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CT Findings in A Case of Tracheobronchopathia
Osteochondroplastica
 

Devang J Desai, Dinesh S Baviskar, Navdeep Hooda, Sunila T Jaggi, Inder Talwar

We present a case report of tracheobronchopathia osteochonroplastica, which is a rare entity leading to tracheal and central bronchial luminal narrowing.

 
Introduction

Tracheobronchopathia osteochondroplastica is a rare condition of unknown aetiology, characterized by tracheal and central bronchial luminal narrowing. Submucosal nodularity and sparing of the posterior wall is characteristic of this pathological condition. It has to be differentiated from other causes of tracheobronchial narrowing.

Case Report

A 55-year-old man came with history of cough and wheezing since six months. Since the past two months, he had developed stridor, and had received ayurvedic treatment with no relief.

Pulmonary function test was suggestive of severe expiratory outflow obstruction.

CT scan was then performed, which showed nodular thickening of the anterior and lateral tracheal wall, sparing of the posterior tracheal wall, with luminal narrowing. It was seen to involve the entire length of the trachea and the main bronchi. Calcification of few of the submucosal nodules was seen. There was no evidence of lymphadenopathy and the pretracheal and paratracheal soft tissues were normal.

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Discussion

Tracheopathia osteochrondroplastica is an uncommon abnormality of the cartilaginous tracheal wall, characterized by the presence of osteocartilaginous calcified nodules within the submucosa, with variable degree of diffuse tracheal narrowing.1 The disorder is usually asymptomatic and most of the cases have been diagnosed incidentally at autopsy or during bronchoscopy.2 However, a small number develop severe airway stenosis. Symptoms may include dyspnoea, hoarseness, cough, haemoptysis, and recurrent pneumonia.2,3

Plain chest X-ray films are often unremarkable but may demonstrate atelectasis, consolidation, tracheal nodularity, or narrowing.3

CT scans show thickening of the interstitial structures of the trachea and central bronchi. Multiple calcified submucosal nodules are seen. The trachea and central bronchi appear distorted, and narrowed, with variation in caliber along their lengths. The posterior membranous wall of the trachea is spared, because it does not contain cartilage, as is seen in our case. This helps to differentiate tracheobronchopathia osteochondro-plastica from amyloidosis, where the posterior membrane is also involved.4,5 The other differential diagnoses of nodular excrescences include endobronchial sarcoidosis, calcifying lesions of tuberculosis, papillomatosis and tracheobronchial calcinosis. Awareness of the condition as a differential diagnosis to neoplasms is important, to avoid unnecessary surgery or chemotherapy.6

 
 
References
1. Restrepo S, Pandit M, Villamil MA, et al. Tracheobronchopathia osteochondroplastica : helical CT findings in 4 cases. J Thorac Imaging 2004; 19 (2) : 112-6.
2. Barthwal MS, Chatterji RS, Mehta A. Tracheobronchopathia osteochondroplastica. Indian J Chest Dis Allied Sci 2004; 46 (1) : 43-6.
3. Zack JR, Rozenshtein A. Tracheobronchopathia osteochondroplastica : report of three cases. J Comput Assist Tomogr 2002; 26 (1) : 33-6
4. Mariotta S, Pallone G, Pedicelli G, et al. Spiral CT and endoscopic findings in a case of tracheobronchopathia osteochondroplastica. J Comput Assist Tomogr 1997; 21 (3) : 418-20
5. Glazer HS, Semenkovich JW, Gutierrez FR. Mediastinum. In : Computed Body Tomography with MRI Correlation, 3rd ed. Lee JKT, Sagel SS, et al. Philadelphia: Lippincott - Raven; 1998; 338.
6. Meyer CN, Dossing N, Broholm H. Tracheobronchopathia osteochondroplastica. Respir Med 1997; 91 (8) : 499-502.