Tracheobronchopathia osteochondroplastica is a rare disorder consisting of multiple hard nodules in the submucosa of trachea and main bronchi. This rare disease remains an under recognized entity due to lack of awareness. One case of such disease reported in this report
KEYWORDS:tracheopathia osteochondroplastica, trachea, tracheopathia osteoplastica, hemoptysis, chronic cough, anosmia.
Tracheobronchopathia osteochondroplastica is a disease characterized bysubmucosal osseous nodules overlying the cartilaginous rings of the trachea and main bronchi and -on rare occasions-the larynx(1) . In some situation, calcifiednodular densities will protrude into the tracheal lumen(2).However, majority of TPO patients were asymptomaticthroughout their lives. The recurrence or chronic resolvingpneumonia may appear with the deterioration of airway stenosisaccompanied by such symptoms as dyspnoea, hoarseness,persistent, productive cough and haemoptysis (3,4).
A 55-year-old non-smoker single woman was referred for evaluation of a persistent dry cough for more than one year's duration. These symptoms were thought to be caused by asthma and had been treated with various medications with no significant response. Her medical history was significant for persistent nasal congestion, postnasal drips and anosmia with no history of TB contact. Laryngeal polypectomy and nasal septetomy done at 1990 and 1991 respectively with no endotracheal tube complications. Her history of anosmia dated back may years before these operations. Multinodular goiter diagnosed 5 years ago, for which thyroid
function was normal and fine needle nodule aspirate showed a benign process.No history of
head trauma, neurological disorders, or nutritional
*Baghdad College of Medicine. Baghdad Teaching Hospital.
**Doncaster Royal Infirmary.South Yorkshire. England.
disorders. Clinical examination revealed average body built. There was multinodular goiter.
Otonasolaryngological examination showed features of allergic rhinitis. Chest auscultations revealed scattered expiratory rhonchi. Neurological examination was within normal. Pulmonary function tests including a flow volume loop proved normal. Her sputum cytology was negative for both malignant cells and acids fast bacilli stain and culture.
Computed tomography of the chest with 3D multidetecror views showed multiple, different sizes calcified nodules projected from the tracheal wall involving the whole length of the trachea with sparing of the posterior tracheal membrane and extending to both main bronchi (Figure 2and 3 ). Brain CT was normal. Laboratory tests including a complete blood count, liver and kidney functions were normal. Recent thyroid function proved normal. Fibreoptic bronchoscopy showed large numbers of "rock-like" different sizes nodules extended throughout the trachea and main bronchi and lower lobe bronchi with copius frothy secretions ( Figure1). Bronchial wash sample showed small number of mature lymphocytes and was negative both for infective microorganisms and malignant cells. Microscopic examination show non-specific chronic inflammation. Cardiothoracic consultation was arranged and rigid bronchoscopy performed with biopsy samples taken from areas in between these nodules in the trachea and main bronchi and were negative for amyloid stain, but no osseous tissue could be seen in these samples. Serial chest radiographs had been within normal.
Added together, these findings are compatible with the diagnosis of tracheobronchopathia osteochondroplastica. Differential diagnosis of nodular excrescences includes tracheobronchial amyloidosis, endobronchial sarcoidosis, calcificating lesions of tuberculosis, papilomatosis,
tracheobronchial calcinosis and relapsing polychondritis. Our patient didn't have any of the systemic symptoms that usually point out to the