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Al Omari A, Al-Qarqaz W, Khresat M, Sataloff RT. Tracheobronchopathia osteochondroplastica in the setting of COVID-19. EAR, NOSE & THROAT JOURNAL 2024; 103:98S-101S. [PMID: 35324341 PMCID: PMC8960750 DOI: 10.1177/01455613221083822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tracheobronchopathia osteoplastica (TO) is a rare, benign disease of unknown etiology, primarily affecting the major tracheobronchial tree, characterized by irregular nodular calcifications of the cartilaginous component of the inner wall of the tracheobronchial tree while sparing the posterior wall, leading to progressive narrowing of the airway. We report the case of a 60-year-old male otherwise healthy nonsmoker, who complained of chronic breathing discomfort and recurrent chest infections and was found to have TO according to radiographic, microlaryngoscopic, and biopsy findings. He experienced a flare up with worsening of disease progression after years of being in stable condition, after his infection with SARS-CoV-2.
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Affiliation(s)
- Ahmad Al Omari
- Department of Special Surgery,
Jordan
University of Science and Technology,
Irbid, Jordan
- Department of Otolaryngology - Head
and Neck Surgery, Drexel University College of
Medicine, Philadelphia, PA, USA
| | - Wisam Al-Qarqaz
- Department of Special Surgery,
Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammd Khresat
- Department of Special Surgery,
Jordan University of Science and Technology, Irbid, Jordan
| | - Robert T. Sataloff
- Department of Otolaryngology - Head
and Neck Surgery, Drexel University College of
Medicine, Philadelphia, PA, USA
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2
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Jiang H, Yang X, Guo Y. Multi-Nodule of Large Airway: Tracheobronchopathia Osteochondroplastica, Two Cases Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2024; 103:NP226-NP228. [PMID: 34636258 DOI: 10.1177/01455613211051662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report two subjects with tracheobronchopathia osteochondroplastica (TO), including the clinical manifestations, histological findings, and clinical treatments, which were analyzed retrospectively. One patient with TO was a 60-year-old woman, and the other was a 47-year-old man. The main clinical manifestations were cough, chest pain, and dyspnea. Computed tomography (CT) images showed that TO mainly occurred in the trachea and main bronchus. Histological analysis showed inflammatory exudation, squamous metaplasia, submucosal cartilaginous, and ossification. We present the two cases to increase physician and patient awareness of this benign disease and to improve their understanding of the disease manifestations and potential complications.
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Affiliation(s)
- He Jiang
- Department of Pathology, Xi'an Daxing Hospital, Xi'an, China
| | - Xiaoying Yang
- Department of Department of Respiratory and Critical Care Medicine, Xi'an Daxing Hospital, Xi'an, China
| | - Ying Guo
- Department of Pathology, Xi'an Daxing Hospital, Xi'an, China
- Key Laboratory of Resource Biology and Biotechnology in Western China, Ministry of Education, School of Medicine, Northwest University, Xi'an, China
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3
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Hu C, Su P, Huang L, Lee C, Huang T. Tracheopathia osteochondroplastica-A benign disorder with a daunting appearance. Respirol Case Rep 2024; 12:e01306. [PMID: 38379820 PMCID: PMC10878827 DOI: 10.1002/rcr2.1306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
Tracheopathia osteochondroplastica (TO) is a rare and benign condition. It typically manifests as multiple osteocartilaginous nodules in the submucosa of the central airway. TO-related clinical symptoms and physical signs are nonspecific. The bronchoscopic examination is helpful in establishing the diagnosis. Treatment for TO is mostly conservative and symptom-oriented. The prognosis of TO is generally good, although cases of associated airway stenosis have been reported. In this case report, we describe the clinical, imaging, and histological features, and videoed bronchoscopic findings, of a middle-aged male patient with incidentally diagnosed TO.
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Affiliation(s)
- Chia‐Hao Hu
- Division of Chest Medicine, Department of Internal MedicineNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainanTaiwan
| | - Po‐Lan Su
- Division of Chest Medicine, Department of Internal MedicineNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainanTaiwan
| | - Li‐Ting Huang
- Department of Diagnostic RadiologyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainanTaiwan
| | - Chung‐Ta Lee
- Department of PathologyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainanTaiwan
| | - Tang‐Hsiu Huang
- Division of Chest Medicine, Department of Internal MedicineNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainanTaiwan
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4
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Rodriguez NJV, Manto JT, Sydiongco-Inocencio PMM, Dela Cruz JMG, Ilustre GMS, Dela Cruz APC. Tracheobronchopathia osteochondroplastica: a case report highlighting the importance of clinico-radiologic correlation. BJR Case Rep 2023; 9:20230062. [PMID: 37928711 PMCID: PMC10621586 DOI: 10.1259/bjrcr.20230062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/02/2023] [Accepted: 09/18/2023] [Indexed: 11/07/2023] Open
Abstract
Tracheobronchopathia osteochondroplastica (TBPO) is a rare and benign idiopathic disease of the tracheobronchial tree, characterized by osseous, and/or cartilaginous submucosal nodules involving the anterior and lateral walls of the airways with sparing of the posterior wall. We present a case of a 51-year-old non-smoker female, presenting with a 2-year history of gradually enlarging anterior neck mass with foreign body sensation, frequent throat clearing, and occasional hoarseness. She was initially diagnosed with recurrent respiratory papillomatosis due to the presence of nodules on flexible laryngoscopy. A plain neck and chest CT then showed irregularity of the tracheal walls with calcified nodules projecting into the lumen, sparing the posterior wall, consistent with TBPO. Fiberoptic bronchoscopy with biopsy was also done which confirmed the inferior extent of the nodules down to the level of the carina, and the presence of fragments of mature bone tissue within the nodules.
