An Unusual Differential for Intractable Cough and Hoarseness: Tracheocele

SESSION TITLE: Miscellaneous SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Tracheocele is a congenital or acquired diverticulum of the trachea. Although its incidence is variable, there have been very few symptomatic cases requiring active intervention. We present to you a case of tracheocele manifesting as intractable cough with hoarseness and recurrent respiratory tract infections (RTI). CASE PRESENTATION: 53 year old woman, never smoker, with papillary carcinoma thyroid s/p total thyroidectomy complicated by pneumonia requiring tracheostomy with decannulation after 8 weeks. She presented to our clinic 4 years later with debilitating dry cough and hoarseness with at least 20 emergency room visits in the last 6 months. During such episodes she was diagnosed with RTI on two different occasions requiring antibiotics. Oral steroids and various inhalers for her suspected cough variant asthma were stopped as she did not improve. Laryngoscopy revealed paradoxical vocal fold motion (PVFM) for which she underwent behavioral and voice therapy. Other etiologies for her cough including sinus disease and acid reflux were ruled out. Further evaluation with CT scan chest showed an air pocket measuring 13 mm x 22 mm at thoracic inlet level on right side of cervical trachea suggestive of a tracheocele. Bronchoscopy revealed a small mucosal outpouching with free movement of air and secretions confirming our suspicion of tracheocele. She subsequently underwent a right cervical neck exploration with resection of right tracheocele with full restoration of voice and some improvement in her cough. DISCUSSION: Tracheocele is usually located in the right postero-lateral trachea at level of thoracic inlet presumably as this space is unsupported when compared with the left side, which is supported by the aortic arch and esophagus. Her prior h/o thyroidectomy and tracheostomy is indicative of a traumatic/ acquired version but the location is strongly suggestive of a congenital tracheocele. Findings of PVFM, RTI and tracheocele suggest multi-factorial etiology of her cough, but an improvement in symptoms after resection strongly suggests that the tracheocele was not an incidental finding. CONCLUSIONS: Although rare, tracheocele should be on list of differentials for cough and hoarseness which can be fixed surgically. Reference #1: Tanrivermis S. et.al The diseases of airway-tracheal diverticulum: a review of the literature. Journal of Thoracic Disease. 2016;8(10):E1163-E1167 DISCLOSURE: The following authors have nothing to disclose: Karthika Linga, Minkyung Kwon, Vichaya Arunthari, Brendon Colaco, Jorge Pascual No Product/Research Disclosure Information