A 68-yr-old man with invasive thyroid cancer underwent thyroidectomy and tracheal resection. Two days postoperatively, he developed increasing respiratory distress. Examination of his neck showed a subcutaneous air pouch (indicated by arrows), which alternately inflated during expiration (panel A) and deflated during inspiration (panel B).

Tracheocele describes an air pocket in the neck that communicates with the tracheal lumen. Although it may be congenital, it most commonly results from surgeries involving the trachea such as tracheostomy, tracheal resection, and tracheocutaneous fistula repair.

Anatomically, this unusual breathing pattern occurs because rigid tracheal rings hold patent a tracheal defect throughout the respiratory cycle that allows both the exit and the re-entry of expired air to the trachea. Physiologically, the subcutaneous reservoir increases work of breathing by adding significant dead space, eventually leading to hypercapnia, hypoxemia, and...

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