A 38-year-old man with tracheomegaly, tracheal diverticulosis, and bronchiectasis.

A 38-year-old man was referred to our University Hospital for evaluation of chronic cough with sputum production. During the last 15 years, he had experienced an increased expectoration of mucoid sputum that became purulent during infectious exacerbations, sometimes with bloody sputum. He denied fever, wheezes, chest pain, dyspnea, or weight loss. No other respiratory illness was present. His parents and siblings were normal. He works as a security officer. He has never smoked and denies regular alcohol intake. Physical examination revealed a thin but well-nourished patient. Vital signs were normal. Clinical respiratory examination disclosed decreased breath sounds over both lungs and inspiratory crackles at the lower third of both lung fields. Finger clubbing was present. The results of blood analysis were within normal limits. A chest radiograph and helical CT scan (Fig 1, 2) were performed, showing tracheomegaly with transversal diameters of the trachea and right-main bronchus of 36 mm and 26 mm, respectively. Many diverticular outpouchings were present from the trachea to the main bronchi. There was also cystic bronchiectasis involving both lower lobes (Fig 3). A bronchoscopy was performed and disclosed several openings in the posterior and lateral wall of trachea and main bronchus; some of the openings could be easily penetrated by the tip of bronchoscope. In these openings, we could identify a collection of great amounts of secretion. The rest of the examination was normal. Sputum and tracheal aspirate results were negative for mycobacteria.