AIM:　Tracheal　diverticulum,　an　air-filled　sac　typically　located　on　the　right　posterolateral　aspect　of　the　trachea,　has　an　unclear　etiology.　This　study　evaluates　the　clinical　management　and　outcomes　of　incidentally　detected　tracheal　diverticula　in　patients　with　papillary　thyroid　carcinoma,　emphasizing　the　need　for　preoperative　diagnosis　and　selective　treatment.　CASE　PRESENTATION:　Within　our　multi-center　thyroid　surgery　cohort,　seven　cases　of　tracheal　diverticula　were　incidentally　discovered　during　thyroidectomy,　with　preoperative　diagnosis　achieved　in　only　a　subset　of　patients.　Some　tracheal　diverticula　were　surgically　excised,　allowing　for　histopathological　examination,　whereas　others　were　left　in　situ.　All　patients　recovered　without　postoperative　complications.　RESULTS:　Histopathological　examination　of　the　resected　tracheal　diverticula　confirmed　benign　pathology.　All　patients,　including　those　with　untreated　tracheal　diverticula,　remained　asymptomatic　during　follow-up,　with　no　tracheal　abnormalities　or　complications　observed.　High-resolution　computed　tomography　and　three-dimensional　reconstruction　technology　proved　effective　for　the　preoperative　diagnosis　of　tracheal　diverticulum.　CONCLUSIONS:　Routine　surgical　treatment　is　unnecessary　for　asymptomatic　patients,　with　resection　of　tracheal　diverticulum　reserved　for　symptomatic　cases.　Diagnostic　approaches　such　as　high-resolution　computed　tomography　and　three-dimensional　reconstruction　serve　as　essential　preoperative　assessments　before　thyroidectomy,　enabling　accurate　diagnosis　of　tracheal　diverticulum.