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Feng Y, Wang L, Jia R, Zhang X, Wang X, Yuan Y, Yang H, Xie L, Li N, Wang X, Bibas BJ, Kim H, Schweipert J, Ren Y. Tracheobronchopathia osteochondroplastica concurrent with peripheral lung cancer: a case report and perioperative considerations. Transl Cancer Res 2024; 13:2064-2072. [PMID: 38737686 PMCID: PMC11082660 DOI: 10.21037/tcr-24-410] [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: 03/13/2024] [Accepted: 04/19/2024] [Indexed: 05/14/2024]
Abstract
Background Tracheobronchopathia osteochondroplastica (TPO) is a rare, benign, chronic disorder of unknown etiology. It is characterized by submucosal nodules, often calcified, which predominantly affect the anterolateral aspects of the trachea and main bronchi, while sparing the posterior bronchial wall. The co-occurrence of TPO and lung cancer is exceedingly rare. This report presents a case of TPO association with early-stage lung cancer, which was managed through surgical intervention. No active treatment was undertaken for the TPO. Case Description A patient presented with a nodule in the right upper lobe, which was identified during a computed tomography (CT) scan of the chest, suggestive of early-stage lung cancer. Concurrently, multiple calcifications in the cartilaginous rings of the trachea were noted. Bronchoscopy revealed distinctive "pebblestone" nodules along the anterior and lateral tracheal walls, indicative of extensive TPO. The patient underwent bronchofiberscopy, which showed patency in the bronchial lumen of the right lung's upper lobe. A biopsy was not undertaken during this procedure. Comprehensive preoperative tests, including a blood biochemical examination, tumor-marker tests, lung-function tests, head-enhanced magnetic resonance imaging, abdominal ultrasound, and whole-body bone emission CT revealed no significant abnormalities. Despite this, the patient declined a whole-body positron emission tomography (PET)-CT scan. Given the potential malignancy of nodules in the right lung's upper lobe, the lobectomy for lung cancer was carried out, a procedure that would have proceeded irrespective of the presence or absence of TPO. Preoperative planning for potential tracheal intubation difficulties involved consultation with the anesthesiologist, resulting in a smooth intraoperative process. The pathology confirmed invasive adenocarcinoma. Post-surgery, the patient developed an infection in the right lung's lower lobe, identified as pseudomonas aeruginosa and Klebsiella pneumoniae through sputum culture and bronchoscopic lavage. Treatment with meropenem for 2 weeks, as guided by drug sensitivity results and respiratory advice, led to an improvement, allowing for discharge. A follow-up lung CT four months post-operation showed inflammation absorption in the right lower lobe. Conclusions Surgical resection in cases of TPO association with lung cancer may have an increased risk of postoperative pulmonary infection. Proactive intraoperative sputum aspiration by anesthesiologists and the postoperative reinforcement of anti-infection measures, guided by drug sensitivity results, are recommended.