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Affiliation(s)
- Naomi Jillan V. Rodriguez
- Department of Radiology, University of the Philippines–Philippine General Hospital, Manila, Philippines
| | - Jeffrey T. Manto
- Department of Radiology, University of the Philippines–Philippine General Hospital, Manila, Philippines
| | | | - Janine Marriah G. Dela Cruz
- Department of Otolaryngology-Head and Neck Surgery, University of the Philippines–Philippine General Hospital, Manila, Philippines
| | - Gabriel Martin S. Ilustre
- Department of Otolaryngology-Head and Neck Surgery, University of the Philippines–Philippine General Hospital, Manila, Philippines
| | - Anna Pamela C. Dela Cruz
- Department of Otolaryngology-Head and Neck Surgery, University of the Philippines–Philippine General Hospital, Manila, Philippines
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5
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Liu Q, Hu Y, Lei M, Mei C, Yang C. Clinical Characteristics of Tracheobronchopathia Osteochondroplastica: A Retrospective Study of 33 Patients. Int J Gen Med 2023; 16:3447-3455. [PMID: 37601808 PMCID: PMC10438451 DOI: 10.2147/ijgm.s418394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Tracheobronchopathia osteochondroplastica (TO) is a relatively rare benign tracheobronchial disease, which is often misdiagnosed or missed. To date, there is no specific treatment for TO. The aim of this study was to investigate the clinical manifestations, imaging features, bronchoscopy results, pathological findings, and diagnostic points of TO. Patients and methods A total of 33 patients diagnosed with TO were enrolled. Clinical data were collected using retrospective methods in the period from January 2021 and November 2022. Descriptive analysis was used. Results Patients included 17 (51.5%) male and 16 (48.5%) female, with a median age of 54 years. The main clinical manifestations included cough in 15 cases, fever in 6 cases, chest tightness in 4 cases, haemoptysis in 3 cases, and chest pain in 4 cases. The time from the onset of symptoms to diagnosis was 1 week to 96 months. Some patients were diagnosed with other lung diseases, including 16 patients with tuberculosis, 2 patients with lung cancer, 3 patients with nontuberculous mycobacteriosis, 3 patients with tuberculous pleurisy, 2 patients with bronchiectasis, and 1 patient with pneumonia. Chest computed tomography (CT) scan demonstrated calcified nodules in 10 (30.3%) patients. In bronchoscopy, entire tracheal involvement was found in 21 (63.6%) patients, 12 (36.4%) patients were found to have involvement of only part of the trachea. The patients were divided into three groups according to the bronchoscopic presentation, the largest proportion was stage II (19/33), followed by stage I (8/33) and stage III (6/33). Histopathological findings showed squamous metaplasia, cartilaginous, and bony tissues. Conclusion TO is a slowly progressing disease with non-specific clinical symptoms and a low positive rate of imaging diagnosis, making it susceptible to misdiagnosis and missed diagnosis. The disease needs to be diagnosed by combining imaging features, fiberoptic bronchoscopy, and pathological findings.
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Affiliation(s)
- Qiliang Liu
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, Hubei, 430030, People’s Republic of China
| | - Yan Hu
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, Hubei, 430030, People’s Republic of China
| | - Mei Lei
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, Hubei, 430030, People’s Republic of China
| | - Chunlin Mei
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, Hubei, 430030, People’s Republic of China
| | - Chengqing Yang
- Wuhan Pulmonary Hospital, Wuhan Institute for Tuberculosis Control, Wuhan, Hubei, 430030, People’s Republic of China
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Dall'Amico GF, Sharma D, Ritchie L, Sandhu G. Severe tracheobronchopathia osteochondroplastica in an asymptomatic patient. BMJ Case Rep 2023; 16:e249976. [PMID: 37055074 PMCID: PMC10105992 DOI: 10.1136/bcr-2022-249976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
Tracheobronchopathia osteochondroplastica (TO) is a rare condition affecting the lumen of the tracheobronchial tree. It is characterised by the presence of multiple osseous and cartilaginous nodules with posterior wall sparing. While it is a benign condition, it can cause narrowing of the tracheal lumen and subglottis to varying degrees. Approximately 400 cases have been reported worldwide, with an incidence of 0.3% in autopsies and between 1 in 125 and 1 in 5000 on bronchoscopy. As most patients are asymptomatic, this may contribute to underdiagnoses and relative low incidence. Severity of the condition is often unrelated to patient symptomatology. We present a patient with one of the most severe cases of TO seen at our institution. Despite being asymptomatic, significant tracheal and bronchial narrowing was found incidentally on laryngobronchoscopy.
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Affiliation(s)
| | - Dave Sharma
- ENT Department, Imperial College Healthcare NHS Trust, London, UK
| | - Lulu Ritchie
- ENT Department, Imperial College Healthcare NHS Trust, London, UK
| | - Guri Sandhu
- National Centre for Airway Reconstruction, Imperial College London, London, UK
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7
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Saxena P, Singh S, Verma R, Sharma N, Kumar K, Singh V. Tracheobronchopathia osteochondroplastica as an unusual cause of chronic cough. Med J Armed Forces India 2023. [DOI: 10.1016/j.mjafi.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
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Abali H. A rare case of rapidly progressive Tracheobronchopathia Osteochondroplastica. Respir Med Case Rep 2023; 43:101853. [PMID: 37124055 PMCID: PMC10131121 DOI: 10.1016/j.rmcr.2023.101853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/02/2023] Open
Abstract
Tracheobronchopathia Osteochondroplastica (TO) is a rare benign disorder that is seldom progressive. Here, we report a case diagnosed with TO in our hospital. Bronchoscopy revealed multiple cartilaginous and ossifying nodules that are diagnostic for TO. Nodules protruding into the airways were observed as widespread and extended by the repeat bronchoscopy after 2 months of the diagnosis. TO was confirmed with the histopathology of the biopsies from nodules. Then he was referred to an interventional pulmonologist for laser ablation.
