Congenital anterior tracheal diverticulum with cartilaginous wall calcifications identified on CT: a case report

Anterior congenital tracheal diverticula are rare developmental anomalies of the trachea that differ from the more common acquired tracheal diverticula, which typically arise from the posterolateral membranous wall of the trachea. This article describes an exceptionally rare anterior congenital tracheal diverticulum with wall calcifications identified on computed tomography (CT) and highlights the imaging features supporting its congenital origin. A 71-year-old Middle Eastern man underwent CT imaging of the chest as part of routine clinical evaluation. CT demonstrated a 2.5-cm blind-ending, air-filled diverticulum arising from the anterior wall of the distal trachea superior to the carina. The diverticulum contained focal wall calcifications suggestive of cartilaginous components. The finding was discovered incidentally, and the patient had no symptoms attributable to the diverticulum. The diverticulum arose from the anterior wall of the distal trachea and demonstrated cartilaginous wall components, with the presence of cartilage supporting a congenital rather than acquired lesion. Congenital tracheal diverticula are thought to result from abnormal embryologic development and are far less common than acquired diverticula, making recognition of their characteristic imaging appearance important. To our knowledge, no prior CT-reported case of an anterior tracheal diverticulum with cartilaginous wall calcifications has been described in the literature. Recognition of the characteristic CT appearance of anterior congenital tracheal diverticula may help differentiate these lesions from other causes of paratracheal air collections. Familiarity with this rare entity enables radiologists to confidently recognize its benign congenital nature and appropriately guide patient management.