Tracheobronchopathia osteochondroplastica--a rare or an overlooked entity?

Clinicopathological Features and Management Principles of Tracheobronchopathia Osteochondroplastica - A Scoping Review

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.

Clinical Characteristics of Tracheobronchopathia Osteochondroplastica: A Retrospective Study of 33 Patients

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.

Pebbled Trachea: A Case Series and Literature Review of Tracheobronchopathia Osteochondroplastica

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.

CT findings of non-neoplastic central airways diseases

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.

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

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.

Clinical Characteristics of Six Cases of Tracheobronchopathia Osteochondroplastica

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.

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

Patient: Male, 62

Final Diagnosis: Tracheobronchopathia osteochondroplastica

Symptoms: Cough

Medication: —

Clinical Procedure: —

Specialty: Pulmonology

Tracheobronchopathia osteochondroplastica: awareness is the key for diagnosis and management

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.

Right Upper Lobe Shadow and Tracheobronchopathia Osteochondroplastica Confined to Right Main Bronchus: A Case Report and Literature Review

Tracheobronchopathia osteochondroplastica (TO) is a well documented benign entity of endoscopic interest. We describe a case of 76-year-old patient who presented with fever, cough, purulent sputum during the past four days, and presence of an ovoid shadow in right upper zone of his chest X-ray. Medical history included diagnosis of colon diverticuli identified by colonoscopy 3 months ago. Chest CT revealed a compact elongated lesion containing air-bronchogram stripes. Bronchoscopy showed normal upper airways and trachea but presence of unequal sized mucosal nodules, protruding into the lumen, along the entire length of the right main bronchial mucosa. No other abnormal findings were detected. Moreover, brushing and washing smears from the apical segment of right upper lobe (RUL), where the compact lesion was located, were negative for malignancy. Biopsy from the mucosal nodules of right main bronchus showed presence of cartilaginous tissue in continuity through thin pedicles with submucosal cartilage. This finding posed the diagnosis of TO while RUL lesion was cleared by antibiotic treatment. Case is reported because, to our knowledge, it represents a unique anatomic location of TO which was confined exclusively in the right main bronchus mucosa without affecting trachea.

Tracheobronchopathia osteochondroplastica: Case report and literature review

Tracheobronchopathia osteochondroplastica (TPO) is a rare disorder characterized as multiple osseous or cartilaginous nodules in the submucosa of trachea and main bronchi. TPO remains an under recognized entity due to lack of awareness. Four cases of TPO are reported in this review as well as various facets of TPO description.

Tracheobronchopathia osteochondroplastica: two cases and a review of the literature

INTRODUCTION

Tracheobronchopathia osteochondroplastica (TO) is a rare disorder involving the lumen of the trachea-bronchial tree and characterized by multiple sub-mucosal osseous and cartilaginous nodules in the trachea and bronchus, sparing the posterior wall. We here report two cases of patients with tracheobronchopathia osteochondroplastica and review the relevant literature briefly.

CASE PRESENTATION

Case 1 was a 64-year-old woman with a history of Chronic Obstructive Pulmonary Disease (COPD) who presented with frequent non-productive cough for 2 years. Chest computed tomography (CT) showed signs consistent with COPD and evident irregular narrowing of the tracheal and both main bronchial lumen caused by calcific foci. Fibre optic bronchoscope (FOB) was performed and showed dozens of sub-mucosal nodules protruding into the lumen of lower half of the trachea and both main bronchi. Histopathological exam demonstrated sub-mucosal ossification and cartilage in the sample. Her follow-up has been uneventful for 3 years. Case 2 was a 37-year-old man presented with hoarseness, exertional dyspnea, and intermittent dry cough for about 3 years. Chest CT scans showed irregular nodules around the entire circumference of the trachea extending from sub-glottic region to lower trachea. FOB showed glottic stenosis and diffused sub-mucosal calcified nodules protruding from the antero-lateral portion of the trachea in the subglottic region. Over the following 12 months, his disease is stable.

CONCLUSIONS

TO is a rare, benign disease with slow progression, clinicians should be aware of TO and should consider it in patients with chronic cough, recurrent respiratory infection and evolving exertional dyspnea.

[Extended laryngotracheal stenosis and osteochondroplastic tracheopathy]

The present article was designed to report a case of the surgical treatment of the patient presenting with extended laryngotrachealstenosis related toosteochondroplasticlaryngo- and tracheopathy. The development of the osteochondroplastic transformation of the laryngeal and tracheal walls was regarded as a single pathomorphologicalprocess associated with chronic inflammation. The study has demonstrated the relationship between the squamous cell hyperplasia in the epithelium of the upper respiratory tract and destructive chondro-perichondritis of the larynx and trachea accompanied by osteochondroplastic changes and concomitant extended laryngotracheal stenosis.

Tracheobronchopathia osteochondroplastica: two cases and a review of the literature

INTRODUCTION

Tracheobronchopathia osteochondroplastica (TO) is a rare disorder involving the lumen of the trachea-bronchial tree and characterized by multiple sub-mucosal osseous and cartilaginous nodules in the trachea and bronchus, sparing the posterior wall. We here report two cases of patients with tracheobronchopathia osteochondroplastica and review the relevant literature briefly.

CASE PRESENTATION

Case 1 was a 64-year-old woman with a history of Chronic Obstructive Pulmonary Disease (COPD) who presented with frequent non-productive cough for 2 years. Chest computed tomography (CT) showed signs consistent with COPD and evident irregular narrowing of the tracheal and both main bronchial lumen caused by calcific foci. Fibre optic bronchoscope (FOB) was performed and showed dozens of sub-mucosal nodules protruding into the lumen of lower half of the trachea and both main bronchi. Histopathological exam demonstrated sub-mucosal ossification and cartilage in the sample. Her follow-up has been uneventful for 3 years. Case 2 was a 37-year-old man presented with hoarseness, exertional dyspnea, and intermittent dry cough for about 3 years. Chest CT scans showed irregular nodules around the entire circumference of the trachea extending from sub-glottic region to lower trachea. FOB showed glottic stenosis and diffused sub-mucosal calcified nodules protruding from the antero-lateral portion of the trachea in the subglottic region. Over the following 12 months, his disease is stable.

CONCLUSIONS

TO is a rare, benign disease with slow progression, clinicians should be aware of TO and should consider it in patients with chronic cough, recurrent respiratory infection and evolving exertional dyspnea.