Tracheal diverticulum

from Wikipedia, the free encyclopedia
Tracheal diverticulum in computed tomography. Typical position to the right dorsal next to the esophagus. The connection to the trachea can just be seen (arrow).
Tracheal / bronchial diverticulum at the much rarer location in the area of ​​the branching off of the windpipe. Computed tomography axial and as virtual bronchoscopy .

A tracheal diverticulum is a protrusion of the layers of skin from the lumen of the windpipe (trachea) into the surrounding tissue. Tracheal diverticula are occasionally found incidentally in the form of a small accumulation of air next to the windpipe on computed tomography , during a bronchoscopy, or during other medical examinations.

Definitions

In the specialist literature , in addition to tracheal diverticula , the terms tracheocele ( tracheocele , tracheocoele ) or generally descriptive ( English ) paratracheal air cyst ( PTAC , air-filled cyst located next to the windpipe ) are used. Today the convention has prevailed to distinguish only between congenital and acquired tracheal diverticula and to use the term tracheocele (short definition: rupture of the windpipe ) as a synonym for an acquired tracheal diverticulum .

The Clinical Dictionary of Springer-Verlag names the tracheocele synonymous with the rupture of the trachea , the tracheal hernia and the tracheal diverticulum and defines these as the "protuberance of the tracheal mucosa caused by a congenital wall weakness". The lexicon of medicine explains the tracheal diverticulum differently as a protuberance of the soft trachea, and also as a traction diverticulum in the case of shrinking processes in the vicinity.

The lexicon of medicine describes the tracheal diverticula as protrusions of the trachea. True diverticula are congenital and represent short, mostly to the right-pointing, excess bronchial tubes from the tachea. The end of the bronchus is not blind, but merges into lung tissue , referred to as the tracheal lobe of the lung . False diverticula are acquired. These tracheoceles are hernial sac-like protrusions of the tracheal mucosa. These ruptures of the windpipe can be found as bulges in the windpipe, even when the cough is severe, as a result of the abnormal yielding of the cartilage rings. Analogously, Otto Dornblüth, since the first edition in 1894 and subsequently Willibald Pschyrembel up to the current edition of their clinical dictionary, have interpreted the tracheocele as a protrusion of the trachea on the neck with a strong cough as a result of a diverticulum ; the keyword tracheal diverticulum is missing.

Another representation can be found in 1980 in the hand dictionary of medicine . Tracheal diverticula are hernia-like protuberances of the soft trachea, with shrinking lymph node processes in the vicinity also as “traction diverticula” created by tensile force, or congenitally as rudimentary additional bronchi near the tracheal fork. In a broader sense, it is understood to include diverticulum-like formations in the pars membranacea , especially in chronic bronchitis , which contain air, mucus and possibly pus as mucous gland cysts , some of which have acinar structures , and which appear as so-called cyst fibromas in the case of reactive connective tissue overgrowth .

construction

While congenital tracheal diverticula contain all anatomical layers of the trachea, in acquired forms ( tracheoceles ) only the respiratory epithelium bulges outward through the other layers into the mediastinum . The diverticula are usually about 0.2 to 3 cm in size and the connection to the lumen of the windpipe is often so narrow that it cannot be seen in computed tomography or bronchoscopy.

localization

The vast majority (97 to 98%) of the tracheal diverticula are found on the right side behind the trachea at the level of the upper thoracic aperture . A second, rare localization is the region of the carina tracheae , whereby these cases already concern the transition to the main bronchi and one can therefore discuss the term tracheal or bronchial diverticulum.

distribution

The frequency of tracheal diverticula is stated differently with values ​​from about 0.75 to a good 8%, the numbers depending on the method used (computer tomography, magnetic resonance tomography , bronchoscopy, autopsy ). They were found more frequently in women in some studies and more frequently in men in others.

While some publications suggest a connection with chronic obstructive pulmonary disease (COPD), other authors found none. A causal connection with a previous trauma could also not be proven.

