Tracheobronchopathia Osteochondroplastica: Diagnostic Value of Computed Tomography

Abstract

A 43-year-old woman complaining of cough and yellow phlegm was admitted to our hospital to determine the cause of her chest radiograph–identified atelectasis. A physical examination showed no abnormalities. She had tuberculous pleurisy 20 years ago, which was cured without recurrence. Her medical history was otherwise unremarkable. Multislice spiral computed tomography (CT) of chest showed diffuse submucosal calcified nodules in the anterolateral trachea and bilateral major bronchi protruding into the lumen (Figure 1A). Fiberoptic bronchoscopy showed numerous whitish nodules with intact mucosa along the lower two third of the trachea with sparing the posterior trachea (Figure 1B). A biopsy showed bony tissue in the submucosal tissue of the trachea (Figure 1C), confirming the tracheobronchopathia osteochondroplastica (TO) diagnosis. TO is a benign rare disorder of unknown etiology presenting with chronic cough (54%); lobular or segmental bronchi lesions often lead to atelectasis. Invasive fiberoptic bronchoscopy is not performed in all patients and cannot provide sufficient TO complication information. Multislice CT scans, which are sensitive to calcification, can reveal characteristic TO-related changes. TO may develop slowly into tracheal stenosis with respiratory insufficiency. Multislice spiral CT scanning is highly specific and could be important for primary TO diagnosis and follow-up. Histopathological biopsy examinations should still be performed to verify cartilage ossification.