Paratracheal air cysts: prevalence and relevance to pulmonary emphysema and bronchiectasis using thoracic multidetector CT

PURPOSE

We aimed to determine the prevalence of paratracheal air cysts (PTACs) and the relationship of PTACs with emphysema and bronchiectasis through retrospective analysis of multidetector computed tomography (MDCT) findings.

METHODS

MDCT findings of 1027 consecutive patients who underwent routine thorax examination between January 2012 and January 2013 were evaluated retrospectively for the presence of PTACs. Localization of the PTACs, as well as their size, shape, and relationship with the trachea were examined. Presence of emphysema and bronchiectasis was recorded, and bronchiectasis severity index was calculated when present. We randomly selected 80 patients who had no visible PTACs as the control group. The findings of patients with and without PTACs were compared.

RESULTS

PTACs were determined in 82 of 1027 patients (8%), in 8.8% of females and 7.3% of males. The presence of PTACs was determined to be independent of gender (P = 0.361). Eighty-one PTACs (98.8%) were located in the right side of the trachea and 56.1% had a tracheal connection. The presence of PTACs significantly correlated with the presence and severity of bronchiectasis (P = 0.001 and P = 0.005 respectively). There was no significant relationship between the presence of PTACs and the presence of emphysema on CT images (P = 0.125).

CONCLUSION

The prevalence of PTACs was determined as 8% in this study. There was significant association between PTACs and bronchiectasis.Paratracheal air cysts (PTACs) are small collections of air adjacent to the trachea at the level of the thoracic inlet (1). Pathological diagnosis of PTACs in surgically confirmed cases includes tracheal diverticulum, lymphoepithelial cyst, and bronchogenic cyst (1–3). These cysts are covered with ciliary columnar epithelium and connected with the trachea (4). The majority of PTACs are reported as tracheal diverticula in the literature, due to their connection with the trachea (2). The thoracic inlet between the cartilage and muscle layers in right posterolateral wall of the trachea is the most common location for PTACs. A relationship may be seen between an isolated PTAC and the trachea l lumen (5). These lesions may cause recurrent infections by acting as a reservoir for secretions.Occasionally, PTACs can be confused with other causes of extraluminal air collections as laryngocele, pharyngocele, Zenker’s diverticulum, apical hernia of the lung, mediastinal air, apical paraseptal blebs, or bullae. To distinguish PTACs from other pathologies, its typical location in the right posterior paratracheal region at the thoracic inlet can be helpful: PTACs locate away from the lung pleura, communicate with the trachea and have rounded margins that can be differentiated from emphysematous changes (6).PTACs are usually discovered incidentally on thorax computed tomography (CT). They may be associated with a chronic cough or chronic obstructive pulmonary diseases (COPD). The reported prevalence of PTACs ranges from 0.75% to 8.1% (4, 6–8). There have been a limited number of studies reporting the incidence of PTACs related to COPD or emphysema as detected by CT, and the reported results are variable (4, 6, 8–11). The relationship between PTACs and pulmonary emphysema or bronchiectasis is still unclear. To our knowledge, no published study has evaluated the relationship between PTACs and bronchiectasis, using a bronchiectasis severity index and objective measures to determine the extent of bronchiectasis on CT images.The purpose of our study was to evaluate the prevalence and characteristics of PTACs, as well as their relationship with bronchiectasis and emphysema, on thorax CT scans.