Tracheobronchial Involvement in Relapsing Polychondritis Diagnosed on Endobronchial Ultrasound

Abstract

Respiratory tract chondritis is not uncommon in patients with relapsing polychondritis (RP); however, diagnosing this condition remains problematic, especially in patients whose extrapulmonary manifestations do not predominate, as there are broad differential diagnoses of airway obstruction. We herein report the case of a 56-year-old man who presented with cough and dyspnea. Computed tomography of the chest demonstrated diffuse smooth thickening of the visualized tracheobronchial wall with a moderately narrowed lumen. Airway chondritis was diagnosed on endobronchial ultrasound following demonstration of thickening of the submucosal and cartilaginous layers in the anterior and lateral aspects of the bronchial wall, while the posterior region expressed less involvement. In conjunction with nasal and auricular chondritis, which were previously overlooked, RP was finally diagnosed.

Ultrasonography of auricular cartilage is a potential tool for diagnosing relapsing polychondritis and monitoring disease activity

“…Although some previous studies reported the clinical implications of imaging tests such as contrast‐enhanced CT, MRI, FDG‐PET/CT and bone scintigraphy for assessment of disease activity, 9–16 performing these imaging tests frequently is unrealistic without careful consideration of cost, convenience, invasiveness and radiation exposure. In tracheal chondritis—one of the fatal complications in RP—it has been reported that endobronchial ultrasonography is useful for monitoring disease activity 30–32 . Swelling of the submucosal and cartilage layer and improvement in swelling is observed when the disease activity is high and low, respectively.…”

“…In tracheal chondritis—one of the fatal complications in RP—it has been reported that endobronchial ultrasonography is useful for monitoring disease activity. 30 , 31 , 32 Swelling of the submucosal and cartilage layer and improvement in swelling is observed when the disease activity is high and low, respectively. In contrast, because bronchoscopy itself is highly invasive and may cause respiratory failure, it is critical for clinicians to be careful about its indication.…”