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Affiliation(s)
- Hulya Abali
- Kazlıcesme, 34020, Zeytinburnu, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
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9
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Patel PM, Jean ME, Reich K, Kaveeshwar O, Patel SP. Tracheobronchopathia Osteochondroplastica: A Rare, Underrecognized Entity. Cureus 2022; 14:e28832. [PMID: 36225397 PMCID: PMC9535971 DOI: 10.7759/cureus.28832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 02/05/2023] Open
Abstract
Tracheobronchopathia Osteochondroplastica (TO) is an extremely rare condition characterized by the presence of nodules made of bone and cartilage within the submucosa of the tracheobronchial wall. These protuberant nodules inside the trachea and bronchi can lead to airway obstruction, resulting in patients who experience recurrent respiratory systems and infections. The exact etiology is unknown. The mean age of diagnosis is in the 5th - 6th decades of life. TO is often confused with other diagnoses, especially asthma. We report a 41-year-old female who presented with intermittent exertional dyspnea for 10 years. Workups, including pulmonary function test, CT chest, and most importantly, flexible bronchoscopy, aided in the appropriate diagnosis. The unique feature observed during bronchoscopy is the sparing of the posterior wall of the trachea and bronchi.
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Affiliation(s)
- Paras M Patel
- Interventional Pulmonology, John Peter Smith Hospital / TCU and UNTHSC School of Medicine, Fort Worth, USA
| | - Mallory E Jean
- Medical School, School of Health Sciences, John Hopkins University, Baltimore, USA
| | - Kenzie Reich
- Interventional Pulmonology, John Peter Smith Hospital, Fort Worth, USA
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10
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Tracheobronchopathy Osteochondroplasty Arising with Hemoptysis. Ann Thorac Surg 2022; 114:e155. [PMID: 35247346 DOI: 10.1016/j.athoracsur.2022.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/23/2022]
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11
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OLIVEIRA TM, GUEDES FT. Tracheobronchopathia osteochondroplastica: distinct clinical presentations, the same bronchoscopic diagnosis. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2022. [DOI: 10.23736/s0393-3660.19.04285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Datta A, Ghosh S, Mohapatra PR. A rare case of hemoptysis. Lung India 2022; 39:80-81. [PMID: 34975059 PMCID: PMC8926216 DOI: 10.4103/lungindia.lungindia_358_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 39-year-old nonsmoker male presented with complaints of cough with recurrent mild hemoptysis. Computed tomography of thorax showed nodular lesions on the right lateral wall of trachea. Fiber-optic bronchoscopy revealed multiple nodular lesions on the right lateral wall of lower one-third of trachea. Histopathological examination of biopsy specimen from the nodules was suggestive of tracheobronchopathia osteochondroplastica which is an uncommon airway disorder.
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Affiliation(s)
- Ananda Datta
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sudip Ghosh
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prasanta Raghab Mohapatra
- Department of Pulmonary Medicine and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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13
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Yoshida S, Morizumi S, Sumitomo K, Shinohara T. Tracheobronchopathia Osteochondroplastica Complicated with Mycobacteroides abscessus Pulmonary Disease. Intern Med 2021; 60:3051-3052. [PMID: 33814496 PMCID: PMC8502671 DOI: 10.2169/internalmedicine.6844-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Seiji Yoshida
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Japan
- Division of Internal Medicine, Rehabilitation Oomiko Hospital, Japan
| | - Shun Morizumi
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Japan
- Department of Community Medicine for Respirology, Graduate School of Biomedical Sciences, Tokushima University, Japan
| | - Kenya Sumitomo
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Japan
| | - Tsutomu Shinohara
- Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Japan
- Department of Community Medicine for Respirology, Graduate School of Biomedical Sciences, Tokushima University, Japan
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14
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CT findings of non-neoplastic central airways diseases. Jpn J Radiol 2021; 40:107-119. [PMID: 34398372 DOI: 10.1007/s11604-021-01190-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/10/2021] [Indexed: 01/02/2023]
Abstract
Non-neoplastic lesions of central airways are uncommon entities with different etiologies, with either focal or diffuse involvement of the tracheobronchial tree. Clinical symptoms of non-neoplastic tracheobronchial diseases are non-specific, and diagnosis is difficult, especially in the early stages. Three-dimensional computed tomography (3D-CT) is an evaluable tool as it allows to assess and characterize tracheobronchial wall lesions and meanwhile it enables the evaluation of airways surrounding structures. Multiplanar reconstructions (MPR), minimum intensity projections (MinIP), and 3D Volume Rendering (VR) (in particular, virtual bronchoscopy) also provide information on the site and of the length of airway alterations. This review will be discussed about (1) primary airway disorders, such as relapsing polychondritis, tracheobronchophathia osteochondroplastica, and tracheobronchomegaly, (2) airway diseases, related to granulomatosis with polyangiitis, Chron's disease, Behcet's disease, sarcoidosis, amyloidosis, infections, intubation and transplantation, (3) tracheobronchial malacia, and (4) acute tracheobronchial injury. 3D-CT findings, especially with MPR and 3D VR reconstructions, allows us to evaluate tracheobronchial disease morphologically in detail.
