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Devaraja K, Surendra VU. Clinicopathological Features and Management Principles of Tracheobronchopathia Osteochondroplastica - A Scoping Review. Indian J Otolaryngol Head Neck Surg 2023; 75:3798-3814. [PMID: 37974722 PMCID: PMC10646011 DOI: 10.1007/s12070-023-03998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 06/16/2023] [Indexed: 11/19/2023] Open
Abstract
Tracheobronchopathia osteochondroplastica (TO) is an orphan disease of the tracheobronchial tree without any known etiological attributes. There are several case reports published on this condition, yet the available information about the TO is discrete and of little clinical value. This scoping review is the first large-scale review on TO that collates individual patient data from the published case reports and descriptively analyses the clinicopathological features of this unique condition along with its management approaches and therapeutic outcomes. The objective was to synthesize comprehensive literature review on TO that can aid clinical practice and further research. An electronic search conducted in five large databases, including PubMed, EMBASE, CINAHL, CENTRAL, and Web of Science, for the published articles of TO yielded 1072 items. After screening, the individual patient data of 371 TO cases from 228 eligible articles were included and analysed in this scoping review. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03998-6.
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Affiliation(s)
- K Devaraja
- Division of Head and Neck Surgery, Department of Otorhinolaryngology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
| | - Vyshak Uddur Surendra
- Department of Respiratory Medicine, Yenapoya Medical College Yenapoya University, Mangalore, Karnataka 575018 India
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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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Miller ME, Lina I, Sateri S, Bhatti N. Impact of Tracheobronchopathia Osteochondroplastica on Difficult Intubation. OTO Open 2023; 7:e81. [PMID: 37727399 PMCID: PMC10506180 DOI: 10.1002/oto2.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Affiliation(s)
- Mattea E. Miller
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Ioan Lina
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Sara Sateri
- Department of Anesthesiology and Critical Care MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Nasir Bhatti
- Department of Otolaryngology‐Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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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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Chaurasia S, Ray S, Chowdhury S, Balaji B. Tracheobronchopathia osteochondroplastica: A rare case of misdiagnosis and difficult intubation. J R Coll Physicians Edinb 2022; 52:54-56. [DOI: 10.1177/14782715221088978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tracheobronchopathia osteochondro-plastica (TPO) is a rare disorder of yet unknown etiology. The common clinical features include cough with expectoration, breathing difficulty, hemoptysis, and recurrent airway infections, which can lead to a misdiagnosis as another chronic respiratory illness in a large number of cases due to the rare nature of TPO. Here we present a 25-year-old lady who was misdiagnosed as bronchial asthma for many years, and was found to have TPO after difficulty in intubation for administering general anesthesia prior to a surgical procedure.
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Affiliation(s)
- Sheetal Chaurasia
- Department of Pulmonary Medicine, Manipal Hospital Whitefield, Bangalore, India
| | - Shalina Ray
- Department of Otorhinolaryngology, Manipal Hospital Whitefield, Bangalore, India
| | - Saurav Chowdhury
- Department of Pulmonary Medicine, Manipal Hospital Whitefield, Bangalore, India
| | - Blessy Balaji
- Department of Otorhinolaryngology, Manipal Hospital Whitefield, Bangalore, India
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Sharma D, Kamath S, Acharya VK, Rai S. Pebbled Trachea: A Case Series and Literature Review of Tracheobronchopathia Osteochondroplastica. J Glob Infect Dis 2021; 13:180-182. [PMID: 35017875 PMCID: PMC8697822 DOI: 10.4103/jgid.jgid_379_20] [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: 10/21/2020] [Revised: 03/23/2021] [Accepted: 05/07/2021] [Indexed: 11/15/2022] Open
Abstract
We report a series of three cases diagnosed with tracheobronchopathia osteochondroplastica on bronchoscopy and computed tomography (CT) chest. Most patients were diagnosed incidentally on evaluation for chronic cough. The association of this entity with chronic bacterial infections and tuberculosis is an intriguing entity that was observed in our patients. Nodular, ulcerative, and calcific lesions in the trachea are bronchoscopic findings seen in quite a few other conditions posing diagnostic challenges. However, the classical bronchoscopic appearance with CT imaging in an appropriate clinical context can lead to an accurate diagnosis of this condition. We describe this array of cases with varying clinical presentations, their associations, and deliberate the literature reviews on this rare entity.
