First Case of Tracheobronchopathia Osteochondroplastica in an 82-Year-Old Patient From Saudi Arabia

Abstract

Background: Tracheobronchopathia osteochondroplastica (TPO) is a benign tracheobronchial disorder characterized by the presence of osseous or cartilaginous nodules, typically affecting the proximal large airways while sparing the posterior membranous trachea. Around 600 cases has been documented worldwide for this rare disorder. While most cases are asymptomatic, some patients may exhibit symptoms such as dyspnea and chronic cough. These symptoms could be attributed to either the ulceration of the nodules or the onset of an acute infection. As it is a vague and rare disease, TPO goes undiagnosed in most cases.

Case description: This case represents an 82-year-old male with ischemic cardiomyopathy and a history of colon cancer who presented with a six-month history of mild hemoptysis, occasional cough, and wheezing. Laboratory tests were normal except for a positive PPD test. Imaging showed tracheal thickening with nodularity and calcification, and bronchoscopy confirmed the diagnosis. The patient was managed with symptomatic treatment and close follow-up. Over 2 years, he remained stable, experiencing only two self-limiting hemoptysis episodes with resolution of other symptoms.

Conclusion: This is the first case of TPO reported in Saudi Arabia. Given its nonspecific presentation, clinicians consider TPO as a differential diagnosis for patients with recurrent respiratory symptoms that do not respond to standard medical treatment.

Level of evidence: 4.

Keywords: TPO; bronchoscopy; hemoptysis; large airway disease; tracheal stenosis.

FIGURE 1

Axial contrast‐enhanced CT image of the trachea in a lung window, showing nodular thickening of the tracheal wall.

FIGURE 2

Sagittal contrast‐enhanced CT image of the trachea in a lung window, showing nodular thickening of the anterior tracheal wall with sparing of the posterior wall.

FIGURE 3

Trachea and bronchial tree showed diffuse nodular changes, with no discrete mass or obstruction.

FIGURE 4

The changes were more prominent in the trachea and proximal bronchial tree, gradually fading toward the second‐order distal bronchi where the area is easily irritable and prone to bleeding.