However, a significantly increased prevalence was found in patients with cystic fibrosis and in the rare Mounier-Kuhn syndrome (idiopathic tracheobronchomegaly). More than one diverticulum was also found more often in both patient groups.

meaning

Tracheal diverticula are usually asymptomatic, which is shown by studies on their frequency, in which they only occurred as an incidental finding without themselves having a disease value. In individual case reports, however, patients are naturally often described who have become conspicuous due to symptoms. There were infections caused by accumulations of mucus in the diverticulum, hiccups , irritation of the vagus nerve , recurrent palsy or impairment of the upper respiratory tract and difficulty swallowing .

Differential diagnosis

If an accumulation of air is found next to the windpipe during a radiological examination (e.g. computed tomography), it is usually possible to differentiate it from other clinical pictures due to the typical position of the tracheal diverticulum on the right rear at the level of the upper thoracic aperture. A Zenker's diverticulum , which starts from the hypopharynx , is very often directed to the left and is less often filled with air in computer tomography. A laryngocele starts from the larynx and is accordingly higher. A mediastinal emphysema often has only a single bubble at this point. In most cases, a differentiation is also possible based on the anamnesis, for example in the case of a chest trauma or a perforation of a hollow organ (e.g. the esophagus ). A tracheoesophageal fistula ( esophagotracheal fistula ) can develop here. In Zenker's diverticulum, a fetor ex ore can facilitate the differential diagnosis on physical examination .

treatment

Since most tracheal diverticula are asymptomatic, no treatment is necessary for them. If symptoms do occur, conservative therapy is usually recommended, depending on the nature of the symptoms. So with repeated can infections an antibiotics may be necessary.

In isolated cases, surgery was performed on patients in whom symptoms progressively worsened despite appropriate medical therapy. The general state of health of the patient was taken into account in order to assess the risk-benefit ratio . Surgical therapy then consisted of resection of the diverticulum.

Illustration from the 1838 publication by Rokitansky

history

The first description of a tracheal diverticulum is attributed to Carl von Rokitansky (in 1838). As a generic term to the description as is bronchogenic cyst (English: bronchogenic cyst ), not to be confused with the branchial cyst (or fistula).

embryology

In the approximately three-week-old embryo , the pulmonary anus appears as an endodermal diverticulum from which the pulmonary diverticulum is formed. After a further two weeks, the trachea develop from this and, at the age of six weeks, the two main bronchi develop. The esophageal atresia and the esophagotracheal fistula as well as the lung cysts are corresponding malformations .

