A case of tracheobronchopathia ostochondorplastica

Key message

Tracheobronchopathia osteochondroplastica (TO) is a disorder caused by the accumulation of calcium phosphate in the submucosa of large airways. Benign proliferation of bone and cartilage lead to the narrowing of airways. Bronchoscopy is the diagnostic test for TO. It shows characteristic smooth nodules emerging from tracheal rings that never involves the posterior membranous wall.

We present an interesting case of a 55 year old man who presented with history of weight loss, cough and right sided chest pain. CT showed right upper lobe cavity. He was evaluated with possibility of TB, malignancy or vasculitis. Fibreoptic bronchoscopy was done that showed a ‘stony cave’ trachea. Histopathology confirmed the diagnosis to be ‘Tracheobronchopathia osteochondroplastica (TO)’. He was treated with antibiotics for his infection with total resolution of chest sahdows. He is managed conservatively for his TO.

A man in his 50s, presented with a 2‐year history of chronic cough with scanty expectoration and 5 kg weight loss over the previous 6 months. He denied any history of evening rise of temperature, fever, haemoptysis, chest pain, rash, joint pains or oral ulcers. He had been diagnosed with diabetes mellitus type II for the last 5 years but denied a history of tuberculosis, hypertension, pneumonia or asthma.

CT scan showed a 37 × 29 mm focus of consolidation in the posterior segment of the right upper lobe with areas of breakdown and fluid level with few enlarged right hilar and mediastinal lymph nodes. There were diffuse submucosal calcified nodules protruding from the anterolateral portion of the trachea with a lack of involvement of the posterior membranous portion of the trachea (Figure 1).

FIGURE 1.

(A) Computed tomography scan coronal section showing calcification of trachea (arrow) with right upper lobe cavity. (B) Bronchoscopy image showing speculated nodules arising from anterior and lateral wall of trachea with relative sparing of posterior membranous wall of trachea. (arrow). (C) Bronchoscopy showing nodules on lateral wall of trachea (arrow). (D): Image showing relative sparing of bronchial tree beyond carina.

Fiberoptic bronchoscopy showed numerous protruding nodules, which resembled icicles with intact mucosa along the entire trachea except the post‐membranous wall (Figure 1). Biopsy of the nodules showed lymphoplasmacytic infiltration of sub‐epithelium and foci of cartilage with nodular ossified tissue without any evidence of amyloidosis, granulomatous inflammation or malignancy (Figure 2).

FIGURE 2.

(A) (H & E 100×) sub epithelium showing foci of cartilage with nodular ossified tissue and lympho‐plasmacytic infiltration. (B) (H&E: 400×): sub epithelium showing foci of cartilage with nodular ossified tissue and lympho‐plasmacytic infiltration.

The final diagnosis of Tracheobronchopathia osteochondroplastica was thus made. ¹

The lung infection was due to uncontrolled diabetes and improved with antibiotics and tight glycaemic control with near total resolution of the abscess as shown in the repeat chest radiograph (Figure 3).

FIGURE 3.

(A) Chest radiograph showing right middle zone cavity with fluid level and surrounding consolidation. (B) Post‐treatment chest radiograph showing remnant fibrotic bands with near total resolution of the previous cavity.

CONFLICT OF INTEREST STATEMENT

None declared.

ETHICS STATEMENT

The authors declare that appropriate written informed consent was obtained for the publication of this manuscript and accompanying images.

Mehta AA, Ashok A, Haridas N, Kunoor A, Yesodharan J. A case of tracheobronchopathia ostochondorplastica. Respirology Case Reports. 2023;11:e01189. 10.1002/rcr2.1189

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.