대한흉부영상의학회 Weekly Chest Cases

Case No : 373 Date 2004-12-18

Courtesy of Semin Chong, M.D., Tae Sung Kim, M.D., Jongho Han, M.D. / Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
Age/Sex 60 / F
Chief ComplaintIncidental abnormality on chest radiograph, known essential hypertension

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Diagnosis With Brief Discussion

Diagnosis: Tracheobronchopathia osteochondroplastica
Radiologic Findings: Chest radiograph shows diffuse narrowing of tracheobronchial lumen. Chest CT scans show nodular calcifications in the anterior and lateral wall of trachea, sparing posterior wall.
Brief Review: Tracheobroncopathia osteochondroplastica (TO), also called tracheopathia osteoplastica or osteochondroplastica, is a rare benign disease.

It is characterized by the presence of osteocartilaginous nodules (arrowheads in the left photomicrograph), within the submucosa of the cartilage-bearing airways, and affects only the anterior and lateral walls in the trachea. The clinical manifestations are variable, from asymptomatic presentation and incidental finding, to shortness of breath, cough, and hemoptysis. The mean age is 51 years for women and 42 years for men. Many different causes include chronic inflammatory or degenerative processes, ozena and chemical irritation, amyloidosis, infectious origin associated either with tuberculosis or syphilis, and hereditary causes, Two different theories of pathogenesis have been proposed: ecchondrosis and exostosis from the cartilage rings, or cartilaginous and osseous metaplasia of the elastic tissue in the internal elastic fibrous membrane. Radiographic abnormalities are usually confined to the trachea and proximal bronchi, manifested by diffuse luminal narrowing that may depict a nodular pattern.
Most reports described involvement of the trachea, but distal involvement at the level of the lobar bronchi manifesting atelectasis. CT, which is the imaging modality of choice, reveals the presence of abnormal nodular calcifications that protrude into the tracheal lumen involving the anterior and lateral walls, as well as wall thickening adjacent to the cartilages with sparing of the posterior or membranous portion of the tracheal wall, and deformed tracheal cartilage rings without evidence of extrinsic compression. Radiologic differential diseases include tracheobronchial amyloidosis, tracheobronchial papilomatosis, relapsing polychondritis, tracheal tumors, mediastinal fibrosis, mediastinal malignant tumors, lymphoma, Wegener granulomatosis, and Saber-sheath deformity. There is no specific therapy for this entity. Treatment options have varied from a conservative management, laser resection, and radiation therapy to more aggressive surgical repair or placement of stents to maintain the tracheal lumen.
References: 1. Restrepo S, Pandit M, Villamil MA, Rojas IC, Perez JM, Gascue A. Tracheobronchopathia osteochondroplastica: helical CT findings in 4 cases. J Thorac Imaging. 2004;19(2):112-6.

2. Zack JR, Rozenshtein A. Tracheobronchopathia Osteochondroplastica: Report of Three Cases. Journal of Computer Assisted Tomography. 2003;26(1):33-36.
Keywords: Airway, Non-infectious inflammation, Tracheal abnormality,

No. of Applicants : 41

▶ Correct Answer : 35/41, 85.4%

- Aditya Imaging Centre, Baroda, India Vivek Patel
- Annecy Hospital, France Gilles Genin
- Asan Medical Center, Korea Eun Jin Chae
- Auxerre Hospital, France Sebastien Larive
- Boomin Hospital, Busan, Korea Sangwoo Lee
- Catholic University Kangnam St mary hospital, Korea Chae Hun Lim
- Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
- CHU Nancy-Brabois, France Denis Regent
- Chungnam National University Hospital, Korea Mi Hyun Park
- CIM Saint Dizier, France JC Leclerc
- Clinic OBP, Russia Lepikhina Dasha
- Dong-A University Hospital, Korea Ki-Nam Lee
- Ewha Womans University Mokdong Hospital, Korea Yoo Kyoung Kim
- Govt. Medical College, Vadodara , India Vijay Vaidya
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Hospital Universitario de Valme, Sevilla, Spain Marcos Sanchez Moreno
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Jinju Jeil Hospital, Korea Hyung Gon Lee
- Kokura Memorial Hospital, Japan Kouei Uchida
- Korea University Hospital, Korea Kyoung-Rae Kim
- Mallinckrodt Institute of Radiology, USA Jin Mo Goo
- Marien Hospital, Hamm, Germany Davis Chiramel
- Max Hospital, Delhi, India Vickrant Malhotra
- Naples, Ospedale Monaldi, Italy Gaetano Rea
- National Taiwan University Hospital, Taiwan Tan Che Kim
- National Taiwan University Hospital, Taiwan Lin Sheng-Hsiang
- Sharma Clinic, Jaipur, India Dinesh Sharma
- Shiga University of Medical Science, Japan Yukihiro Nagatani
- Seoul National University Hospital, Korea Heesun Park
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Soonchunhyang University Cheonan Hospital, Korea Hae Seung Lee
- University of Colorado, USA Brian Petersen
- Wagga Medical Imaging, NSW, Australia Rashid Hashmi

▶ Semi-Correct Answer : 2/41, 4.9%

- Hospital of the University of Pennsylvania, PA, USA Paul Kinniry
- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 373 Date 2004-12-18

Discussion

No. of Applicants : 41