Swellings of the Tracheal Region

The trachea begins at the lower edge of the cricoid cartilage of the larynx at the level of sixth cervical vertebra (C6) and ends at the carina, the point where the trachea branches into left and right main bronchi, at the level of the fourth thoracic vertebra (T4). This chapter discusses the pathology, etiology, clinical presentation, complications, investigations (workup), diagnosis, differential diagnosis, management, and prognosis of midline neck swellings that may occur in the tracheal region, namely pre-tracheal lymph nodes (tuberculous—metastatic), tracheal adenoid cystic carcinoma, solid nodules in the isthmus of the thyroid gland (benign—malignant), as well as cystic and partially cystic nodules in the isthmus of the thyroid gland. This chapter also addresses staging of malignant nodules and discusses in detail papillary thyroid carcinoma of the isthmus. It also discusses the recent updates of nonsurgical treatment of isthmic cysts including aspiration, percutaneous ethanol ablation, percutaneous polidocanol aspiration, and thermal ablation (radio-frequency ablation—laser ablation).