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

Stylianos A Michaelides,Maria Chorti,George Ionas,Stephanie Vgenopoulou,George D Bablekos

doi:10.1155/2015/368485

Abstract

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.

Highlights

Tracheobronchopathia osteochondroplastica (TO) is an uncommon disorder that was first described in the middle of the 19th century and has a higher incidence in northern Europe [1]
We report the case of a male patient, who was investigated for a compact lesion in his right upper lobe (RUL) zone and eventually diagnosed to have lesions of TO only in his right main bronchus
This is about a 76-year-old heavy smoking male patient who presented with a history of 4-day duration of fever, cough, and purulent sputum

Summary

Introduction

Tracheobronchopathia osteochondroplastica (TO) is an uncommon disorder that was first described in the middle of the 19th century and has a higher incidence in northern Europe [1]. Clinical presentation is variable, ranging from complete lack of symptoms to cough, hemoptysis, breathlessness, or recurrent chest infections [3] It can more rarely cause tracheal stenosis resulting in difficult intubation of the patient [4,5,6]. We report the case of a male patient, who was investigated for a compact lesion in his right upper lobe (RUL) zone and eventually diagnosed to have lesions of TO only in his right main bronchus. The particularity about this case is the presence of these nodules exclusively along the whole length of the right main bronchial mucosa, without involvement of the trachea.

Case Presentation

Discussion

Findings

Conclusion