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Weekly Chest CasesArchive of Old Cases

Case No : 228 Date 2002-03-09

  • Courtesy of Mi-Ran Jung, M.D. Jin Seong Lee, M.D., Koun-Sik Song, M.D. / Asan Medical Center, Seoul, Korea
  • Age/Sex 54 / F
  • Chief ComplaintHoarseness and sputum for several months
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Trachebronchopathia Osteochondroplastica
Radiologic Findings
Axial CT scans show irregular narrowing of the trache and central bronchi with mural calcification, calcified nodules. Coronal reformatted image and SSD image show well general configuration of tracheobronchial tree. Virtual bronchoscopic images show irregular narrowing of the tracheal lumen with excellent correlation with corresponding real bronchoscopic images.

Excision of subglottic nodule, which is seen on first axial image, revealed chronic inflammation with osteocartilagenous tissue, consistent with trachebronchopathia osteochondroplastica. Congo-red staining for the specimen failed to demonstrate any findings suggesting amyloiodosis.
Brief Review
Tracheobronchopathia osteochondroplastica (TO) is a rare idiopathic and usually asymptomatic disorder of old man: This disorder is characterized by submucosal cartilaginous or bony nodules projecting into the lumen of the trachea and major bronchi, sparing the posterior membranous portion. When symptoms are present, they include dyspnea, cough, wheezing, hoarseness and hemoptysis that can be the result of an ulceration of a nodule or an acute infection. Chest X-ray may show calcification of the tracheobronchial tree, especially in the lateral projection. CT of the trachea and major bronchi reveals calcific nodules projecting in to the lumen, thus distorting their normal configuration. These calcific deposits are absent in the posterior wall. Bronchoscopy is diagnostic. The tracheal and bronchial walls present numerous sessile and polypoid nodules with 3 to 8 mm diameter. Biopsies are often difficult to perform because of the hard consistency of the nodules.
The etiology of the disease is still unknown. Two major pathogenic theories have been proposed: (a) Virchow affirmed that TO lesions are the result of ecchondrosis and exostosis from the perichondrium of cartilage rings; (b) Aschoff thought TO to be due to cartilaginous and bony metaplasia of elastic tissue.
The prognosis of TO is generally good and depends upon the airway stenosis caused by the nodules. The disease is rarely progressed.
References
1. Prakash UBS. McCullough AE. Edell ES, Nienhuis DM. Tracheopathia Osteoplastica: familial occurrence. Mayo Clin Proc 1989;64:1091-6.
2. Lundgren R, Stjernberg NL. Tracheobronchopathia osteochondroplastica: a clinical bronchoscopic and spirometric study. Chest 1981;80:706-9.
3. Mariotta S, Pallone G, Pedicelli G, Bisetti A. Spiral CT and endoscopic findings in a case of tracheobronchopathia osteochondroplastica. J Comput Assist Tomogr 1997;21:418-420
4. Van Nierop MA, Wagenaar SS, Van Den Bosch JM, Westermann CJ. Tracheobronchopathia Osteochondroplastica: report of four cses. Eur J Respir Dis 1983;64:129-33.
Keywords
Airway, Non-infectious inflammation,

No. of Applicants : 26

▶ Correct Answer : 21/26,  80.8%
  • - Choong-ju Hospital Konkuk University, Korea Chang Hee Lee
  • - CHU Nancy-Brabois, France Denis Regent
  • - Clinic SC, Brazil Arismar Leon Pereira
  • - Dong-eui Medical Center, Korea Ha Jong Lee
  • - Ewha Womans' University, Mokdong Hospital, Korea Kyung Soo Cho
  • - Gochang Hospital, Korea Jiyong Rhee
  • - Gospel Hospital Kosin University, Korea Kyung Hwa Jung
  • - Harasanshin hospital, Fukuoka, Japan Shunya Sunami
  • - Ilsan Gospel Hospital, Korea Hoe Seok Jung
  • - Inha University Hospital, Korea Dong-Jae Shim
  • - Korea Cancer Center Hospital, Korea Donghee Park
  • - Masan Yeonse Hospital, Korea Sang Hee Lee
  • - Ospedale di Jesi, Italy Giancarlo Passarini
  • - Public Health Center, Korea Seung Hyung Kim
  • - Samsung Medical Center, Korea Young Cheol Yoon
  • - Samsung Medical Center, Korea Chin A Yi
  • - Sctimst, Trivandrum, India Vilvendhan Rajendran
  • - Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
  • - Sungji Hospital, Korea Jung Hee Kim
  • - Wallaece Memorial Baptist Hospital, Korea Mi ok Sunwoo
  • - Hyung Geun Lim
▶ Semi-Correct Answer : 5/26,  19.2%
  • - Bharat Scans, Chennai, India R G Gopinath
  • - Daejeon Sun Hospital, Korea Dong Jip Na
  • - Pulmonologist, Korea Jae-Joon Yim
  • - Xray Clinic, Pune, India M D Rahalkar
  • - Hye Sung Kim
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