Tracheobronchopathia osteochondroplastica: a cause of chronic cough and haemoptysis

Abstract

Tracheobronchopathia osteochondroplastica (TPO) is a rare disorder of the tracheopulmonary tree characterised by osseous and cartilaginous submucosal nodules projecting into the tracheal lumen, sparing the posterior tracheal membranous wall. Symptoms are non-specific and may include dry cough, hoarseness, dyspnoea, recurrent pneumonia and occasionally haemoptysis. A fibreoptic bronchoscopy showing multiple tracheal nodules followed by pathological biopsy is required to reach the final diagnosis. Here, we report two cases of TPO, both with history of biomass fuel exposure and almost similar clinical presentions with chronic cough, shortness of breath and intermittent haemoptysis. They both underwent fibreoptic bronchoscopy showing multiple tracheal nodules whose histopathological analysis showed the diagnosis of TPO. Both patients were treated conservatively and remained in good health afterwards. Physicians should be aware about the need of advanced surgical procedures including endotracheal stent placement in more severe cases.

Keywords: bronchitis; pneumonia (respiratory medicine); respiratory system.

Figure 1

Chest X-ray showing bilateral reticulonodular infiltrates with atelectasis in the right middle lobe.

Figure 2

Longitudinal sections of CT scan of the chest showing irregular-beaded appearance of trachea with small nodules in bilateral lung zones.

Figure 3

Bronchoscopic view showing diffuse nodular lesions in trachea sparing posterior tracheal wall.

Figure 4

Histological examination of biopsy of tracheal nodules showing presence of calcified tissue beneath the surface epithelium, a characteristic histological feature of tracheobronchopathia osteochondroplastica.

Figure 5

Bronchoscopy showing multiple small, rounded nodules in the tracheal lumen with sparing of posterior tracheal wall. Anthracosis was also seen in the right upper lobe.

Figure 6

Histological examination of tracheal nodules of second case showing calcified tissue.