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Affiliation(s)
- Deepthi Sharma
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Sindhu Kamath
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Vishak K Acharya
- Department of Pulmonary Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
| | - Sharada Rai
- Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, Karnataka, India
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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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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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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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Bozorgmehr R, Rahimi B. Diagnosis and Treatment Process of Tracheobronchopathia Osteochondroplastica with Concurrent Chronic Eosinophilic Pneumonia: a Case Report. TANAFFOS 2020; 19:267-271. [PMID: 33815549 PMCID: PMC8008416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Tracheobronchopathia Osteochondroplastica (TBPO) is a rare disease with a benign period affecting the bronchial system. It is characterized by the presence of numerous osseous submucosal nodules or cartilaginous protruding into the tracheobronchial lumen. These wounds are diagnosed incidentally during bronchoscopy. We reported the stages of diagnosis and treatment of a 46-year-old patient with TBPO and concurrent chronic eosinophilic pneumonia. CASE PRESENTATION A 46-year-old non-smoking Afghan male exposed to adhesives and chemicals in Iran for more than 25 years was admitted to a pulmonary ward with symptoms of exertional dyspnea, dry coughing, occasional nocturnal sweating for 6 years, tachycardia, hypoxia, and generalized wheezing during expiration. A symbicort inhaler and Montelukast pills were prescribed for him with the probable diagnosis of asthma. High-resolution computed tomography (HRCT) was performed on the patient and the results showed non-significant multiple lymph nodes with maximum diameters (SAD = 7 mm). HRCT also showed that the patient had protuberances on the trachea surface and thus underwent bronchoscopy for further examination. The results indicated numerous protuberances of white cartilage from the proximal part of the trachea to the distal part without the involvement of the posterior membrane. The biopsy result confirmed TBPO. Prednisolone was prescribed for the patient to treat the chronic eosinophilic pneumonia. However, we had to continue the daily dose of 5mg prednisolone due to the recurrence of the symptoms. CONCLUSION The lack of response to a bronchodilator in a patient suspicious to asthma must make us think about other causes of respiratory wheezing such as TBPO.
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Affiliation(s)
- Rama Bozorgmehr
- Clinical Research Development Unit, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Besharat Rahimi
- Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Riva G, Girolami I, Luchini C, Villanova M, Valotto G, Cima L, Carella R, Riva M, Fraggetta F, Novelli L, Eccher A. Tracheobronchopathia Osteochondroplastica: A Case Report Illustrating the Importance of Multilevel Workup Clinical, Endoscopic and Histological Assessment in Diagnosis of an Uncommon Disease. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:74-77. [PMID: 30655500 PMCID: PMC6345107 DOI: 10.12659/ajcr.911859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Patient: Male, 62 Final Diagnosis: Tracheobronchopathia osteochondroplastica Symptoms: Cough Medication: — Clinical Procedure: — Specialty: Pulmonology
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Affiliation(s)
- Giulio Riva
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Ilaria Girolami
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Claudio Luchini
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Manuela Villanova
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Giovanni Valotto
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Cima
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
| | - Rodolfo Carella
- Department of Pathology, Central Hospital of Bolzano, Bolzano, Italy
| | - Maurizio Riva
- Department of Pathology, Central Hospital of Bolzano, Bolzano, Italy
| | | | - Luca Novelli
- Institute of Histopathology and Molecular Diagnosis, Careggi Hospital, Florence, Italy
| | - Albino Eccher
- Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
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Devaraja K, Sagar P, Chirom AS. Tracheobronchopathia osteochondroplastica: awareness is the key for diagnosis and management. BMJ Case Rep 2017; 2017:bcr-2017-220567. [PMID: 28784888 DOI: 10.1136/bcr-2017-220567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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.
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Affiliation(s)
- K Devaraja
- Department of Otorhinolaryngology, Kasturba Medical College, Manipal, Karnataka, India
| | - Prem Sagar
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Amit Singh Chirom
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, New Delhi, Delhi, India
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