Abstract
Purpose
This paper describes an asymptomatic and rarely diagnosed entity without a clear correlation with respiratory disease identified in 1%–2% of cases at spiral computed tomography (CT).
Materials and methods
We retrospectively reviewed the CT features of air collections contiguous to the tracheal or main bronchial wall and communicating with the airway in 16 patients undergoing CT for other reasons. Four patients were also studied by virtual bronchoscopy and three by actual bronchoscopy.
Results
Thirteen of the 16 patients had a single diverticulum, whereas the remaining three had multiple diverticula. Only one patient had a bronchial diverticulum. The most frequent site was the right posterolateral wall of the trachea at the level of the second or third thoracic vertebral body. In 2/3 of patients, chronic obstructive pulmonary disease was not documented.
Conclusions
CT was the most effective method for evaluating the presence and features of diverticula. A correlation between tracheobronchial diverticula and chronic respiratory disease was documented in 5/16 patients, whereas no respiratory disorder was identified in the remaining 11. Although chronic inflammatory tracheobronchial changes and increased endoluminal pressure may be important causes, we hypothesise that other, as yet unknown, aetiopathological factors could exist.
Riassunto
Obiettivo
Gli autori descrivono una patologia poco riconosciuta, spesso di riscontro occasionale presente nell’1%–2% degli esami TC del torace, priva di sintomatologia caratterizzante e non sempre correlabile a pre-esistenti malattie dell’apparato respiratorio.
Materiali e metodi
Vengono esaminate retrospettivamente le caratteristiche TC di raccolte aeree contigue alle pareti della trachea e dei bronchi e comunicanti con i rispettivi lumi aerei rilevate in 16 pazienti sottoposti ad esame TC per altra patologia. In 4 pazienti è stata eseguita l’endoscopia virtuale e in 3 anche l’endoscopia reale.
Risultati
In 13 casi i diverticoli sono risultati unici, in 3 multipli. La localizzazione tracheale unica in corrispondenza della parete postero-laterale destra a livello della II e III vertebra toracica è stata prevalente. In un solo caso è stato riscontrato diverticolo unico bronchiale. Nei 2/3 dei casi non è stata documentata broncopneumopatia cronica ostruttiva.
Conclusioni
Una correlazione tra diverticoli tracheobronchiali e malattie croniche dell’apparato respiratorio è stata riscontrata in 5 pazienti su 16, mentre nei rimanenti 11 non era presente sintomatologia respiratoria. Ciò induce a ritenere che oltre alle alterazioni delle pareti tracheobronchiali su base infiammatoria cronica ed all’aumento delle pressioni endoluminali, possano esistere meccanismi eziopatogenetici diversi e attualmente sconosciuti. La TC è risultata la metodica più efficace nel valutare sia la presenza che le caratteristiche dei diverticoli.
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Polverosi, R., Carloni, A. & Poletti, V. Tracheal and main bronchial diverticula: the role of CT. Radiol med 113, 181–189 (2008). https://doi.org/10.1007/s11547-008-0249-6
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DOI: https://doi.org/10.1007/s11547-008-0249-6