Imaging of trichoptysis - how a radiologist can help?

Trichoptysis is a rare symptom, but pathognomonic of a teratoma having a bronchial communication. Thoracic teratomas are usually located within the anterior mediastinum, but rarely present with trichoptysis, as transpleural erosion of a mediastinal teratoma into lung and hence bronchial tree is exceedingly rare. We report the characteristic radiological and clinical features in one such case with ruptured mature mediastinal teratoma having a bronchial communication leading to trichoptysis. Only nine cases of trichoptysis have been reported in the literature as yet, but a fistulous communication with the bronchial tree on computed tomography, as seen in the present report, has not been demonstrated in any of these preceding reports. Histopathological sample obtained during the surgery further confirmed the presence of a mediastinal teratoma with transpleural broncho-pulmonary communication.