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15
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Proctor S, Crocker H, Au V, Aiyappan V. Chronic cough with dual pathologies of pulmonary ossification. BMJ Case Rep 2021; 14:14/7/e243538. [PMID: 34281945 DOI: 10.1136/bcr-2021-243538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 81-year-old man presented with chronic cough, which did not respond to the initiation of combined bronchodilator/inhaled corticosteroid therapy. CT of the chest revealed calcified nodules throughout the trachea sparing the posterior membrane, and tiny peripheral parenchymal nodules with basal interlobular septal thickening and calcification. Flexible bronchoscopy demonstrated endobronchial nodularity from the proximal trachea to the mid-sections of both main bronchi, sparing the posterior membrane. Histopathology revealed submucosal fibrous connective tissue and benign bone, confirming a diagnosis of tracheobronchopathia osteochondroplastica. CT was consistent with a concurrent diagnosis of dendriform pulmonary ossification. These two rare phenomena often present with non-specific symptoms, and the diagnosis can be made with imaging in both conditions. There is a role for bronchoscopy in the diagnosis of tracheobronchopathia osteochondropastica, and the endobronchial appearance could be diagnostic. The concurrence of both phenomena in our case might represent activity of a common cellular pathway of ossification in both sites.
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Affiliation(s)
- Simon Proctor
- Respiratory and Sleep Services, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Helen Crocker
- Respiratory and Sleep Services, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Virginia Au
- Division of Medical Imaging, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Vinod Aiyappan
- Respiratory and Sleep Services, Flinders Medical Centre, Bedford Park, South Australia, Australia
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16
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Lim SY, Abu Samah MF, Pereirasamy L, Chew BS, Hyder Ali IA. Tracheobronchopathia osteochondroplastica-stalactite of airways. Respirol Case Rep 2021; 9:e00790. [PMID: 34094575 PMCID: PMC8155807 DOI: 10.1002/rcr2.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 12/04/2022] Open
Abstract
A case of tracheobronchopathia osteochondroplastica (TO) was diagnosed in a 53-year-old man, who presented with prolonged cough and recurrent respiratory tract infection. Bronchoscopy revealed exostosis over the anterolateral wall of trachea and main bronchi sparing the posterior membranous wall. The endobronchial biopsy subsequently revealed ossification of the cartilage. To date, the aetiology of this condition remains unknown, and treatment is mainly symptomatic, emphasizing on timely management of recurrent respiratory infections. Bronchoscopy or surgical intervention is usually reserved for symptomatic patients with severe airway narrowing and airflow obstruction.
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Affiliation(s)
- Suat Yee Lim
- Department of Respiratory MedicinePenang General HospitalPenangMalaysia
| | | | | | - Bee See Chew
- Department of PathologyPenang General HospitalPenangMalaysia
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17
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García CA, Sangiovanni S, Zúñiga-Restrepo V, Morales EI, Sua LF, Fernández-Trujillo L. Tracheobronchopathia Osteochondroplastica-Clinical, Radiological, and Endoscopic Correlation: Case Series and Literature Review. J Investig Med High Impact Case Rep 2021; 8:2324709620921609. [PMID: 32406259 PMCID: PMC7238787 DOI: 10.1177/2324709620921609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Tracheobronchopathia osteochondroplastica (TO) is a rare idiopathic and benign disease that is often underdiagnosed. TO is characterized by multiple submucosal cartilaginous and osseous tracheobronchial nodules that spare the posterior wall. It usually affects the elderly, developing when the person is around 60 years old without gender preference and has a reported incidence of 0.11%. TO can be symptomatic and should be considered in patients with chronic cough, dyspnea, and recurrent pulmonary infections. Diagnosis is usually incidental by computed tomography or bronchoscopy, the latter being the gold standard diagnostic test for TO. Many thoracic imagers are not well acquainted with TO; thus, these patients are often underdiagnosed or misdiagnosed. We came across 5 patients in our institution who were incidentally diagnosed with TO, inspiring us to review the available literature on this disease. A total of 33 patients diagnosed with TO between 2009 and 2019 were identified by our retrospective review. Clinical and imaging data were collected on these patients. We also included the clinical, radiological, and endoscopic data of our 5 cases. TO should be considered in patients with chronic cough, dyspnea, and recurrent pulmonary infections. Our experience is that both computed tomography and bronchoscopy can be used to make a reliable diagnosis. It is crucial for physicians, especially radiologists and pulmonologists, to be aware of the existence of TO in order to ensure proper diagnosis.
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Affiliation(s)
| | | | | | | | - Luz Fernanda Sua
- Fundación Valle del Lili, Cali, Colombia.,Universidad Icesi, Cali, Colombia
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18
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Hoan L, Hang LM, Thanh Hong DT, Nhu Quynh NT, Linh LT, Cuong NN, Minh TN, Luan DT, Thang ND, Delphine N. A 69-Year-Old Man With Chronic Cough and Recurrent Pneumonia. Chest 2021; 158:e283-e287. [PMID: 33280770 DOI: 10.1016/j.chest.2020.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/29/2020] [Accepted: 07/15/2020] [Indexed: 11/30/2022] Open
Abstract
CASE PRESENTATION A 69-year-old man consulted for a 3-day history of fever, wet cough, and yellow-green phlegm. He denied having any dyspnea, chest pain, hemoptysis, swallowing disorders, choke, chills, asthenia, anorexia, or weight loss. He reported a continuous dry cough and three episodes of pneumonia in the past 4 years. He was a nonsmoker, without any other personal or familial medical history. He had no known professional exposure. He was born and lived in Vietnam but had no known contact with TB in his family or workplace. He was never imprisoned or homeless and did never travel abroad.
