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Weekly Chest CasesArchive of Old Cases

Case No : 695 Date 2011-02-21

  • Courtesy of Song Choi, Hyun JuSeon, Yun Hyeon Kim / Chonnam National University Hospital
  • Age/Sex 61 / F
  • Chief ComplaintCough, blood tinged sputum for 3 months
  • Figure 1
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Diagnosis With Brief Discussion

Diagnosis
Bronchopathia Osteochondroplastica
Radiologic Findings
Chest radiogram shows atelectasis of anteromedial basal segment of left lower lobe. Pre-contrast and contrast enhanced chest CT with mediastinal window setting represents a segmental consolidation and atelectasis containing a fluid bronchogram in the anteromedial basal segment of the left lower lobe with several endobronchial calcified nodules and bronchial obstruction in the proximal segmental bronchus.

A fiberoptic bronchoscopy was done and the left lower lobar bronchus was totally occluded by a hard irregularly lobulated mass that was difficult for mucosal biopsy.

A left lower lobectomy was done by way of thoracotomy. The resected tumor was 1.8 x 1.9 cm solitary calcified mass attached at the orifice of basal segment of the left lower lobe. On microscopic exam revealed and endobronchial polypoid mass, mainly composed of mature bone having abundant marrow component and mature cartilage. These features were suggestive for bronchopathia osteochondroplastica (BO).
Brief Review
Tracheobronchopathia osteochondroplastica (TBO) is a rare disorder of the large airways characterized by the presence of multiple, very small osseous nodules localized to the submucosa of the cartilaginous tracheal or bronchial wall. The lesion has mostly been reported to occur in the lower two-thirds of the trachea, and occasionally has been found to involve the proximal bronchi as well. Unlike the usual case of TBO, it is very rare that exclusive bronchial involvement and solitary mass formation.
The incidence of TBO at autopsy was estimated of approximately 3/1,000, while data from bronchoscopy were widely varying from 1/125 to 1/6000. The majority of patients have mild respiratory symptoms such as a cough, small amount hemoptysis, exertional dyspnea, wheezing or recurrent tracheobronchial infections.
The diagnosis of a TBO can be made by fiberoptic bronchoscopy; the findings of this disorder are unique and include multiple osteocartilaginous calcified nodules within the submucosa of the anterior and lateral aspects of the tracheobronchial tree; the membranous portions of the trachea are characteristically spared in contrast to tracheobronchial amyloidosis. Chest CT, MRI or virtual bronchoscopy can all detect these submucosal nodules in the trachea and main bronchi; in half of the cases the nodules are calcified.
In this case, there was no typical multiple tracheobronchial calcified nodules. Because we could not exclude lung malignancy in imaging study, surgical resection was performed.
References
1.Leske V, Lazor R, Coetmeur D, Crestani B, Chatte G, Cordier JF. Tracheobronchopathiaosteochondroplastica: a study of 41 patients. Medicine (Baltimore). 2001 Nov;80(6):378-90.
2.Nienhuis DM, Prakash UB, Edell ES. Tracheobronchopathiaosteochondroplastica. Ann OtolRhinolLaryngol. 1990 Sep;99(9 Pt 1):689-94.
3.Doshi H, Thankachen R, Philip MA, Kurien S, Shukla V, Korula RJ. Tracheobronchopathiaosteochondroplastica presenting as an isolated nodule in the right upper lobe bronchus with upper lobe collapse. J ThoracCardiovasc Surg. 2005 Sep;130(3):901-2.
4.Shigematsu Y, Sugio K, Yasuda M, Sugaya M, Ono K, Takenoyama M, et al. Tracheobronchopathiaosteochondroplastica occurring in a subsegmental bronchus and causing obstructive pneumonia. Ann Thorac Surg. 2005 Nov;80(5):1936-8.
5.Meyer CN, Dossing M, Broholm H. Tracheobronchopathiaosteochondroplastica.Respir Med. 1997 Sep;91(8):499-502.
Keywords
Airway, Bronchial abnormlity,

No. of Applicants : 110

▶ Correct Answer : 2/110,  1.8%
  • - Assam Medical College , India Pankaj Nagori
  • - Severance Hospital , Korea (South) Hyun Gi Kim
▶ Correct Answer as Differential Diagnosis : 1/110,  0.9%
  • - IRSA , France jean-luc BIGOT
▶ Semi-Correct Answer : 54/110,  49.1%
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - NTUH , Taiwan Kuei-pin Chung
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - radiologist, aditya imaging centre , India vivek patel
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - University of British Columbia , Canada Amr Ajlan
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
  • - Severance hospital , Korea (South) Saerom Hong
  • - Teleradiology solutions , India harish bhambore
  • - Catholic medical center , Korea (South) hyuna kim
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae Wook Yeh
  • - Smile Radiologic clinic , Korea (South) Sung-Kyu Choi
  • - Chonnam National University , Korea (South) se hee Jung
  • - Auckland hospital , New Zealand (Aotearoa) Yuranga Weerakkody
  • - Radiologie Brabois adultes , France ROPION helene
  • - attikon hospital , Greece konstantinos kagouridis
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Department of Radiology, Chonnam National University Hospital , Korea (South) Hyungjun Kim
  • - Chonnam national university hospital , Korea (South) Yunhong Yoon
  • - Chonnam National University Hospital , Korea (South) Jung hyun Kim
  • - Chonnam national university hosipital , Korea (South) Byung chan Lee
  • - Chonnam national univ. hospital , Korea (South) Choi Seul Gi
  • - Chonnam university hospital , Korea (South) LEE JI HYUN
  • - CNUH , Korea (South) Seoin Jeong
  • - Chonnam National University Hospital , Korea (South) Daun Lee
  • - Montreal , Canada D J
  • - Songtan public health center, Goduk substation , Korea (South) Jaewang Shin
  • - CH de la C�te Basque , France Paul ARDILOUZE
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - chungbuk uni. hospital , Korea (South) JY Ahn
  • - Hanmaeum hospital , Korea (South) Ji Young Ko
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - chest hospital , India k bhaskar
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Mallinckrodt Institute of Radiology , United States Travis Henry
  • - Gifu Chuo Hospital , Japan Yo Kaneko
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Zaid Alsheriti hospital- Alsweida , Syria jehad alakabani
  • - Seoul St Mary hospital , Korea (South) Chaehun Lim
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - St-Luc Bruxelles , Belgium Tancredi Illario
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - All India Institute of medical sciences , India Justin Moses
  • - Saga University , Japan Ryoko Egashira
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Okayama university , Japan Mayu Uka
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