Clinical Case of Tracheobronchopathia Osteochondroplastica

Abstract

Tracheobronchopathia osteochondroplastica (TO) is a rare chronic disease of the airways characterized by the growth of cartilage and/or bone tissue in the submucosal layer of the trachea and large bronchi with varying degrees of their lumen narrowing. In a significant percentage of cases diagnosis is made only posthumously due to the late onset of clinical manifestations and the considerable complexity of life-time diagnostics.The objective of the research was to conduct the clinical observation of OT.Materials and methods. A patient Sh., 49 years of age, was admitted to the department of differential diagnostics of regional clinical pulmonology center to determine the cause of prolonged cough and bronchial obstruction syndrome. Only fiber-optic bronchoscopy (FBS) was the only informative method of examination. On the mucous membrane of the trachea and right main bronchus the dense white protuberance was found. The biopsy material was taken. Histological examination revealed areas of calcified cartilage located in subepithelial layer. Results. Taking into account the reasearch data, the TO was suspected. The disease has a benign course for many years and is asymptomatic at initial stages. However, deformation and narrowing of the lumen of the trachea and the large bronchi with epithelial atrophy causes a disturbance of phlegm discharge. This promotes the development of infectious and inflammatory processes in the lung tissue. Patients complain of cough, hemoptysis, shortness of breath, chest pain. X-ray examination of the lungs may detect the infiltrative changes. The indicators of lung function are normal or correspond to the type of obstructive disorders. CT radiograph and virtual bronchoscopy determine the deformation and narrowing of the trachea and the large bronchi due to the elements of cartilage and bone tissue. Definitive diagnosis is possible only according to the results of FBS and histological examination.Conclusions. Awareness on such rare pathology as TO is essential, especially in patients with chronic cough. In case of absence of specific clinical and radiographic changes, the computed tomography of the chest and FBS with for histological examination sampling should be performed to confirm the diagnosis.