Tuberc Respir Dis.  2008 Feb;64(2):144-148.

A Case of Tracheomegaly and Recurrent Pneumomediastinum Combined with Pulmonary Fibrosis

• Jeon SR
• Uh ST
• Kim KU
• Lee YM
• Kim YK
• Jung EJ
• Kim JY
• Park EJ

Abstract

Tracheomegaly is a distinctive condition that presents with marked dilation of the trachea. Spontaneous pneumomediastinum is the result of alveolar rupture with dissection of the airway along the bronchus and into the mediastinum. Tracheomegaly and recurrent spontaneous pneumomediastinum are rare complications of pulmonary fibrosis when combined with rheumatoid arthritis. We present a case of tracheomegaly and recurrent spontaneous pneumomediastinum that was precipitated by repeated respiratory infection and chronic cough in a patient with pulmonary fibrosis that was associated with rheumatoid arthritis.

Keyword

Tracheomegaly; Recurrent pneumomediastinum; Pulmonary fibrosis

MeSH Terms

Arthritis, Rheumatoid
Bronchi
Cough
Humans
Mediastinal Emphysema
Mediastinum
Pulmonary Fibrosis
Rupture
Trachea

Figure

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  Figure 1 Chest PA and HRCT (high resolution computerized tomography) of lung at one year ago (A, B) and admission (C, D). At admission, chest PA shows more dilated diameter of trachea (26.5 mm, thick arrow, C) compared to that of chest PA one year ago (19.7 mm, A). Furthermore, linear radiolucent density is observed along with right mediastinum suggesting pneumomediastinum (thin arrow, C) which is not observed at one ago (A). HRCT shows more aggravated diffuse peripheral and lower lung reticulation and honeycombing (B) compared to that of HRCT at one year ago (D).

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  Figure 2 Chest CT scan at one year ago (A), 4 months ago (B), and at admission (C). Chest CT scan taken one year ago shows normal luminal diameter of the trachea and no pneumomediastium (A). As compared with A, chest CT scan taken 4 months ago (B) shows more enlarged trachea and small amount of mediastinal air surrounding the trachea. At admission, chest CT scan (C) shows prominent dilatation of trachea and large amount of recurrent pneumomediastinum.

Reference

1. Breatnach E, Abbott GC, Fraser RG. Dimensions of the normal human trachea. AJR Am J Roentgenol. 1984. 142:903–906.

2. Woodring JH, Barrett PA, Rehm SR, Nurenberg P. Acquired tracheomegaly in adults as a complication of diffuse pulmonary fibrosis. AJR Am J Roentgenol. 1989. 152:743–747.

3. Yun SY, Kim YH, Choi EK, Hong SK, Ji YK, Lee KY, et al. A case of spontaneous pneumomediastinum and pneumopericardium in a patient with acute exacerbation of idiopathic pulmonary fibrosis. Tuberc Respir Dis. 2001. 50:704–709.

4. Patel A, Kesler B, Wise RA. Persistent pneumomediastinum in interstitial fibrosis associated with rheumatoid arthritis: treatment with high-concentration oxygen. Chest. 2000. 117:1809–1813.

5. Schernthaner G, Scherak O, Kolarz G, Kummer F. Seropositive rheumatoid arthritis associated with decreased diffusion capacity of the lung. Ann Rheum Dis. 1976. 35:258–262.

6. Park CS, Kim JS. Tracheobronchmegaly with multiple diverticula: a case report. J Korean Radiol Soc. 1993. 29:99–103.

7. Celenk C, Celenk P, Selçuk MB, Ozyazici B, Kuru O. Tracheomegaly in association with rheumatoid arthritis. Eur Radiol. 2000. 10:1792–1794.

8. Fraser RG. Measurements of the calibre of human bronchi in three phases of respiration by cinebronchography. J Can Assoc Radiol. 1961. 12:102–112.

9. Griscom NT, Vawter GF, Stigol LC. Radiologic and pathologic abnormalities of the trachea in older patients with cystic fibrosis. AJR Am J Roentgenol. 1987. 148:691–693.

10. Feist JH, Johnson TH, Wilson RJ. Acquired tracheomalacia: etiology and differential diagnosis. Chest. 1975. 68:340–345.

11. Abolnik I, Lossos IS, Breuer R. Spontaneous pneumomediastinum. A report of 25 cases. Chest. 1991. 100:93–95.

12. Miller WE, Spiekerman RE, Hepper NG. Pneumomediastinum resulting from performing Valsalva maneuvers during marihuana smoking. Chest. 1972. 62:233–234.

13. Susan MD. Wolfson AB, Hendery GW, Gregory W, Hendry PL, Linden CH, Rosen CL, editors. Chapter 37. Spontaneous pneumothorax and pneumomediastinum. Harsood-Nuss's clinical practice of emergency medicine. 2005. 4th ed. Baltimore: Lippincott Willams & Wilkins;231–232.

14. Lee CT. Ann CM. Mediastinal disease. Respiratory diseases. 2004. 1st ed. Seoul: Koonja Publishing Inc;685–691.

15. Matsuda Y, Tomii M, Kashiwazaki S. Fatal pneumomediastinum in dermatomyositis without creatine kinase elevation. Intern Med. 1993. 32:643–647.