The accidental discovery of a tracheal diverticulum

Excerpt

An 83-year-old female with a medical history of hypertension, apical aneurysm secondary to previous inferior-septal myocardial infarction, mitral and tricuspidal valve insufficiency, severe pulmonary hypertension and COPD was admitted to the ICU for acute respiratory distress and oliguria. Non-invasive positive pressure ventilation was started in the pneumology department, but, due to a worsening of her ventilation parameters, an endotracheal (ET) intubation and a cleaning bronchoscopy were performed. Following those manoeuvres, a sudden development of face, neck and thorax emphysema was observed. A CT scan showed a pneumomediastinum (Fig. 1a, b). Because of a doubt about a possible tracheal laceration, another bronchoscopy was performed (Fig. 1c), which showed an area of laxity of the pars membranacea. No clear signs of perforation were observed. Under bronchoscopy, the tip of the ET was positioned over the observed tracheal defect, just across the tracheal carena. The ET stayed in place for 7 days, when another bronchoscopy (Fig. 1d) was performed and, using methylene blue, the presence of a tracheal-acquired diverticulum was confirmed, while excluding a tracheo-oesophageal fistula. On day 10, the patient was extubated. She had never undergone a general anaesthesia procedure before this event.

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