SESSION TITLE: Bronchology/Interventional Student/Resident Case Report Posters II
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Tracheobronchopathia Osteochondroplastica (TPO) is a rare disorder of the large airways characterized by benign submucosal cartilaginous and bony nodules involving the anterior and lateral walls, usually sparing the posterior walls due to lack of cartilage.1 We present a patient with respiratory failure requiring multiple intubations and tracheostomy due to TPO.
CASE PRESENTATION: A 72-year-old male with coronary artery disease and COPD presented with progressive dyspnea leading to respiratory failure and suspicion for a tracheal tumor. CT scan showed significant tracheal and bronchial mainstem calcifications with tracheal stenosis. Rigid bronchoscopy confirmed distal tracheal stenosis with firm calcified nodules along the tracheal rings. The bronchoscope was used to dilate the stenosis, then a silicone Y-stent was placed. Endobronchial biopsies showed metaplastic bone formation and ossification consistent with TPO. The patient was unable to be weaned from mechanical ventilation after 1 week and a second rigid bronchoscopy was done with stent removal and further dilation. Tracheostomy was placed for persistent respiratory failure the following week.
DISCUSSION: The incidence of TPO is thought to be around 0.11% of patients who undergo bronchoscopy.1,2 The nodules can alter the efficiency of clearing secretions leading to infections and cause variable degrees of airway obstruction.1 The clinical presentation varies from an incidental finding to central airway obstruction with chronic cough, dyspnea on exertion, and hemoptysis being the most common symptoms.1,3 CT scans will show multiple calcified or non-calcified nodules protruding into the airway. Posterior wall involvement should raise suspicion for other diagnoses.1 Pulmonary function testing can show varying inspiratory/expiratory airflow limitations or be normal based on the degree of central airway obstruction.1,3 Bronchoscopy remains the gold standard for diagnosis with histopathologic confirmation reasonable in the majority of patients.1 Treatment is usually reserved for symptomatic patients with severe airway obstruction.1 Possible treatments include laser therapy, debridement with a rigid bronchoscope, or stent placement; with >50% of patients having symptomatic improvement.1,2
CONCLUSIONS: TPO needs to be considered in the appropriate clinical context and imaging. Laser treatment, rigid bronchoscope coring, and stent placement can improve the quality of life in most cases, but did not in our patient.2
Reference #1: 1. Abu-Hijleh, Muhanned, et al. 2008. Tracheobronchopathia Osteochondroplastica: A Rare Large Airway Disorder. Lung. 186: 353-59.
Reference #2: 2. Jabbardarjani, Hamid, et al. 2008. Tracheobronchopathia Osteochondroplastica: Presentation of Ten Cases and Review of the Literature. Lung. 186: 293-297.
Reference #3: 3. Leske, Vivian, et al. 2001. Tracheobronchopathia Osteochondroplastica: A study of 41 patients. Medicine. 80: 378-90.
DISCLOSURE: The following authors have nothing to disclose: Kevin Haas, Sara Greenhill, Kevin Kovitz
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