SESSION TITLE: Bronchology Cases
SESSION TYPE: Case Reports
PRESENTED ON: Sunday, March 23, 2014 at 09:00 AM - 10:00 AM
INTRODUCTION: Osteochondroplastic tracheobronchopathy (OT) is a rare benign disorder, with unknown etiology, characterised by the presence of osteocartilaginous nodules within the submucosa of the anterior and lateral walls of the trachea and the main bronchus.
CASE PRESENTATION: Case report 1: 70 year-old male, past smoker, with a history of pulmonary tuberculosis, was sent to Pulmonology for a lung nodule observed in a chest x-ray. He complained of occasional cough and uncharacteristic left thoracic pain. The chest-CT revealed lung micronodules, the biggest with 8.6 mm, diffuse bronchiectasis and small irregular nodularities, with tracheobronchial lumen projection. The patient was submitted to a bronchofibroscopy, where nodular deformities in the anterior and lateral walls of the trachea were observed and biopsied. The histological examination confirmed the diagnosis of OT. No specify therapy was initiated and the patient maintained follow-up. Now, 2 years after the diagnosis, he is asymptomatic and with radiological stabilization of the lesions. Case report 2: 70 year-old male, admitted to the hospital for a left pleural effusion, which was interpreted as metapneumonic and treated with antibiotherapy for 17 days. The chest-CT revealed a left pleural effusion and calcified nodular irregularities in the lower portion of the anterior wall of the trachea. After hospital discharge, the result of blood cultures were obtained, which were positive for Mycobacterium Tuberculosis (MT), and the patient was readmitted. He initiated tuberculostatic treatment and was submitted to a bronchofibroscopy, where white ‘rock’ lesions were observed in the distal portion of trachea and were biopsied. The histological examination confirmed the diagnosis of OT. MT were isolated from bronchial secretions and the diagnosis of Pulmonary Tuberculosis was also established. The patient had hospital discharge and now he is the 4-month of treatment and is asymptomatic.
DISCUSSION: As described in the literature and observed in these patients, the diagnosis of OT is usually incidental and the clinical course is benign, with only a few cases requiring local specific treatment for stenosis or uncontrolled symptoms. It is also worth noting the increasing risk of infections.
CONCLUSIONS: We highlight the high specificity of the radiological and endoscopic changes described, an therefore the importance of thinking in this diagnosis when they are present.
Reference #1: Pinto JA, Silva LC, Perfeito DJP. Osteochondroplastic tracheobronchopathy - report on 2 cases and bibliographic review. Braz. j. otorhinolaryngol. 2010 Nov./Dec., vol.76 no. 6
DISCLOSURE: The following authors have nothing to disclose: Marta Sousa, Vitor Melo, Eloisa Silva, Jorge Vale, João Silva, Bárbara Rodrigues, António Torres
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