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Affiliation(s)
- Le Hoan
- Respiratory Medicine Department, Hanoi French Hospital, Hanoi, Vietnam
| | - Le Minh Hang
- Respiratory Medicine Department, Hanoi French Hospital, Hanoi, Vietnam
| | | | | | - Le Tuan Linh
- Radiology Department, Hanoi French Hospital, Hanoi, Vietnam
| | | | - Tran Ngoc Minh
- Pathology Department, Hanoi French Hospital, Hanoi, Vietnam
| | - Dao Thi Luan
- Pathology Department, Hanoi French Hospital, Hanoi, Vietnam
| | | | - Natali Delphine
- Respiratory Medicine Department, Hanoi French Hospital, Hanoi, Vietnam.
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19
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Shahzad T, Rizvi N, Siddiqui S, Ahmed R. Tracheobronchopathia osteochondroplastica: a cause of chronic cough and haemoptysis. BMJ Case Rep 2021; 14:e240125. [PMID: 33846182 PMCID: PMC8047991 DOI: 10.1136/bcr-2020-240125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/04/2022] Open
Abstract
Tracheobronchopathia osteochondroplastica (TPO) is a rare disorder of the tracheopulmonary tree characterised by osseous and cartilaginous submucosal nodules projecting into the tracheal lumen, sparing the posterior tracheal membranous wall. Symptoms are non-specific and may include dry cough, hoarseness, dyspnoea, recurrent pneumonia and occasionally haemoptysis. A fibreoptic bronchoscopy showing multiple tracheal nodules followed by pathological biopsy is required to reach the final diagnosis. Here, we report two cases of TPO, both with history of biomass fuel exposure and almost similar clinical presentions with chronic cough, shortness of breath and intermittent haemoptysis. They both underwent fibreoptic bronchoscopy showing multiple tracheal nodules whose histopathological analysis showed the diagnosis of TPO. Both patients were treated conservatively and remained in good health afterwards. Physicians should be aware about the need of advanced surgical procedures including endotracheal stent placement in more severe cases.
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Affiliation(s)
- Talha Shahzad
- Pulmonary Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Nadeem Rizvi
- Pulmonary Medicine, Ziauddin University Hospital, Karachi, Pakistan
| | - Sabeeh Siddiqui
- Pathology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Rashida Ahmed
- Pathology and Microbiology, Aga Khan University, Karachi, Pakistan
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Takamori R, Shirozu K, Hamachi R, Abe K, Nakayama S, Yamaura K. Intubation Technique in a Patient with Tracheobronchopathia Osteochondroplastica. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928743. [PMID: 33460424 PMCID: PMC7823150 DOI: 10.12659/ajcr.928743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tracheobronchopathia osteochondroplastica (TO) is a rare disorder characterized by cartilaginous or ossified submucosal nodules of unknown etiology that project into the tracheobronchial lumen. TO is often accompanied by endotracheal stenosis from cartilage proliferation and is often detected by difficult endotracheal intubation incidence. CASE REPORT Here we report the case of a patient (67-year-old man) with TO scheduled to undergo robot-assisted total prostatectomy for prostate cancer. The tracheal lumen was especially narrow at an area 1 cm below the glottis, with the smallest lumen diameter being 9 mm. After rapid induction, the bronchoscope passed through the stenosed region, and a 6.5-mm spiral endotracheal tube (ETT) was inserted with bronchoscopic assistance. However, because of resistance, the spiral ETT could not pass through the stenosed area. After changing to a 6.5-mm normal ETT, intubation was successfully performed with gentle rotation. Owing to the rotation, the tip entered and gained access to the gap between nodules. With use of a bronchoscope, we confirmed that the tip of the ETT was advanced 10 cm from the glottis, where the site of maximum stenosis was not covered by the tube cuff, and where the tip did not cross the bifurcation. After surgery, no bleeding or edema was found on bronchoscopy. CONCLUSIONS In patients with TO, it is important to assess the airway condition and prepare for difficult intubation. In this case, tracheal intubation was performed with rotation using a bronchoscope and normal ETT.
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Affiliation(s)
- Ryoko Takamori
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka City, Fukuoka, Japan
| | - Kazuhiro Shirozu
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka City, Fukuoka, Japan
| | - Ryosuke Hamachi
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka City, Fukuoka, Japan
| | - Kiyokazu Abe
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka City, Fukuoka, Japan
| | - Shoko Nakayama
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Hospital, Fukuoka City, Fukuoka, Japan
| | - Ken Yamaura
- Department of Anesthesiology and Critical Care Medicine, Kyushu University Graduate School of Medicine, Fukuoka City, Fukuoka, Japan
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21
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Huang L, Wang J, Chen S, Fang X. Study and reflection on anesthesia for tracheobronchopathia osteochondroplastica. J Int Med Res 2020; 48:300060520971498. [PMID: 33233977 PMCID: PMC7705287 DOI: 10.1177/0300060520971498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tracheobronchopathia osteochondroplastica (TO) is a rare disease that may cause unexpected difficult intubation. There is no available consensus on the management of difficult intubation that is associated with TO. A 45-year-old woman was scheduled for modified radical mastoidectomy, canaloplasty, and tympanoplasty under general anesthesia. We encountered significant resistance during tracheal intubation, although the laryngeal view was normal with the video laryngoscope. A fiberoptic bronchoscope was then used to facilitate intubation, and we noted that the trachea was obviously narrowed due to cartilaginous ring hypertrophy. The tracheal tube was fully lubricated with tetracaine gel, and smoothly inserted into the trachea. After the operation, bronchoscopy and a computed tomography (CT) scan were performed to confirm the diagnosis of TO. Fiberoptic bronchoscopy-assisted tracheal intubation is safe and effective choice for the patients in whom subglottic intubation is difficult. CT scan and bronchoscopy might be helpful for preoperative airway assessment. Identifying patients with TO is important to avoid unexpected tracheal intubation impediment. Assessment of the subglottic airway should also be taken seriously.