See also

-zele

Sources and literature

  1. ↑ Josef Hammerschmid-Gollwitzer: Dictionary of Medical Terms , ISBN 3-88102-061-6 , Wilhelm Goldmann Verlag, Munich 1981. P. 412.
  2. ↑ a b c d e f B. M. Teh, C. Hall, S. Kleid: Infected tracheocoele (acquired tracheal diverticulum): case report and literature review. In: The Journal of Laryngology & Otology. 125, 2011, p. 540, doi: 10.1017 / S0022215110003026 ( full text ).
  3. ↑ a b c d e f g h i A. Tanrivermis Sayit, M. Elmali, D. Saglam, C. Celenk: The diseases of airway-tracheal diverticulum: a review of the literature. In: Journal of thoracic disease. Volume 8, number 10, October 2016, pp. E1163 – E1167, doi: 10.21037 / jtd.2016.10.92 , PMID 27867581 , PMC 5107528 (free full text) (review).
  4. ↑ Peter Reuter: Springer Clinical Dictionary 2007/2008 , 1st edition, Springer-Verlag, Heidelberg 2007, ISBN 978-3-540-34601-2 , p. 1845.
  5. ↑ Linus Geisler : Lexicon medicine. The reference work for doctors, pharmacists and patients. 4th, revised and expanded edition, Lexikon-Redaktion Elsevier GmbH Munich, special edition, Naumann & Göbel Verlagsgesellschaft, Cologne no year (2005), ISBN 978-3-625-10768-2 , p. 1673.
  6. ^ Analogue: Roche Lexicon Medicine . Published by Hoffmann-La Roche AG and Urban & Schwarzenberg, 5th edition, Urban & Fischer, ISBN 3-437-15156-8 , Munich, Jena 2003, pp. 1842 f.
  7. ↑ Maxim Zetkin , Herbert Schaldach: Dictionary of Medicine (abbreviation: WdM). 16th edition Lexikon der Medizin , Ullstein Medical, Wiesbaden 1999, ISBN 3-86126-126-X ; 16th edition Lexicon of Medicine , special edition, Elsevier Munich, Fackelträger Verlag, ISBN 3-7716-4326-0 , Cologne without year (2005), p. 2024 f.
  8. ^ Duden - The dictionary of medical terms , 4th edition, Bibliographisches Institut, Mannheim / Vienna / Zurich 1985, ISBN 3-411-02426-7 , p. 684.
  9. ^ Specialist dictionary of medicine , Verlag Manfred Pawlak, Herrsching 1984, ISBN 3-88199-163-8 , p. 481.
  10. ^ Otto Dornblüth : Dictionary of clinical art expressions for students and doctors , Leipzig 1894, Verlag von Veit & Comp., P. 137, keyword "Tracheocele".
  11. ↑ Willibald Pschyrembel: Clinical Dictionary , 267th edition, de Gruyter Verlag, Berlin / Boston 2017, ISBN 978-3-11-049497-6 , p. 1819.
  12. ↑ Günter Thiele (Ed.): Handlexikon der Medizin , Volume 4 (S − Z), Urban & Schwarzenberg, Munich / Vienna / Baltimore 1980, p. 2465.
  13. ↑ a b c J. M. Goo, JG Im, JM Ahn, WK Moon, JW Chung, JH Park, JB Seo, MC Han: Right paratracheal air cysts in the thoracic inlet: clinical and radiologic significance. In: American Journal of Roentgenology . Volume 173, Number 1, July 1999, pp. 65-70, doi: 10.2214 / ajr.173.1.10397101 , PMID 10397101 .
  14. ↑ a b c A. Kurt, AT Sayit, A. Ipek, IG Tatar: A multi detector computed tomography survey of tracheal diverticulum. In: The Eurasian journal of medicine. Volume 45, number 3, October 2013, pp. 145–148, doi: 10.5152 / eajm.2013.31 , PMID 25610271 , PMC 4261431 (free full text).
  15. ^ Donald MacKinnon: Tracheal diverticula. In: The Journal of Pathology and Bacteriology. 65, 1953, p. 513, doi: 10.1002 / path.1700650223 .
  16. ↑ HJ Bae, EY Kang, HS Yong, YK Kim, OH Woo, YW Oh, KW Doo: Paratracheal air cysts on thoracic multidetector CT: incidence, morphological characteristics and relevance to pulmonary emphysema. In: The British journal of radiology. Volume 86, number 1021, January 2013, p. 20120218, doi: 10.1259 / bjr.20120218 , PMID 23255540 , PMC 4651063 (free full text).
