Paratracheal cyst rupture: a differential diagnosis for tracheal rupture

Marques, João Antônio Pinheiro; Henriques, Ana Rita; Azevedo, Luiz Lanziotti; Almeida, Amélia; Chaló, Daniela

doi:10.1097/00003643-201206001-00787

Cited by 3 publications

(3 citation statements)

References 5 publications

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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: 95%

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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Section: Discussionmentioning

confidence: 95%

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

Kim¹,

Jung²,

Park³

2021

Gland Surg

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“…They are most commonly asymptomatic, though they can act as reservoirs for infection or have mass effect. They are an uncommon cause of tracheobronchial rupture 2 3. The patient's symptoms improved with conservative management.…”

Section: Descriptionmentioning

confidence: 93%

Barotrauma induced tracheal diverticulum rupture: imaging findings

O’Leary

Ryan²,

Corbett

et al. 2016

BMJ Case Reports

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“…In general anesthesia, tracheal diverticula cause failures in tracheal intubation, positivepressure ventilation, and lung isolation [2][3][4]. Additionally, positive-pressure ventilation for tracheal diverticula causes tracheal diverticula rupture, subcutaneous emphysema, and pneumomediastinum [4][5][6][7][8][9][10][11]. Thus, preventing positive-pressure ventilation to tracheal diverticula is important to avoid these adverse events.…”

Section: Introductionmentioning

confidence: 99%

Positional relationships between a tracheal diverticulum and the tracheal tube under general anesthesia: a single-center observational and simulation study

Mitsuzawa

Kumagai²,

Uchida³

et al. 2023

Preprint

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Background Incomplete sealing of tracheal diverticula by a tracheal tube cuff during positive-pressure ventilation causes barotrauma but the concrete possibility of incomplete sealing has not been indicated. We aimed to assess the possibility of incomplete sealing in a simulated situation of tracheal intubation for patients with tracheal diverticula with tube fixation where the tracheal tube’s vocal cord guide overlaps with the patient’s vocal cord. Methods We retrospectively assessed the characteristics of tracheal diverticula based on thoracic computed tomography data in our institution from January 2018 to July 2020. Then, we assessed the structural parameters of three single-lumen tracheal tubes (Parker Flex-Tip [Parker Medical, Bridgewater, CT, USA], Portex Soft Seal [ICU Medical, San Clemente, CA, USA], and Shiley TaperGuard [Medtronic, Dublin, Ireland]; 6.0–8.0 mm inner diameter size) and simulated the positional relationships between tracheal diverticula and the tracheal tube during tracheal intubation where the vocal cord guide overlaps with the patient’s vocal cord. We assessed each tube product’s possibility of incompletely sealing tracheal diverticula and the possibility of unintended bronchial intubation. Results In 5,854 patients, the prevalence of tracheal diverticula was 5.7%. The mean (SD) length from the vocal cord to the distal end of the tracheal diverticula was 52.2 (12.8) mm. Tracheal tubes with length from the distal end of the tracheal cuff to the vocal cord guide of ≥70 mm had a low risk of incompletely sealing tracheal diverticula (<5%) and length from the distal end of the tube to the vocal cord guide of ≤95 mm had a low risk of unintended bronchial intubation (<5%). No products in this study satisfied both outcomes. Conclusions Tube fixation, where the vocal cord guide overlaps with the patient’s vocal cord, is associated with risk of incompletely sealing of tracheal diverticula depending on the tube’s manufacturer and tube’s inner diameter size, although it was not a high risk. The use of small inner diameter sized tube relative to patient’s body size is high risk of incomplete sealing of tracheal diverticula. Trial registration This trial was prospectively registered at University Hospital Medical Information Network (UMIN). Clinical trial number and registry URL: UMIN000043317 (URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048055)

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Paratracheal cyst rupture: a differential diagnosis for tracheal rupture

Cited by 3 publications

References 5 publications

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

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

Barotrauma induced tracheal diverticulum rupture: imaging findings

Positional relationships between a tracheal diverticulum and the tracheal tube under general anesthesia: a single-center observational and simulation study

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