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Affiliation(s)
- Luping Huang
- Department of Anesthesiology, The First
Affiliated Hospital of Zhejiang University, Zhejiang, China
- Department of Anesthesiology, The First
Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Junlu Wang
- Department of Anesthesiology, The First
Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Sijia Chen
- Department of Anesthesiology, The First
Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Xiangming Fang
- Department of Anesthesiology, The First
Affiliated Hospital of Zhejiang University, Zhejiang, China
- Xiangming Fang, School of Medicine, Zhejiang
University, 866 Yuhangtang Road, Hangzhou 310058, China.
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Abstract
Background Tracheobronchopathia osteochondroplastica (TPO) is characterized by the presence of diffuse cartilaginous or bony submucosal nodules that lead to airway lumen narrowing. So far, there was no study in South Korea analysing a large number of TPO patients. We aimed to elucidate its treatment strategy and clinical course by analysing the characteristics of TPO patients. Methods In this retrospective study, we reviewed the clinical data of 40 patients diagnosed with TPO by bronchoscopy between October 1997 and April 2019 at a single referral hospital. Results Of the 40 patients, 26 (65.0%) were male and the median age was 63.0 years. The most common symptom was cough (n=12, 30%). Pulmonary function test (PFT) revealed an obstructive pattern in 10 (25.7%) patients. Chest computed tomography (CT) scan showed 23 (62.6%) patients with diffuse narrowing and calcified nodules. In bronchoscopy, the entire trachea was found to be involved in 30 (75.0%) patients and airway narrowing was identified in 6 (15.0%) patients. Endobronchial biopsies were obtained from 15 patients and the most common findings included typical cartilaginous and bony tissues (n=14, 93.3%). Since most patients were asymptomatic or had mild symptoms, they did not undergo any specific treatment. Of the 19 symptomatic patients, 2 (5.0%) patients received laser therapy for treating tracheal stenosis. Conclusions TPO is a slowly progressing disease and is well managed with conservative therapies. Although TPO shows a distinctive pattern by bronchoscopy, it follows a benign clinical course.
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Affiliation(s)
- Hyun Kyu Cho
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Gul F, Peterson E, Dejoy R, Eiger G, Mora Carpio A, Gupta E. Tracheobronchopathia osteochondroplastica: rare but not to be forgotten. Respirol Case Rep 2020; 8:e00609. [PMID: 32607244 PMCID: PMC7317299 DOI: 10.1002/rcr2.609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/29/2022] Open
Abstract
We report a case of a 59-year-old male with a one-month history of pleuritic chest pain who was diagnosed with tracheobronchopathia osteochondroplastica (TO). TO is a rare benign condition characterized by protruding submucosal nodules into the tracheobronchial lumen. The disease is generally asymptomatic, with rare cases of progressive nodularity, cough, dyspnoea, and haemoptysis. Diagnosis can be made via bronchoscopic visualization of bony and cartilaginous nodules on tracheal walls. Although generally benign, the rarity of this condition makes diagnosis difficult even for trained pulmonologists and frequently predisposes patients to unnecessary invasive diagnostic testing and improper management of symptoms and contributing co-morbid conditions. We present this case to increase physician and patient awareness about this disease to help improve diagnostic strategy and knowledge of disease manifestations and potential complications.
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Affiliation(s)
- Fahad Gul
- Department of Internal MedicineEinstein Medical CenterPhiladelphiaPAUSA
| | - Eric Peterson
- Department of Internal MedicineEinstein Medical CenterPhiladelphiaPAUSA
| | - Robert Dejoy
- Department of Internal MedicineEinstein Medical CenterPhiladelphiaPAUSA
| | - Glenn Eiger
- Department of Internal MedicineEinstein Medical CenterPhiladelphiaPAUSA
- Department of Pulmonary and Critical CareEinstein Medical CenterPhiladelphiaPAUSA
| | | | - Ena Gupta
- Department of Pulmonary and Critical CareEinstein Medical CenterPhiladelphiaPAUSA
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Rana A, Mezughi H, Malik SA, Mansoor K, Al-Astal A. Rare Manifestation of Idiopathic Tracheobronchopathia Osteochondroplastica: Misdiagnosed and Untreated Entity? Cureus 2020; 12:e9407. [PMID: 32864236 PMCID: PMC7449619 DOI: 10.7759/cureus.9407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Tracheobronchopathia osteochondroplastica (TBPO) is a rare benign disease of unknown cause, in which multiple cartilaginous or bony submucosal nodules project into the trachea and proximal bronchi. It usually occurs in men in their fifth decade and can cause airway obstruction, bleeding and chronic cough; patients are more prone to post-obstructive pneumonia and chronic lung infection in some instances. We report a case of a 69-year-old female who presented with shortness of breath and lower extremity swelling over the past couple of weeks. Echocardiography (ECHO) was consistent with heart failure with preserved ejection fraction, and she was treated with diuretics accordingly. Imaging revealed persistent pleural effusions bilaterally, more pronounced on the right side. During the course of her hospitalization, the patient coded once and had to be resuscitated. She had bronchoscopy done and pathology was consistent with TBPO. In this condition, there are numerous osseous or cartilaginous submucosal nodules in the trachea and the main bronchus and nodules are formed due to the deposition of calcium phosphate that results in the proliferation of osseous and cartilaginous structures resulting in the obstruction of large airways. Treatment for the most part is supportive and resolves around bronchodilators for symptomatic relief.
