Tracheobronchopathia Osteochondroplastica: A Case Report Illustrating the Importance of Multilevel Workup Clinical, Endoscopic and Histological Assessment in Diagnosis of an Uncommon Disease

Abstract

Patient: Male, 62Final Diagnosis: Tracheobronchopathia osteochondroplasticaSymptoms: CoughMedication: —Clinical Procedure: —Specialty: PulmonologyObjective:Rare diseaseBackground:Tracheobronchopathia osteochondroplastica (TO) is a rare idiopathic disease with a stable course, which involves the lumen of the tracheobronchial tree. Clinical manifestations at time of presentation may differ, typically including hoarseness, persistent and/or productive cough, hemoptyses, and dyspnea. There are no well-established guidelines for diagnostic workup and treatment. Our aim here is to present a paradigmatic case of TO together with a concise survey of the most important clinical, radiological, and histological criteria.Case Report:We report a case of a 62-year-old non-smoker male with persisting cough and no prior history of respiratory disease. Chest radiography (RX) and computed tomography (CT) were unremarkable. Given the persistence of symptoms, the patient underwent bronchoscopic examination, which revealed protruding sessile nodules into the tracheal lumen, with cobblestone appearance. Histopathological examination of biopsies taken during bronchoscopy showed cartilaginous and osseous submucosal nodules consistent with the diagnosis of TO.Conclusions:TO is not always an easily recognized disease, and a multidisciplinary team work is often required for diagnosis, with particular importance of endoscopic-pathological correlation.

Rare Manifestation of Idiopathic Tracheobronchopathia Osteochondroplastica: Misdiagnosed and Untreated Entity?

“…TBPO is an idiopathic, rare, benign pulmonary condition with an incidence of 0.01 to 4.2 per 100,000 people [1]. It was first described in 1857 and was observed in an autopsy of a patient with pulmonary tuberculosis [2]. In TPBO, there are numerous osseous or cartilaginous submucosal nodules in the trachea and the main bronchus as implied by the name.…”

“…It usually occurs in men in their fifth decade and cause airway obstruction, bleeding and chronic cough, and patients are more prone to post-obstructive pneumonia and chronic lung infection in some instances. Nodules causing this condition are formed due to deposition of calcium phosphate [2]. Most patients are asymptomatic and are diagnosed incidentally.…”

Tracheobronchopathia Osteochondroplastica—Clinical, Radiological, and Endoscopic Correlation: Case Series and Literature Review

“…Furthermore, physical examination was unremarkable in 64% of the patients, similarly to that reported in the literature. 4,6…”

“…A diagnostic algorithm should include chest computed tomography (CT) scan and bronchoscopy. 4,6 Many thoracic images are not well acquainted with TO; therefore, these patients are misdiagnosed. We believe that a better understanding of the disease and improvement in recognition of its signs will lead to an early and adequate diagnosis.…”

Multi-nodule of large airway: tracheobronchopathia osteochondroplastica

“…Tracheobronchopathia osteochondroplastica (TO) is a rare benign disease with a stable or indolent course, which is characterized by the formation of multiple cartilaginous or osseous submucosal nodules that originate from the cartilaginous rings of the airway projecting into the tracheobronchial lumen, spare the posterior membranous wall, causing hoarseness, persistent and/or productive cough, hemoptyses, dyspnea and some other symptoms (1).…”