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Affiliation(s)
- Yong Feng
- Department of Thoracic Surgery, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Linlin Wang
- Department of Thoracic Surgery, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Renxiang Jia
- Department of Thoracic Surgery, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Xiangchao Zhang
- Department of Anesthesiology, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Xiaohan Wang
- Department of Endoscopic Therapy Center, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Yana Yuan
- Department of Pathology, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Hong Yang
- Department of Pathology, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Liwei Xie
- Department of Radiology, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Na Li
- Department of Pharmacy, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Xiaoge Wang
- Department of Respiratory Medicine, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
| | - Benoit Jacques Bibas
- Hospital Municipal Vila Santa Catarina Dr. Gilson de Cássia Marques de Carvalho, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Johannes Schweipert
- Division of Thoracic Surgery, Department of Visceral, Thoracic and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Yi Ren
- Department of Thoracic Surgery, Shenyang Chest Hospital and Tenth People’s Hospital, Shenyang, China
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Lauinger AR, Yu-Ballard A. Tracheopathia osteochondroplastica: a case report illustrating the importance of imaging in this rare disorder. AME Case Rep 2024; 8:32. [PMID: 38711905 PMCID: PMC11070977 DOI: 10.21037/acr-23-119] [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: 08/09/2023] [Accepted: 12/03/2023] [Indexed: 05/08/2024]
Abstract
Background Tracheopathia osteochondroplastica (TPO) is an uncommon and benign abnormality of the cartilaginous tracheal wall. It is characterized by multiple calcified nodules in the submucosa of the trachea and main bronchi. This disorder can present as a wide range of nonspecific symptoms; therefore, TPO is usually found as an incidental finding during bronchoscopy. However, it does pose a risk for complicated intubations and recurrent respiratory infection. The etiology of the disease is unknown, and treatments are often only for symptomatic relief, if necessary. Case Description In this report, we present a case of a 71-year-old woman who presents with chest pain and dyspnea on exertion. She has a history of takotsubo cardiomyopathy, and the symptoms have been persistent since the diagnosis over 6 months ago. A chest computed tomography (CT) demonstrated possible endobronchial lesions and minimal fibrosis. A bronchoscopy was completed following this observation, and it revealed nodular lesions on the cartilaginous rings of the trachea. She was diagnosed with TPO. The patient also has a history of gastroesophageal reflux disease (GERD) and reports relief from chest pain and dyspnea post-esophageal dilation for dysphagia. Conclusions This case illustrates the relationship between esophageal, cardiac, and pulmonary symptoms, and highlights the role of imaging in the diagnosis of TPO. It also demonstrates a possible treatment option for symptomatic TPO that hasn't previously been discussed.
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Affiliation(s)
- Alexa R. Lauinger
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL, USA
| | - Aimee Yu-Ballard
- Geriatric Medicine, Carle Foundation Hospital, Champaign, IL, USA
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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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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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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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Dumazet A, Launois C, Lebargy F, Kessler R, Vallerand H, Schmitt P, Hermant C, Dury S, Dewolf M, Dutilh J, Abouda M, Ferreira M, Atallah I, Lachkar S, Charriot J, Jouneau S, Uzunhan Y, Chouabe S, Coiffard B, Dutau H, Hagenburg J, Briault A, Dormoy V, Lirsac M, Vergnon JM, Deslee G, Perotin JM. Tracheobronchopathia osteochondroplastica: clinical, bronchoscopic, and comorbid features in a case series. BMC Pulm Med 2022; 22:423. [PMID: 36397041 PMCID: PMC9670617 DOI: 10.1186/s12890-022-02225-2] [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] [Received: 07/06/2022] [Accepted: 11/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Tracheobronchopathia osteochondroplastica (TO) is a rare condition of unknown etiology. TO is characterized by submucosal nodules, with or without calcifications, protruding in the anterolateral walls of the trachea and proximal bronchi. The objective of this study was to describe TO features and associated comorbidities in a series of patients. Methods Patients suffering from TO were retrospectively included by investigators from the Groupe d’Endoscopie Thoracique et Interventionnelle Francophone (GETIF). Demographic, clinical, comorbidities, bronchoscopic, functional, and radiological characteristics, and outcomes were recorded and analyzed. Results Thirty-six patients were included (69% male with a mean of 65 ± 12 years). Chronic symptoms were described by 81% of patients including cough (74%) and dyspnea on exertion (74%). TO was associated with COPD in 19% of the cases and gastroesophageal reflux disease in 6%. A mild to severe airflow obstruction was present in 55% of the cases. CT scan showed tracheal submucosal nodules in 93% of patients and tracheal stenosis in 17%. Bronchoscopy identified TO lesions in the trachea in 65% of the cases, and 66% of them were scattered. A bronchoscopic reevaluation was performed in 7 cases, 9 ± 14 months [1–56] after initial diagnosis, and showed the stability of lesions in all cases. Three patients underwent interventional bronchoscopic treatment. Conclusion The diagnosis of TO relies on typical bronchoscopic findings and can be evoked on a CT scan. Histologic diagnosis can be useful in atypical cases for differential diagnosis. Given its low consequences in terms of symptoms, lung functions, and evolution, no treatment is usually required.
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