Tracheobronchopathia osteochondroplastica: awareness is the key for diagnosis and management

Abstract

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.

Clinical Characteristics of Tracheobronchopathia Osteochondroplastica

“…18 In contrast to TO, relapsing polychondritis, another condition with a potentially similar radiological picture, presents with thickened and deformed cartilage, without intraluminal nodules. 21 Although positive finding of CT scan in our study was 87.5% (28/32), TO is easy to missed in diagnosis by radiologists. Bronchoscopy is the most common and definitive diagnostic test for this condition.…”

“…Sarcoidosis, amyloidosis, and papillomatosis could have a similar endoscopic appearance, but none of these selectively spare the posterior membranous wall. 21 In some cases, howeer, biopsy is needed to distinguish between TO, tracheobronchial amyloidosis, and tuberculosis. Pathological examination of TO will show ossification and calcification.…”

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

“…CT is usually the best non-invasive method for evaluation of tracheobronchial lesions [21]. Findings on CT scans usually show calcified nodular densities protruding into the tracheal lumen, with an abnormally irregular tracheal morphology and decreased lateral diameter [7,22]. In our case, initial imaging investigations did not indicate diagnosis of the disease, and subtle alterations in general imaging were considered within normal limits, as sometimes reported [4,19]; therefore, bronchoscopic examination was necessary.…”

“…Diagnosis of TO is made on the basis of endoscopy, CT scan, and histopathology, highlighting the need for a multidisciplinary approach [3,10,22,25]. There is no consensus for treatment of this rare disease, and most therapies are palliative, focusing on the symptoms.…”

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

“…2 TO presents multiple submucosal cartilaginous and osseous tracheobronchial nodules in the anterior and lateral walls, over the cartilaginous rings, preserving the posterior membranous wall. 2-4 Although its etiology has not been elucidated, TO might be associated with cartilaginous outgrowth with latter ossification, elastic tissue metaplasia, atrophic rhinitis, pulmonary infections, amyloidosis, lung cancer, among others. 1,5 No relationship has been established between TO and calcium or phosphorus metabolism.…”