulum is rarely encountered in a clinical setting since almost all patients are asymptomatic. However, its presence may become a problem during esophageal cancer operations in terms of anesthesia and lymph node dissection of superior mediastinum lymphadenectomy. A 70-year-old man with esophageal cancer was referred to our hospital. During thoracoscopic subtotal esophagectomy, we found a cystic lesion connected to the right posterior wall of the trachea. We evaluated the preoperative computed tomography scan during surgery and made a diagnosis of tracheal diverticulum because of the presence of paratracheal air cysts, which had not been noticed preoperatively. It was resected by a linear stapler and the postoperative course of the patient was uneventful. A careful preoperative evaluation of computed tomography and operation are necessary to avoid injury of tracheal diverticulum during thoracoscopic esophagectomy for esophageal cancer revealing a tracheal diverticulum.

Overlooked diagnosis of infected paratracheal air cysts in patients with respiratory symptoms: Case report

RATIONALE

Infected paratracheal air cysts as the focus of respiratory symptoms can be overlooked in practice because of nonspecific symptoms and physician's scant knowledge for this entity. We report 2 cases of infected paratracheal air cyst diagnosed at chest computed tomography (CT) and bronchoscopy/endobronchial ultrasound.

PATIENT CONCERN

Two patients visited our hospital with respiratory symptoms, including cough, sputum, and fever.

DIAGNOSES

Chest CT showed paratracheal cystic lesions with air-fluid level in the thoracic inlet. In the first patient, endobronchial ultrasound revealed a right paratracheal hypoechoic mass corresponding to the lesion on CT scan. In the second patient, bronchoscopy revealed purulent discharge from a dimpling at posterolateral wall of trachea, which was the opening of communication between the trachea and infected paratracheal air cyst.

INTERVENTIONS

Both patients received antibiotic treatment.

OUTCOME

After medical treatment, the patients' symptoms were improved. Follow-up chest CT scans showed air-filled paratracheal air cysts without internal fluid or rim enhancement.

LESSONS

A physician should pay attention to paratracheal air cyst in patients with respiratory symptoms when their lungs are clear on CT scan.

Transcervical resection of tracheal diverticulum

Tracheal diverticulum is a clinical entity rarely reported in the literature. It can be congenital or acquired in origin, and most cases are asymptomatic, usually being discovered incidentally at CT scan. Therefore, treatment has not been widely reported. We present the case of a 30-year-old man with a 6-month history of repeatedly coughing and tracheobronchitis. CT scanning revealed the lesion. The patient underwent surgical resection of the tracheal diverticulum via a transcervical approach. Symptoms resolved after surgical treatment. Reexamination of the neck, chest, trachea, and lungs of the patient was performed with CT scan postoperative. © 2016 Wiley Periodicals, Inc. Head Neck 39: 187-190, 2017.

Esophageal cancer revealing a tracheal diverticulum

Tracheal diverticulum is a benign entity characterized by single or multiple invaginations of the tracheal wall, and is rarely encountered in clinical practice but frequently in postmortem examination as an incidental finding. Its combination with esophageal cancer is extremely rare. In this case report, we present a patient with these two lesions and analyze their correlation.

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

Tracheal diverticulum, defined as a benign outpouching of the tracheal wall, is rarely diagnosed in clinical practice. It can be congenital or acquired in origin, and most cases are asymptomatic, typically being diagnosed postmortem. We report a case of a 69-year-old woman who was hospitalized after presenting with fever, fatigue, pleuritic chest pain, and a right neck mass complicated by dysphagia. Her medical history was significant: pulmonary emphysema (alpha-1 antitrypsin deficiency); bronchiectasis; and thyroidectomy. On physical examination, she presented diminished breath sounds and muffled heart sounds, with a systolic murmur. Laboratory tests revealed elevated inflammatory markers, a CT scan showed an air-filled, multilocular mass in the right tracheal wall, and magnetic resonance imaging confirmed the CT findings. Fiberoptic bronchoscopy failed to reveal any abnormalities. Nevertheless, the patient was diagnosed with tracheal diverticulum. The treatment approach was conservative, consisting mainly of antibiotics. After showing clinical improvement, the patient was discharged.

Thorax: normal and benign pathologic patterns in FDG-PET/CT imaging

This article describes the normal patterns of thoracic (18)F-fluorodeoxyglucose (FDG) biodistribution, and expands on the role of FDG-PET/computed tomography (CT) for the evaluation of patients suffering from a spectrum of benign pathologic conditions that affect the chest. The discussion addresses the applications of FDG-PET/CT imaging in a wide variety of chest-related disorders. Familiarity with the normal thoracic biodistribution of FDG, coupled with knowledge of the potential nonmalignant causes of increased FDG uptake in the chest, is essential to minimize the incidence of incorrect interpretation of FDG-PET images in daily clinical practice.