Tracheobronchopathia osteochondroplastica and difficult intubation: case report and perioperative recommendations for anesthesiologists

Warner, Matthew A.; Chestnut, D.H.; Thompson, Gregory P.; Bottcher, Michael; Tobert, Daren G.; Nofftz, Mary

doi:10.1016/j.jclinane.2013.05.010

Cited by 21 publications

(11 citation statements)

References 10 publications

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“…They should be warned about the risk of respiratory failure during an episode of superadded airway infection, which is due to further narrowing of the lumen 20. Affected individuals are also at a risk of difficult intubation during any elective surgery 10. If such a need arises, patients should be able to discuss the diagnosis with concerned anaesthesiologists to avoid unanticipated complicated airway.…”

Section: Discussionmentioning

confidence: 99%

Tracheobronchopathia osteochondroplastica: awareness is the key for diagnosis and management

Devaraja¹,

Sagar

Chirom

2017

BMJ Case Reports

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Tracheobronchopathia osteochondroplastica is a rare airway disease of unknown aetiology. Due to overlapping symptomology and lack of awareness, the condition is often missed resulting in unnecessary medical or surgical treatment. A male patient presented with a long-standing history of hoarseness and had earlier received treatment for bronchial asthma and tuberculosis. On evaluation, he had typical submucosal calcified nodules distributed throughout the trachea sparing the posterior membranous part. Although the biopsy confirmed the diagnosis of tracheobronchopathia osteochondroplastica in our case, histopathological examination is not always needed to make this diagnosis. Our patient has been kept under conservative management and is having non-progression of disease at 1-year follow-up. After having reviewed the literature related to pathophysiology and management of tracheobronchopathia osteochondroplastica, we emphasise on the fact that the treating physicians' awareness about this condition is the key to its diagnosis and management.

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Section: Discussionmentioning

confidence: 99%

Tracheobronchopathia osteochondroplastica: awareness is the key for diagnosis and management

Devaraja¹,

Sagar

Chirom

2017

BMJ Case Reports

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“…Specifically, TO was found to develop: (1) 22 cases in trachea [3–5, 16, 18–20], (2) 2 cases where nodules were located from the first tracheal ring to the proximal main stem bronchi [17], (3) 22 cases in trachea and both main stem bronchi [2, 6, 11, 16, 19, 20], (4) 8 cases in trachea and main stem bronchus [3], without determining the number of the right and/or the left main stem bronchi, (5) 2 cases in trachea and left main stem bronchus [2, 20], (6) 1 case in trachea and left lingular bronchus [20], (7) 2 cases in trachea and right main stem bronchus [20], (8) 1 case in trachea and right intermedius bronchus [20], (9) 1 case in RUL bronchus [7], and (10) 1 case in right subsegmental B3b bronchus [8]. …”

Section: Discussionmentioning

confidence: 99%

“…Particular attention should be paid by anesthesiologists as difficult intubation can occur [6] in the presence of TO. For patient's safety, the endotracheal tube should be of appropriate size taking into account airway dimensions by means of preoperative imaging and/or bronchoscopy [6].…”

Section: Discussionmentioning

confidence: 99%

“…For patient's safety, the endotracheal tube should be of appropriate size taking into account airway dimensions by means of preoperative imaging and/or bronchoscopy [6]. Within the context of medical treatment for TO, radiologists, pulmonologists, and general physicians should be experienced with imaging techniques such as Computed Tomography (CT) and findings of bronchoscopy, for making prompt diagnosis and treatment in order to differentiate TO from other entities [2].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical presentation is variable, ranging from complete lack of symptoms to cough, hemoptysis, breathlessness, or recurrent chest infections [3]. It can more rarely cause tracheal stenosis resulting in difficult intubation of the patient [4–6]. Few isolated cases of a single solitary nodule amenable to cartilaginous protrusion of the same pathology as in TO have been reported in lobar [7] or subsegmental [8] bronchi, being causes of atelectasis or pneumonia.…”

Section: Introductionmentioning

confidence: 99%

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

Michaelides

Bablekos

Ionas

et al. 2015

Case Reports in Medicine

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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.

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Tracheobronchopathia osteochondroplastica: a rare cause of tracheal tube cuff leak

Morax

Breitenmoser

Konrad

2023

Anaesthesia Reports

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SummaryWe present the case of a patient with the rare disorder tracheobronchopathia osteochondroplastica who underwent laparoscopic cholecystectomy. After induction of general anaesthesia, we faced difficulties passing the tracheal tube beyond the vocal cords despite bronchoscopic assistance. With a smaller tube, and by using rotating movements, we managed to successfully intubate the trachea. Because of the irregular tracheal surface, however, ventilation was challenging due to a massive cuff leak. Repeated repositioning did not improve this leak. Only cuff overinflation led to adequate ventilation, though we were cognisant of the increased risk of tracheal wall injury with this approach. After completion of the surgery, the patient's trachea was extubated without complication. This case showed that even with good preparation, intra‐operative problems can occur with abnormal subglottic airway anatomy. In some circumstances, these problems can only be solved by compromise. There are no professional consensus or guidelines that can be followed as guiding references for such a case, which can lead to indecisiveness.

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Tracheobronchopathia osteochondroplastica and difficult intubation: case report and perioperative recommendations for anesthesiologists

Cited by 21 publications

References 10 publications

Tracheobronchopathia osteochondroplastica: awareness is the key for diagnosis and management

Tracheobronchopathia osteochondroplastica: awareness is the key for diagnosis and management

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

Tracheobronchopathia osteochondroplastica: a rare cause of tracheal tube cuff leak

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