  17. ↑ Hua-Ming Cheng, Pau-Yang Chang, Kuo-Hsien Chiang, Hsin-Wen Huang, Chau-Chin Lee: Prevalence and Characteristics of Paratracheal Air Cysts and Their Association With Emphysema in a General Population In: European Journal of Radiology 2012 Oct ; 81 (10): 2673-7 doi: 10.1016 / j.ejrad.2011.10.013 .
  18. ↑ a b J. E. Buterbaugh, WK Erly: Paratracheal air cysts: a common finding on routine CT examinations of the cervical spine and neck that may mimic pneumomediastinum in patients with traumatic injuries. In: AJNR. American journal of neuroradiology. Volume 29, Number 6, June 2008, pp. 1218-1221, doi: 10.3174 / ajnr.A1058 , PMID 18544671 .
  19. ↑ a b Joshua J. Reicher, Paul Mohabir, Elika Rad, Gabriela Gayer: Increased prevalence of tracheal diverticula in cystic fibrosis patients. In: The British Journal of Radiology. 89, 2016, p. 20150694, doi: 10.1259 / bjr.20150694 .
  20. ↑ B. Celik, S. Bilgin, C. Yuksel: Mounier-Kuhn syndrome: a rare cause of bronchial dilation. In: Texas Heart Institute journal. Volume 38, Number 2, 2011, pp. 194-196, PMID 21494536 , PMC 3066798 (free full text).
  21. ↑ Christopher L. Smelley, Rebecca Bowen, O. Nathan Cherie-Ann: Intermittently Symptomatic Tracheal Diverticulum: A Case of a Rare Clinical Phenomenon. In: Ear, Nose & Throat Journal. 90, 2019, p. E10, doi: 10.1177 / 014556131109000918 .
  22. ↑ Laurens J. Ceulemans, Philip Lerut, Stefan De Moor, Rob Schildermans, Paul De Leyn: Recurrent Laryngeal Nerve Paralysis by Compression From a Tracheal Diverticulum. In: The Annals of Thoracic Surgery. 97, 2014, p. 1068, doi: 10.1016 / j.athoracsur.2013.06.118 .
  23. ↑ Marco-Domenico Caversaccio, Minerva Becker, Peter Zbären: Tracheal Diverticulum Presenting with Recurrent Laryngeal Nerve Paralysis. In: Annals of Otology, Rhinology & Laryngology. 107, 2016, p. 362, doi: 10.1177 / 000348949810700418 .
  24. ↑ K. Bae, KN Jeon, MJ Park, SJ Lee, HC Kim, SI Cha, JH Byun, JW Kim: Overlooked diagnosis of infected paratracheal air cysts in patients with respiratory symptoms: Case report. In: Medicine. Volume 96, number 29, July 2017, p. E7536, doi: 10.1097 / MD.0000000000007536 , PMID 28723769 , PMC 5521909 (free full text).
  25. ↑ Shota Akabane, Jun Kawachi, Ryuta Fukai, Rai Shimoyama, Hiroyuki Kashiwagi, Hidemitsu Ogino, Kazunao Watanabe: A rare case of an infected tracheal diverticulum requiring emergency intervention: A case report. In: International Journal of Surgery Case Reports. 24, 2016, p. 7, doi: 10.1016 / j.ijscr.2016.04.051 .
  26. ^ Robert M. Youngson: Collins Dictionary of Medicine , Harper Collins Publishers, Glasgow 1992, ISBN 0-583-31591-7 [sic!], P. 597.
  27. ↑ Ammar Haouimi, Laughlin Dawes et al .: Tracheal diverticulum , in: Radiopaedia
  28. ↑ Enrique Javier Soto-Hurtado, Laura Peñuela-Ruíz, Ignacio Rivera-Sánchez, Julio Torres-Jiménez: Tracheal Diverticulum: A Review of the Literature. In: Lung. 184, 2006, p. 303, doi: 10.1007 / s00408-006-0010-7 .
  29. ^ EA Porubsky, CG Gourin: Surgical treatment of acquired tracheocele. In: Ear, nose, & throat journal. Volume 85, Number 6, June 2006, pp. 386-387, PMID 16866115 .
  30. ↑ Carl Rokitansky : About diverticulum-like expansion of the tracheal canal. (1838) Medical yearbooks of the kk Austrian state. No. XXV, pp. 374-385. On Google Books [1] or [2]
  31. ^ Jan Langman: Medical Embryology , 5th edition, Georg Thieme Verlag, Stuttgart 1977, ISBN 3-13-446605-8 , pp. 261-281.