An unusual cause for recurrent chest infections

Abstract

We present a case of an elderly non-smoking gentleman who, since 2005, had been admitted multiple times for recurrent episodes of shortness of breath, wheeze, cough and sputum. The patient was treated as exacerbations of chronic obstructive pulmonary disease (COPD) and/or lower respiratory tract infections. Bronchoscopy was done which revealed multiple hard nodules in the trachea and bronchi with posterior tracheal wall sparing. Biopsies confirmed this as tracheopathia osteochondroplastica (TO). He had increasing frequency of admission due to methicillin-resistant Staphylococcus aureus and pseudomonas infections, which failed to clear despite intravenous, prolonged oral and nebulised antibiotics. The patient developed increasing respiratory distress and respiratory failure. The patient died peacefully in 2012. This case report highlights the typical pathological and radiological findings of TO and the pitfalls of misdiagnosing patients with recurrent chest infections as COPD.

Figure 1

Bronchoscopy—mid-tracheal view showing multiple hard nodules protruding into the lumen, with sparing of posterior wall of the trachea.

Figure 2

Bronchoscopy showing nodule extending into right bronchus intermedius.

Figure 3

CT thorax coronal view showing abnormal areas of calcification/ossification throughout the trachea, extending to the main bronchi.

Figure 4

Comparison of the CT thorax scan in 2007 (left) and 2009 (right) taken at the level above the arch of aorta showing the progression of the ossified nodules in the trachea.

Figure 5

Ciliated respiratory epithelium with subepithelial bone formation (metaplasia).