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Affiliation(s)
- Abdul Rana
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Haitem Mezughi
- Pulmonology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Shuja A Malik
- Internal Medicine, Nawaz Sharif Medical College, University of Gujrat, Gujrat, PAK
| | - Kanaan Mansoor
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Amro Al-Astal
- Internal Medicine/Pulmonology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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25
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Clinical Characteristics of Six Cases of Tracheobronchopathia Osteochondroplastica. Can Respir J 2020; 2020:8685126. [PMID: 32612728 PMCID: PMC7315312 DOI: 10.1155/2020/8685126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/29/2020] [Accepted: 05/04/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the clinical characteristics of tracheobronchopathia osteochondroplastica (TO). Methods The clinical data of six patients with TO from November 2016 to November 2018 were retrospectively analyzed. The etiology, clinical manifestations, diagnosis, and treatment of TO were summarized. Result All six patients with TO were middle-aged males, confirmed by histopathological examination. The main clinical symptoms were cough, sputum, hemoptysis, chest pain, and repeated pulmonary infection. Some patients could make a preliminary diagnosis by chest CT, and bronchoscopy showed that TO mainly occurred in the trachea and the main bronchus and was more likely to invade the right bronchus. The treatment mainly includes anti-infection, phlegm-resolving, and other symptomatic treatment. Conclusion TO is a benign disease predisposing to adults, and males are more likely to be affected. Its clinical manifestations are lack of specificity, and the cause may be related to chronic infection. Bronchoscopy combined with histopathological examination is the primary approach for the diagnosis of TO. There is no well-recognized treatment standard for TO, and the judgment of therapeutic effect is inconsistent. It is necessary to improve the understanding of this disease from a clinical perspective.
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26
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Kafili D, Sampson T, Tolhurst S. Difficult intubation in an asymptomatic patient with tracheobronchopathia osteochondroplastica. Respirol Case Rep 2020; 8:e00526. [PMID: 32025306 PMCID: PMC6996240 DOI: 10.1002/rcr2.526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/08/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022] Open
Abstract
Tracheobronchopathia osteochondroplastica (TO) is a rare, benign, slowly progressive disease of unknown aetiology. It is characterized by numerous sessile, cartilaginous, or osseous submucosal nodules distributed throughout the anterolateral walls of the trachea and projecting into the laryngotracheobronchial lumen. The diagnosis is usually incidental with distinct bronchoscopic or computed tomography (CT) scan findings. We have identified a case of asymptomatic TO through fibreoptic bronchoscopy and biopsy after having a difficult intubation for elective prostate surgery.
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Affiliation(s)
- Dona Kafili
- Department of Respiratory MedicineGreenslopes Private HospitalGreenslopesQueenslandAustralia
| | - Timothy Sampson
- Department of AnaesthesiologyGreenslopes Private HospitalGreenslopesQueenslandAustralia
| | - Sean Tolhurst
- Department of Respiratory MedicineGreenslopes Private HospitalGreenslopesQueenslandAustralia
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27
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Pereira CC, Ferro FM, Freitas FÂ. Tracheobroncopathia Osteochondroplastica – A Picture Is Worth a Thousand Words. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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28
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Coexistence of Tracheobronchopathia Osteochondroplastica and Sarcoidosis: Accidental Finding or Something More? J Bronchology Interv Pulmonol 2019; 26:e7-e8. [PMID: 30562285 DOI: 10.1097/lbr.0000000000000521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Kwon W, Lee SM, Bang S. Costoclavicular block for shoulder surgery in a patient with tracheobronchopathia osteochondroplastica and COPD. J Clin Anesth 2018; 55:13-14. [PMID: 30584975 DOI: 10.1016/j.jclinane.2018.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/06/2018] [Accepted: 12/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Woojin Kwon
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Mook Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seunguk Bang
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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30
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Tracheobronchopathia Osteochondroplastica. Arch Bronconeumol 2018. [DOI: 10.1016/j.arbres.2018.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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31
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Identification of Tracheobronchial Tree Calcifications Using Molecular Imaging Probes. Clin Nucl Med 2018; 43:e278-e279. [DOI: 10.1097/rlu.0000000000002164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Ihara H, Tajima K, Yoshikawa H, Tajima M, Harada N, Takahashi F, Uekusa T, Nagaoka T, Takahashi K. Autofluorescence imaging bronchoscopy as a novel approach to the management of tracheobronchopathia osteochondroplastica: a case report. J Thorac Dis 2016; 8:E1195-E1198. [PMID: 27867586 DOI: 10.21037/jtd.2016.10.48] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Tracheobronchopathia osteochondroplastica (TO) is not only rare but also presents highly varied and unpredictable clinical manifestations. Consequently, the management and treatment strategies remain unclear. An accurate evaluation tool is important for the management of individual patients in the absence of standard guidelines. Although bronchoscopy is the gold standard for diagnosis, it cannot satisfactorily detect the treatment response and disease progression because subtle mucosal changes can go undetected. Therefore, improved techniques that can detect subtle mucosal changes associated with TO are desirable. Autofluorescence imaging bronchoscopy (AFI) is a recently introduced advanced endoscopic technology that can detect subtle mucosal changes with the aid of different colors. Here we report the first case, to the best of our knowledge, involving a 42-year-old man with TO in whom tracheal involvement was evaluated by AFI and detected as the appearance of a magenta color.
