The hidden pouch: Anesthetic challenges in tracheal diverticula management – A case report

Tracheal diverticula are uncommon anatomical anomalies characterized by air-filled outpouchings of the tracheal wall. While typically asymptomatic and incidentally discovered, tracheal diverticula can pose significant challenges in airway management during anesthesia.

We present the case of a 58-year-old female scheduled for microsurgical resection of meningioma. Preoperative imaging revealed a sizable tracheal diverticulum on the posterior tracheal wall, measuring 65 by 26 mm. An awake fiberoptic intubation approach was regarded as the safest approach for airway management. Several anatomical anomalies were identified during flexible bronchoscopy, including tracheomalacia and vascular malformations. Despite these challenges, successful intubation and anesthesia management were achieved without complications.

This case highlights the importance of thorough preoperative evaluation and careful planning in patients with tracheal diverticula, in order to prevent a crisis from difficult intubation, difficult ventilation or even rupture of the diverticulum.