Illustration of a tracheal diverticulum causing dysphagia.

Rare Cause of Dysphagia: A Tracheal Diverticulum Case

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Theo Raines in Health & Wellness December 2025 • 4 min read.

"Unveiling the mysteries of dysphagia: A 61-year-old woman's journey with a tracheal diverticulum"


Tracheal diverticula, characterized by small, air-filled invaginations in the paratracheal area, represent a rare clinical entity. These diverticula can manifest as single or multiple occurrences. Although autopsy findings suggest an incidence of approximately 1%, recent investigations utilizing chest computed tomography (CT) have reported prevalence rates ranging from 2% to 3.7% in patients undergoing evaluation.

The presentation of tracheal diverticula is often nonspecific, complicating the diagnostic process. Ideally, computed tomography (CT) imaging studies are used to confirm the diagnosis, followed by surgical resection as the treatment of choice.

In this article, we present a case of a 61-year-old woman with an acquired tracheal diverticulum, with dysphagia as the only presenting symptom. This case underscores the importance of considering rare etiologies in the evaluation of dysphagia and highlights the role of imaging studies and surgical intervention in the management of tracheal diverticula.

Unusual Presentation: A Case of Acquired Tracheal Diverticulum

Illustration of a tracheal diverticulum causing dysphagia.

A 61-year-old female sought medical attention due to gradually worsening dysphagia experienced over a period of three years. Her medical history included hypertension and constipation, managed with antihypertensive medication and psyllium, respectively. Additionally, she had undergone a thyroidectomy 30 years prior. The patient reported iron deficiency anemia and had been prescribed oral iron supplements for three months.

Previous esophagogastroduodenoscopy revealed an esophageal web accompanied by a submucosal bulge in the upper esophagus. Subsequent CT imaging unveiled a small, slightly enhancing lesion, measuring approximately 24 × 20 × 11.7mm, along the anterior wall of the esophagus, and in the right supraclavicular region at the right posterolateral aspect of the trachea. These findings suggested a tracheal diverticulum. The lesion abutted the right lateral wall of the esophagus and possibly corresponded with the submucosal protuberance observed on esophagogastroduodenoscopy.

  • Surgical Intervention: An incision was made parallel to the anterior border of the sternocleidomastoid. Careful dissection enabled identification of the esophagus and recurrent laryngeal nerve on the right side. The proximal esophagus was identified and encircled with a tape. The tracheal diverticulum, located longitudinally, exerted posterolateral compression on the esophagus. Delineation of the tracheal diverticulum was achieved through positive-pressure insufflation, followed by division of the diverticulum. The posterior tracheal walls were approximated using interrupted 2/0 polydioxanone sutures.
  • Pathological Findings: Gross examination of the specimen revealed a single 8 × 0.5-cm light brown tissue sample. Microscopic analysis revealed a fragment of fibrovascular tissue characterized by smooth muscle bundles, dilated and congested blood vessels, adipose tissue, and seromucinous glands, lined by ciliated respiratory mucosa, confirming the diagnosis of tracheal diverticulum. The patient was discharged on the third postoperative day, with subsequent esophagography demonstrating no contrast leak.
These diagnostic clues are crucial for recognizing similar cases in clinical practice.

Tracheal Diverticula: What We've Learned

In conclusion, tracheal diverticula, though rare, should be considered in the differential diagnosis of dysphagia, particularly when conventional etiologies have been excluded. A high index of clinical suspicion, coupled with appropriate imaging studies, is essential for accurate diagnosis and timely management. Surgical excision remains the treatment of choice for symptomatic diverticula, offering the potential for complete resolution of symptoms and improved quality of life.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

1

What is a tracheal diverticulum, and how common are they?

A tracheal diverticulum is a rare condition characterized by small, air-filled invaginations in the paratracheal area. These can be single or multiple. While autopsy studies suggest an incidence of about 1%, CT scans reveal a prevalence between 2% and 3.7% in patients undergoing evaluation, highlighting that it's often overlooked.

2

What were the key findings in the 61-year-old woman's case, and how did the doctors diagnose the tracheal diverticulum?

The 61-year-old woman presented with gradually worsening dysphagia. Her medical history included hypertension, constipation, a thyroidectomy, and iron deficiency anemia. Initial esophagogastroduodenoscopy revealed an esophageal web and a submucosal bulge. Subsequent CT imaging identified a small, enhancing lesion along the anterior wall of the esophagus and in the right supraclavicular region, indicating a tracheal diverticulum that was compressing the esophagus.

3

How is a tracheal diverticulum typically treated, and what was the surgical approach in this specific case?

Surgical resection is the treatment of choice for symptomatic tracheal diverticula. In this case, an incision was made parallel to the anterior border of the sternocleidomastoid muscle. The esophagus and recurrent laryngeal nerve were identified. The tracheal diverticulum was delineated using positive-pressure insufflation and then divided. The posterior tracheal walls were approximated with sutures.

4

What were the pathological findings after the tracheal diverticulum was removed?

Gross examination of the removed tissue revealed an 8 x 0.5 cm light brown tissue sample. Microscopic analysis of the specimen showed a fragment of fibrovascular tissue, including smooth muscle bundles, blood vessels, adipose tissue, and seromucinous glands. It was lined by ciliated respiratory mucosa, which confirmed the diagnosis of tracheal diverticulum.

5

Why is it important to consider tracheal diverticula in the diagnosis of dysphagia, and what is the key takeaway from this case?

Tracheal diverticula, although rare, should be included in the differential diagnosis of dysphagia, especially when other common causes are ruled out. A high level of clinical suspicion, combined with appropriate imaging studies like CT scans, is crucial for accurate diagnosis and timely management. Surgical excision offers the potential for complete symptom resolution and improved quality of life. This case underscores the importance of considering unusual causes and using imaging and surgery for effective treatment.

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