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Affiliation(s)
- Hiroaki Ihara
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan;; Research Institute for Diseases of Old Ages, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Ken Tajima
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan;; Research Institute for Diseases of Old Ages, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Hitomi Yoshikawa
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan;; Research Institute for Diseases of Old Ages, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Manabu Tajima
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan;; Research Institute for Diseases of Old Ages, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan;; Research Institute for Diseases of Old Ages, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Fumiyuki Takahashi
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan;; Research Institute for Diseases of Old Ages, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Toshimasa Uekusa
- Department of Pathology, Labor Health and Welfare Organization Kanto Rosai Hospital, Kawasaki, Japan
| | - Tetsutaro Nagaoka
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan;; Research Institute for Diseases of Old Ages, Juntendo University, Faculty of Medicine, Tokyo, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University, Faculty of Medicine, Tokyo, Japan;; Research Institute for Diseases of Old Ages, Juntendo University, Faculty of Medicine, Tokyo, Japan
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Eigsti RL, Walsh J, Robinson RA, McNeely PS, Hoffman HT. Laryngeal heterotopic ossification: An atypical etiology of respiratory distress. Laryngoscope 2016; 127:1143-1146. [PMID: 27583381 DOI: 10.1002/lary.26267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2016] [Indexed: 01/18/2023]
Affiliation(s)
- Renee L Eigsti
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Jarrett Walsh
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Robert A Robinson
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Parren S McNeely
- Department of Radiology, Division of Nuclear Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Henry T Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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Fois AG, Arcadu A, Santoru L, Trisolini R, Marras V, Ginesu GC, Canu S, Cordero L, Diana G, Pirina P. Tracheobronchopathia Osteochondroplastica: a rare case report of a non-smoker and non-atopic patient, with a long history of wheezing since childhood. Multidiscip Respir Med 2016; 11:16. [PMID: 27096087 PMCID: PMC4836196 DOI: 10.1186/s40248-016-0050-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background Tracheobronchopathia Osteochondroplastica (TBPO) is an uncommon and benign condition characterized by osseous or metaplastic cartilaginous 1–3 mm nodules in the submucosa of the tracheo-bronchial tree. Posterior membranous wall of trachea is typically spared. Ecchondrosis and exostosis nodules can cause chronic inflammation and mucosal metaplasia, stiffness and airway obstruction. The prevalence of this disease, often asymptomatic or associated with nonspecific symptoms, is underestimated, and the mean age at diagnosis is 50 years. Case presentation We report a case of a 49 year old male, non-smoker. He was a smith, homeless, born in Romania and reported a diagnosis of asthma since childhood. He was admitted to our Respiratory Unit presenting low-grade fever with profuse sweating, cough, purulent sputum, and ground-glass opacity with irregularity in main bronchi detected by High-Resolution Computed Tomography (HRCT) scan. Fibrobronchoscopy revealed the presence of mucosal irregularities up to the segmental bronchi entrance. Histological examination showed nodules of osseouscartilaginous nature, consistent with TBPO. Microbiological tests of Bronchoalveolar Lavage fluid also revealed an infection by Pseudomonas Aeruginosa. Conclusion TBPO is a rare disease characterized by wheezing, cough, hemoptysis, and recurrent pulmonary infections, with typical onset during adulthood. In the case reported, the symptoms began in childhood, although they had been misinterpreted as asthma. Even if childhood-onset is not reported in literature, it is likely that small changes occur in the first few years of life and become more evident in adulthood. The involvement of segmental and sub-segmental bronchi, usually spared in TBPO, could explain the presence of wheezing and non-productive cough reported by our patient since childhood.
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Affiliation(s)
- Alessandro G Fois
- Department of Respiratory Disease, University of Sassari, viale san Pietro 46/b, 07100 Sassari, Italy
| | - Antonella Arcadu
- Department of Respiratory Disease, University of Sassari, viale san Pietro 46/b, 07100 Sassari, Italy
| | - Luigi Santoru
- Department of Respiratory Disease, University of Sassari, viale san Pietro 46/b, 07100 Sassari, Italy
| | - Rocco Trisolini
- Thoracic Endoscopy and Pulmonology Unit, Maggiore Hospital, Bologna, Italy
| | | | - Giorgio C Ginesu
- Department of Clinical and Experimental Medicine, Surgical Clinic, University of Sassari, Sassari, Italy
| | - Sara Canu
- Department of Respiratory Disease, University of Sassari, viale san Pietro 46/b, 07100 Sassari, Italy
| | - Lorenzo Cordero
- Department of Respiratory Disease, University of Sassari, viale san Pietro 46/b, 07100 Sassari, Italy
| | - Gabriella Diana
- Department of Respiratory Disease, University of Sassari, viale san Pietro 46/b, 07100 Sassari, Italy
| | - Pietro Pirina
- Department of Respiratory Disease, University of Sassari, viale san Pietro 46/b, 07100 Sassari, Italy
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35
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Abouda M, Jomni T, Charfi MR. Tracheobronchopathia osteochondroplastica: an unusual cause of chronic cough. QJM 2016; 109:193-4. [PMID: 26370125 DOI: 10.1093/qjmed/hcv166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Abouda
- From the Faculty of Medicine of Tunis, F.S.I. Hospital, University of Tunis El-Manar, TN 2070, Tunisia
| | - T Jomni
- From the Faculty of Medicine of Tunis, F.S.I. Hospital, University of Tunis El-Manar, TN 2070, Tunisia
| | - M R Charfi
- From the Faculty of Medicine of Tunis, F.S.I. Hospital, University of Tunis El-Manar, TN 2070, Tunisia
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