Right Upper Lobe Shadow and Tracheobronchopathia Osteochondroplastica Confined to Right Main Bronchus: A Case Report and Literature Review

Abstract

Tracheobronchopathia osteochondroplastica (TO) is a well documented benign entity of endoscopic interest. We describe a case of 76-year-old patient who presented with fever, cough, purulent sputum during the past four days, and presence of an ovoid shadow in right upper zone of his chest X-ray. Medical history included diagnosis of colon diverticuli identified by colonoscopy 3 months ago. Chest CT revealed a compact elongated lesion containing air-bronchogram stripes. Bronchoscopy showed normal upper airways and trachea but presence of unequal sized mucosal nodules, protruding into the lumen, along the entire length of the right main bronchial mucosa. No other abnormal findings were detected. Moreover, brushing and washing smears from the apical segment of right upper lobe (RUL), where the compact lesion was located, were negative for malignancy. Biopsy from the mucosal nodules of right main bronchus showed presence of cartilaginous tissue in continuity through thin pedicles with submucosal cartilage. This finding posed the diagnosis of TO while RUL lesion was cleared by antibiotic treatment. Case is reported because, to our knowledge, it represents a unique anatomic location of TO which was confined exclusively in the right main bronchus mucosa without affecting trachea.

Tracheobronchopathia Osteochondroplastica—A 61-Year-Old Female with Middle Lobe Syndrome

“…It is believed that it may be associated with chronic inflammation in the airways, e.g. long-lasting infections, injury, silicosis, amyloidosis, allergic bronchopulmonary aspergillosis, asthma or ozaena [8]. Existing theories assume that the initial changes are chondromas, which subsequently ossify; alternatively, ossification of the connective tissue of bronchial mucosa occurs.…”

“…Existing theories assume that the initial changes are chondromas, which subsequently ossify; alternatively, ossification of the connective tissue of bronchial mucosa occurs. Lesion development is connected with the bone morphogenetic protein-2 (BMP-2) and transforming growth factor B1 (TGF-B1) [8,9].…”

Tracheobronchopatia osteochondroplastyczna u 61-letniej kobiety z zespołem płata środkowego

“…Przyczyna schorzenia nadal nie jest wyjaśniona. Uważa się, że może być ono związane z przewlekłym zapaleniem dróg oddechowych, na przykład długotrwałymi zakażeniami, urazem, pylicą płuc, skrobiawicą (amyloidosis), alergiczną aspergilozą oskrzelowo-płucną [8]. Obecne teorie zakładają, że pierwsze zmiany mają postać chrzęstniaka, który następnie kostnieje, lub że dochodzi do kostnienia tkanki łącznej błony śluzowej oskrzeli.…”

“…Obecne teorie zakładają, że pierwsze zmiany mają postać chrzęstniaka, który następnie kostnieje, lub że dochodzi do kostnienia tkanki łącznej błony śluzowej oskrzeli. Rozwój zmian jest związany z morfogenetycznym białkiem kości-2 (BMP-2, bone morphogenetic protein) i transformującym czynnikiem wzrostu b1 (TGF-b1, transforming growth factor) [8,9].…”

Building and validating an artificial intelligence model to identify tracheobronchopathia osteochondroplastica by using bronchoscopic images

“… 3 Although TO is rare, there have been many reports in which it was occasionally diagnosed. 1 , 4 – 27 To date, only a limited number of studies have utilized extensive data to conduct a comprehensive investigation of this disease. 3 , 28 …”