Pneumomediastinum related to distal tracheal diverticulum

Mazul-Sunko, Branka; Zdenčar, Dalibor; Kožul, Iva; Špiček-Macan, Jasna; Stančić-Rokotov, Dinko

doi:10.1111/anae.12193

Cited by 8 publications

(9 citation statements)

References 3 publications

(3 reference statements)

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“…If the patient is under manual ventilation at high pressure, the pouch may perforate, resulting in pneumomediastinum (Dinner et al, ). Mazul‐Sunko et al () report a patient presenting with pneumomediastinum secondary to laceration of a tracheal diverticulum. This was likely the result of accidental perforation of the diverticulum during tracheal intubation.…”

Section: Tracheal Diverticulummentioning

confidence: 99%

Variations of the tracheobronchial tree: Anatomical and clinical significance

et al. 2014

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Tracheobronchial variations can be found during routine bronchoscopy or computed tomography. Previous sources estimate an incidence of 1-12%; however, these variations are often asymptomatic. Symptomatic patients present typically with cough and lower respiratory tract infection. Knowledge and understanding of tracheobronchial variations have important implications for diagnosis of symptomatic patients and performing certain procedures, including bronchoscopy and endotracheal intubation. In this review, we describe the most commonly encountered variations, tracheal bronchus and accessory cardiac bronchus, along with three minor abnormalities of this region. We also review the various imaging modalities in the diagnosis and treatment of these conditions.

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Section: Tracheal Diverticulummentioning

confidence: 99%

Variations of the tracheobronchial tree: Anatomical and clinical significance

et al. 2014

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“…The incidence of incidentally detected tracheal diverticula is up to 6% [4]. There have been isolated case reports in the past where pneumomediastinum and tracheal diverticula were incidentally detected [5][6][7][8]. Some of these cases of diverticula and pneumomediastinum were in patients after endotracheal intubation and ventilation [7].…”

Section: Discussionmentioning

confidence: 99%

Tracheal Diverticulum in SARS-CoV-2 Patients on Non-Invasive Ventilation A not so “Spontaneous” Cause of Pneumomediastinum? An imaging Pictorial Presentation of Two Cases with Review of Literature

Joseph

Lynser

Tiewsoh

et al. 2021

AML

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Spontaneous pneumomediastinum is a rare but potentially life-threatening condition, the incidence of which has showed an increase in patients with SARS-CoV-2 pneumonia, especially when they are on positive pressure ventilation. None of the reported cases of covid related pneumomediastinum had an associated tracheal diverticulum. Also, to the best of our knowledge, tracheal diverticulum has not been reported in patients on NIV. We report 2 cases of COVID-19 pneumonia on NIV with pneumomediastinum, which also had associated tracheal diverticulum, one of which developed after NIV. Though the establishment of causality needs further research, early detection of a tracheal diverticulum, which might be a harbinger of pneumomediastinum, can be a timely alarm to prompt titration of the pressure settings and judicious use of NIV. The role of inverted grey scale CT images in mediastinal window is a simple, yet hardly utilised radiological tool to increase detection of ‘mediastinal air’, let it be free air or air within a diverticulum. Through this case report, we would like to highlight the role of conventional and inverted CT imaging of pneumomediastinum and tracheal diverticulum in general and in SARS-CoV-2 pneumonia in particular, and to call for more objective research to throw light on the plausible relationship between pneumomediastinum and tracheal diverticulum.

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“…All were case reports, and the clinical information of these reports is summarized in Table 1 . 11 – 17 In all cases, the TD was diagnosed by fiberoptic bronchoscopy or CT. Möller et al. 16 reported a case of postoperative mediastinal emphysema due to accidental perforation of a dilated trachea as a result of tracheal intubation.…”

Section: Discussionmentioning

confidence: 99%

“…Mazul-Sunko et al. 15 experienced a case of mediastinal emphysema associated with a TD; however, the authors concluded that mediastinal emphysema was not likely associated with injury to the TD caused by the tracheal tube. Chakraborty et al.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of thoracoscopic pulmonary wedge resection with a giant tracheal diverticulum in the carina: a case report and review of the literature

et al. 2021

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A tracheal diverticulum (TD) is a rare disease that is usually diagnosed as an incidental finding on thoracic computed tomography or bronchoscopy. TDs can be classified as congenital or acquired. In patients undergoing surgery, TDs can result in difficult intubation, difficult ventilation, pneumothorax, and other complications. We herein report a case of anesthetic management of thoracoscopic pulmonary wedge resection in a patient with a giant TD in the carina. Intraoperative double-lumen intubation and single-lung ventilation were challenging to perform. Fiberoptic-guided intubation was helpful, and intraoperative management was tailored to avoid diverticulum rupture. In this report, we also review complications related to TD in surgical patients undergoing mechanical ventilation. Ventilation is one of the most prominent anesthetic challenges. The close collaboration of the entire medical team was a key factor in the successful management of this rare case.

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Pneumomediastinum related to distal tracheal diverticulum

Cited by 8 publications

References 3 publications

Variations of the tracheobronchial tree: Anatomical and clinical significance

Variations of the tracheobronchial tree: Anatomical and clinical significance

Tracheal Diverticulum in SARS-CoV-2 Patients on Non-Invasive Ventilation A not so “Spontaneous” Cause of Pneumomediastinum? An imaging Pictorial Presentation of Two Cases with Review of Literature

Anesthetic management of thoracoscopic pulmonary wedge resection with a giant tracheal diverticulum in the carina: a case report and review of the literature

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