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

• Published in: Jornal brasileiro de pneumologia 2014-12, Vol.40 (6), p.669-672
• Main Authors: Amaral, Cecília Beatriz Alves, Silva, Sónia, Feijó, Salvato
• Format: Article
• Language: English
• Subjects: Aged; alpha 1-Antitrypsin Deficiency - complications; alpha 1-Antitrypsin Deficiency - drug therapy; Anti-Bacterial Agents - therapeutic use; Case Report; Deficiência de alfa 1-antitripsina; Diverticulum - complications; Diverticulum - drug therapy; Divertículo; Doenças da traqueia; Enfisema pulmonar; Female; Humans; Magnetic Resonance Imaging; Meropenem; Pulmonary Emphysema; RESPIRATORY SYSTEM; Thienamycins - therapeutic use; Tomography, X-Ray Computed; Tracheal Diseases - complications; Tracheal Diseases - drug therapy; Vancomycin - therapeutic use
• ISSN: 1806-3713; 1806-3756; 1806-3756; 1806-3713
• DOI: 10.1590/S1806-37132014000600011

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.