Tracheobronchopathia osteochondroplastica: clinical, bronchoscopic, and comorbid features in a case series

Abstract

Background: Tracheobronchopathia osteochondroplastica (TO) is a rare condition of unknown etiology. TO is characterized by submucosal nodules, with or without calcifications, protruding in the anterolateral walls of the trachea and proximal bronchi. The objective of this study was to describe TO features and associated comorbidities in a series of patients.

Methods: Patients suffering from TO were retrospectively included by investigators from the Groupe d'Endoscopie Thoracique et Interventionnelle Francophone (GETIF). Demographic, clinical, comorbidities, bronchoscopic, functional, and radiological characteristics, and outcomes were recorded and analyzed.

Results: Thirty-six patients were included (69% male with a mean of 65 ± 12 years). Chronic symptoms were described by 81% of patients including cough (74%) and dyspnea on exertion (74%). TO was associated with COPD in 19% of the cases and gastroesophageal reflux disease in 6%. A mild to severe airflow obstruction was present in 55% of the cases. CT scan showed tracheal submucosal nodules in 93% of patients and tracheal stenosis in 17%. Bronchoscopy identified TO lesions in the trachea in 65% of the cases, and 66% of them were scattered. A bronchoscopic reevaluation was performed in 7 cases, 9 ± 14 months [1-56] after initial diagnosis, and showed the stability of lesions in all cases. Three patients underwent interventional bronchoscopic treatment.

Conclusion: The diagnosis of TO relies on typical bronchoscopic findings and can be evoked on a CT scan. Histologic diagnosis can be useful in atypical cases for differential diagnosis. Given its low consequences in terms of symptoms, lung functions, and evolution, no treatment is usually required.

Keywords: Bronchoscopy; Case report; Tracheal stenosis; Tracheobronchopathia osteochondroplastica.

Fig. 1

Radiologic and bronchoscopic features of tracheobronchopathia osteochrondroplastica. Chest CT scan shows submucosal nodules and calcifications in the trachea lumen and the proximal bronchi (A, B). Bronchoscopy reveals submucosal scattered (C) or diffuse (D) nodules protruding in the lumen of the trachea

Fig. 2

Histopathological features of tracheobronchopathia osteochrondroplastica (bronchial biopsy). HES staining (hematoxylin-eosin saffron), magnification × 400. A Voluminous cartilaginous nodule (arrow) in the subepithelial stroma. B Two calcified nodules in the subepithelial stroma with one containing bone marrow tissue (arrow)