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

Bae, Kyungsoo; Jeon, Kyung Nyeo; Park, Mi Jung; Lee, Seung Joon; Kim, Ho C.; Seung, Ik Sang; Byun, Joung Hun; Kim, Jong W.

doi:10.1097/md.0000000000007536

Cited by 5 publications

(6 citation statements)

References 11 publications

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“…In humans, PACs are typically asymptomatic, but dyspnoea, dysphagia, chronic cough and hoarseness due to pressure on the recurrent laryngeal nerve have been reported (Arian Nia et al 2018). The cysts act as a reservoir for respiratory secretions and although rare, secondary chronic infections can occur (Bae et al 2017). A S. zooepidemicus infection was confirmed in the foal in this study.…”

Section: Discussionsupporting

confidence: 67%

Paratracheal air cyst in a foal

Zetterström¹,

Horzmann

Yin

et al. 2021

Equine Veterinary Education

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A 1-day-old American Paint Horse was presented for a large air-filled mass along the ventral aspect of the neck. Bronchoscopy and oesophagoscopy revealed no sign of communication with the trachea or oesophagus. Radiographs and a computed tomography scan of the neck identified a communicating tract between the lumen of the cystic mass and mid-trachea. The foal was systemically healthy at this initial presentation, and delayed removal of the cyst was recommended to allow further maturation of the foal prior to undergoing general anaesthesia. Upon discharge, the cyst continued to grow in size and became more fluid than airfilled requiring repeat centesis and draining. The foal was then re-presented at 3 weeks of age for surgical removal. In surgery, direct communication with the trachea was identified and ligated. Histopathology demonstrated that the cyst lining was composed of squamous epithelium with goblet cells and occasional ciliated cells. The location, morphological features and congenital presentation of the mass were consistent with a paratracheal air cyst (PAC). Surgical resection resulted in excellent functional and cosmetic outcome. Although not previously reported in horses, PAC should be included in the differential diagnosis of an air-filled ventral neck mass in equine neonates. Complete surgical excision may result in a successful outcome.

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Section: Discussionsupporting

confidence: 67%

Paratracheal air cyst in a foal

Zetterström¹,

Horzmann

Yin

et al. 2021

Equine Veterinary Education

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“…Intervention is not usually performed in asymptomatic PTACs; however, patients with symptomatic PTACs (large cyst, cyst rupture, or infected cyst) typically undergo medical treatment or surgical removal (15)(16)(17). In our case, the asymptomatic PTAC was removed for ipsilateral CCND during thyroid cancer surgery.…”

Section: Discussionmentioning

confidence: 94%

Incidental paratracheal air cyst in papillary thyroid cancer patient: a case report

Kim¹,

Jung²,

Park³

2021

Gland Surg

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Paratracheal air cyst (PTAC) is a collection of air in the right posterior side of the trachea with an uncertain etiology. We report a papillary thyroid cancer patient with a PTAC that was removed during thyroid cancer surgery. A 68-year-old woman was diagnosed with right papillary thyroid cancer with suspicion of central lymph node metastasis. She had a history of hypertension and a rear-end collision car accident 20 years prior. On computed tomography, an ovoid cyst was incidentally found in the paratracheal region at the thoracic inlet level. Emphysematous lung with an obstructive lung defect was noted without any symptoms. Bilateral total thyroidectomy with ipsilateral central compartment neck dissection was indicated for the patient. During surgery, removal of the cyst was inevitable for complete central neck dissection.Histopathologic analysis revealed an etiology of tracheal mucus sprouting through weak trachea points.No postoperative complications occurred. The patient continued on levothyroxine medication without further radioactive iodine therapy. After 6 months, follow-up ultrasound showed no evidence of recurrence.We hypothesized that obstructive lung disease with impaired lung function or trauma history might have contributed to the development of PTAC. Future studies are needed to determine if PTACs have any association with obstructive lung disease or trauma.

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“…Therefore, reports have suggested a relationship between PTACs and prolonged increased intraluminal pressure due to chronic lung diseases such as Chronic Obstructive Pulmonary Disease (COPD) and emphysema [1] , [5] . Several reports have also described congenital PTACs with other respiratory tract abnormalities [6] . In the presented cases, location and morphological findings were compatible with typical characteristics of PTACs; however, no medical history of COPD, emphysema, or the other respiratory tract abnormality was found, suggesting unknown pathogenesis of the PTACs.…”

Section: Clinical Discussionmentioning

confidence: 99%

Paratracheal air cyst and bronchogenic cyst in patients with esophageal cancer who received thoracoscopic esophagectomy: A case series of three patients

Okumura

Miwa

Watanabe

et al. 2021

International Journal of Surgery Case Reports

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Introduction and importance Mediastinal cystic lesions, such as paratracheal air cyst (PTAC) and bronchogenic cyst (BC), are rare anomaly usually found incidentally in thoracic imaging. Special attention is needed in the case of thoracic surgery. Case presentation All three patients were male, 71, 73, and 76 years old. Preoperative CT showed each had a lobular cystic lesion at the right posterolateral side of trachea in the thoracic outlet 11, 14, and 19 mm in size, respectively, with air density and tracheal communication, leading to a diagnosis of PTACs. An oval cystic lesion, 7 mm in size, was found in one patient at the right lateral side of the upper esophagus with low density and without tracheal communication, leading to a diagnosis of paraesophageal BC. Intraoperative findings of the three PTACs demonstrated a soft bulge from the membranous portion of trachea that was left intact. The BC had an oval elastic structure, mimicking a metastatic lymph node, and was removed with the mediastinal lymph nodes. Histological examination showed ciliated columnar epithelium, confirming a diagnosis of BC. Clinical discussion PTACs are associated with increased intraluminal pressure due to chronic lung disease. BCs are congenital anomalies that originate from abnormal budding of the embryonic foregut. Conclusion PTACs and BCs need to be considered in preoperative image diagnosis in patients with esophageal cancer. PTACs should be left intact to avoid tracheal injury, while removal of isolated BCs is recommended as a diagnostic and therapeutic measure.

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

Cited by 5 publications

References 11 publications

Paratracheal air cyst in a foal

Paratracheal air cyst in a foal

Incidental paratracheal air cyst in papillary thyroid cancer patient: a case report

Paratracheal air cyst and bronchogenic cyst in patients with esophageal cancer who received thoracoscopic esophagectomy: A case series of three patients

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