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Weekly Chest CasesArchive of Old Cases

Case No : 1437 Date 2025-05-05

  • Courtesy of Ji Young Lee, Eui Jin Hwang / Seoul National University Hospital
  • Age/Sex 27 / M
  • Chief ComplaintVoice change, dyspnea
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Relapsing polychondritis
Radiologic Findings
Fig 1. Anteroposterior radiography of neck shows segmental narrowing of subglottic airway.
Fig 2. Chest CT image shows laryngeal stenosis with wall thickening.
Fig 3-4. Chest CT images show wall thickening of trachea and bilateral main bronchi, with sparing of posterior membranous portion of trachea.
Brief Review
Relapsing polychondritis (RP) is a rare multisystem autoimmune disease of unknown origin characterized by recurrent episodes of inflammation and progressive destruction of cartilaginous tissues. Elastic cartilage of the ears and nose, hyaline cartilage of peripheral joints, vertebral fibrocartilage, and tracheobronchial cartilage may be affected. Proteoglycan-rich structures of the eye, heart, blood vessels or inner ear can also be affected. In most patients with RP manifests in a fluctuating but progressive course which eventually results in a significant shortening of life expentancy.

About 20% of patients have respiratory symptoms at presentation, and eventually a third to a half of the patients will develop respiratory tract involvement manifested by laryngeal tenderness, hoarsness, dyspnea, and stridor or wheeze.
Airway involvement causes narrowing of proximal airway, primarily larynx and trachea, while major bronchi can also be affected. CT images can show smooth airway wall thickening with luminal narrowing with increased attenuation of the wall. Notably, posterior membranous proportion of trachea would be spared. Loss of cartilaginous support of airway walls may cause air trapping of lungs in expiratory CT images.
References
1. Hansell DM, Armstrong P, Lynch DA, McAdams HP. Imaging of disease of the chest. 4th Edition, Elsevier Mosby, 2005:589-590.
2. Behar JV, Choi YW, Hartman TA et al. Relapsing polychondritis affecting the lower respiratory tract. Am J Roentgenol 2002;178:173-177.
Keywords

No. of Applicants : 68

▶ Correct Answer : 53/68,  77.9%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - IUHW Narita Hospital , Japan ISSEI FUKUDA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Oita university , Japan AYUMI KAMEI
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - , Korea (South) DONG-HO BANG
  • - , Italy PAOLO BALDASSARI
  • - Teikyo University Hospital , Japan CHIAKI SATO
  • - , Korea (South) JIN YOUNG LEE
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - , Korea (South) KANGHWI LEE
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Osaka University , Japan AKINORI HATA
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - , Japan YOSHIKI ISHII
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - , Portugal JOAO PEDRO LIMA FERNANDES
  • - Hallym University Medical Center , Korea (South) JUNGMIN LIM
  • - Oita university , Japan NORITAKA KAMEI
  • - Other , Korea (South) CHAEHUN LIM
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Mie university , Japan SHIKO OKABE
  • - , Korea (South) DAWON PARK
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kyoto University , Japan SHO KOYASU
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - CHA University, CHA Bundang Medical Center , Korea (South) HWANGSEON JU
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - Samsung Medical Center , Korea (South) SEONGUK KIM
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - , Sweden MOHAMAD TLASS
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - , Japan JUN YOSHIDA
  • - Jiangsu province hospital , China WANGJIAN ZHA
  • - , China ZHOU GANG
▶ Correct Answer as Differential Diagnosis : 5/68,  7.4%
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - , Japan HIROKI MIYAZAKI
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - TB centre kasaragod. , India rikhy krishnan
  • - University of Yamanashi , Japan KOJIRO ONOHARA
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Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

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