Asian Cardiovasc Thorac Ann 2004;12:280-281
© 2004 Asia Publishing EXchange Ltd
IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Tracheobronchopathia Osteochondroplastica as an Incidental Finding
Kamlesh Mohan, MRCP,
Stephen Owen, FRCP,
Chee Yeong, FRCR1
Department of Respiratory Medicine, Warrington Hospital
1 Department of Radiology, Warrington, United Kingdom
For reprint information contact: Kamlesh Mohan, MRCP Tel: 44 192 563 5911 Fax: 44 192 566 2565 Email: kamleshmohan{at}hotmail.com Department of Respiratory Medicine, Warrington Hospital, North Cheshire NHS Trust, Lovely Lane, Warrington WA5 1QG, United Kingdom.
A 75-year-old man with pulmonary metastases on the chest X-Ray was referred for bronchoscopy. In the past he underwent right hemicolectomy for Dukes B colonic carcinoma in 2001. Apart form the metastatic deposits, CT scan of the chest also showed an irregular tracheal wall with multiple nodules and calcification sparing the posterior membranous wall (Figure 1
). At bronchoscopy, multiple, white nodules were noted along the anterolateral walls of the trachea (Figure 2). The rest of the bronchial tree examination was normal. Biopsy was obtained with difficulty given the typical hard consistency of these nodules and the histology showed normal respiratory epithelium along with bony deposits consistent with an incidental finding of Tracheo Bronchopathia Osteochondroplastica (Figure 3). The patient’s poor general condition precluded further investigations and treatment and he died 6 weeks after the diagnosis.
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Figure 1. CT scan showed anterolateral distribution of the nodules, protruding in to the tracheal lumen.
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Figure 2. Bronchoscopy demonstrates multiple, diffuse endotracheal nodules, characteristically sparing the posterior membranous wall.
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Tracheo Bronchopathia Osteochondroplastica (TO) is a benign disorder characterised by the presence of hard, white, cartilaginous and or osseous nodules in the tracheobronchial tree, classically sparing the posterior membranous wall. The etiology of TO remains unknown and there is no reported association with malignancy. Most patients are asymptomatic but larger nodules may cause non-specific respiratory symptoms including rare presentations with tracheal obstruction and difficulty in tracheal intubation. Conservative management is the mainstay of treatment although techniques like laser ablation, external beam radiation and tracheal stent placement have been used in severe cases. Awareness of this benign entity and its characteristic bronchoscopic and CT appearance is important in the differential diagnosis of other tracheobronchial disorders.
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