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Tracheaocoele

Department of Radiology, University of California School of Medicine, San Francisco, California, and the Highland General Hospital, Oakland, California

Richard J. Trevino

Department of Otolaryngology, Highland General Hospital, Oakland, California, and the U.S. Naval Hospital, Oakland, California

This excerpt was created in the absence of an abstract.

A 59-year-old Negro female was seen in the otolaryngology clinic of Highland General Hospital because of hoarseness of three months' duration.

On initial examination, a large goitre-like expansile mass was noted antero-laterally in the inferior portion of the neck. This mass became especially prominent when the patient performed a Valsalva manoeuvre. Indirect laryngoscopy revealed an oedematous polyp of the right true vocal cord.

Radiographs of the soft tissues of the neck revealed a lucent air-filled pocket 5·5 cm long, 2·5 cm deep, and 4 cm wide. This pocket was situated posterior to the trachea with its mid-section about 5 cm inferior to the true vocal cord (Figs. 1A and 1B). On barium oesophagography no filling of the pocket with barium nor any other abnormality in the cervical oesophagus was seen. The air-pocket appeared to collapse when the patient swallowed. Subsequently the patient returned to the department for laryngography with positive contrast medium. Because of secretions, Dionosil Oily did not optimally coat the laryngal mucosa. On this examination, the posterior air-pocket did fill with contrast medium (Figs. 2A and 2B) and revealed a wide-mouthed opening on the posterior trachea at about the 4th tracheal ring. Radiology diagnosis: tracheocoele.

After admission to Highland General Hospital in May, 1970, laryngobronchoscopy was performed. This examination revealed an exophytic lesion on the laryngeal surface of the epiglottis 1·5 cm wide, which extended inferiorly 2·5 cm to 1 mm above the anterior commissure of the vocal cords. Biopsy showed a squamous-cell carcinoma.