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

• Published in: Medicine (Baltimore) 2017-07, Vol.96 (29), p.e7536-e7536
• Main Authors: Bae, Kyungsoo, Jeon, Kyung N., Park, Mi J., Lee, Seung J., Kim, Ho C., Cha, Seung I., Byun, Joung H., Kim, Jong W.
• Format: Article
• Language: English
• Subjects: Aged; Air; Anti-Bacterial Agents - therapeutic use; Clinical Case Report; Diagnosis, Differential; Diagnostic Errors; Female; Humans; Male; Mediastinal Cyst - diagnostic imaging; Mediastinal Cyst - drug therapy; Middle Aged; Respiratory Tract Infections - diagnostic imaging; Respiratory Tract Infections - drug therapy
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000007536

Infected paratracheal air cysts as the focus of respiratory symptoms can be overlooked in practice because of nonspecific symptoms and physician's scant knowledge for this entity. We report 2 cases of infected paratracheal air cyst diagnosed at chest computed tomography (CT) and bronchoscopy/endobronchial ultrasound. Two patients visited our hospital with respiratory symptoms, including cough, sputum, and fever. Chest CT showed paratracheal cystic lesions with air-fluid level in the thoracic inlet. In the first patient, endobronchial ultrasound revealed a right paratracheal hypoechoic mass corresponding to the lesion on CT scan. In the second patient, bronchoscopy revealed purulent discharge from a dimpling at posterolateral wall of trachea, which was the opening of communication between the trachea and infected paratracheal air cyst. Both patients received antibiotic treatment. After medical treatment, the patients' symptoms were improved. Follow-up chest CT scans showed air-filled paratracheal air cysts without internal fluid or rim enhancement. A physician should pay attention to paratracheal air cyst in patients with respiratory symptoms when their lungs are clear on CT scan.