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Vocal cord nodule biopsy section shows granulomatous inflammation with Langhans giant cells (H and E, ×40)
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... CT chest may show submucosal nodules protruding into the airway with or without calcification [1]. CT chest has often shown to be normal [3,7,8]. ...
Tracheobronchopathia osteochondroplastica (TBO) is a rare benign disease of the tracheobronchial tree characterised by osseocartilaginous nodules in the submucosa, and the exact aetiology of this disease is not known. This case report describes the presence of endotracheal nodules in a confirmed case of pulmonary tuberculosis. These nodules were initially suspected to be endobronchial tuberculosis; however, their typical bronchoscopic appearance and histopathological evidence suggested TBO. The coexistence of TBO with pulmonary tuberculosis is rarely reported. It should be considered in the differential diagnosis of endotracheal nodules after other possible aetiologies have been ruled out. It has a benign course in the majority of cases and does not require any active intervention.
... There are few reports on the combination of TO with TB. Mittal, S, etc., found that a patient with laryngeal tuberculosis had a secondary TO during the course of treatment, and concluded that the cause of the etiology of granulomatous diseases such as tuberculosis infection can lead to the development of TO. 15 Another report showed that old TB and active TB may lead to TO, 16 but whether mycobacterium tuberculosis is a direct causative factor of TO needs to be confirmed by further studies. ...
Introduction
Tracheobronchopathia osteochondroplastica (TO) is a relatively rare benign tracheobronchial disease, which is often misdiagnosed or missed. To date, there is no specific treatment for TO. The aim of this study was to investigate the clinical manifestations, imaging features, bronchoscopy results, pathological findings, and diagnostic points of TO.
Patients and methods
A total of 33 patients diagnosed with TO were enrolled. Clinical data were collected using retrospective methods in the period from January 2021 and November 2022. Descriptive analysis was used.
Results
Patients included 17 (51.5%) male and 16 (48.5%) female, with a median age of 54 years. The main clinical manifestations included cough in 15 cases, fever in 6 cases, chest tightness in 4 cases, haemoptysis in 3 cases, and chest pain in 4 cases. The time from the onset of symptoms to diagnosis was 1 week to 96 months. Some patients were diagnosed with other lung diseases, including 16 patients with tuberculosis, 2 patients with lung cancer, 3 patients with nontuberculous mycobacteriosis, 3 patients with tuberculous pleurisy, 2 patients with bronchiectasis, and 1 patient with pneumonia. Chest computed tomography (CT) scan demonstrated calcified nodules in 10 (30.3%) patients. In bronchoscopy, entire tracheal involvement was found in 21 (63.6%) patients, 12 (36.4%) patients were found to have involvement of only part of the trachea. The patients were divided into three groups according to the bronchoscopic presentation, the largest proportion was stage II (19/33), followed by stage I (8/33) and stage III (6/33). Histopathological findings showed squamous metaplasia, cartilaginous, and bony tissues.
Conclusion
TO is a slowly progressing disease with non-specific clinical symptoms and a low positive rate of imaging diagnosis, making it susceptible to misdiagnosis and missed diagnosis. The disease needs to be diagnosed by combining imaging features, fiberoptic bronchoscopy, and pathological findings.
... We recently reported a patient with TPO following laryngeal tuberculosis. [2] Treatment is usually conservative and long-term follow-up has shown that these patients may remain relatively asymptomatic for long durations. [3] Uncommonly, diagnosis is made incidentally during difficult intubation. ...
Tracheobronchopathia osteochondroplastica (TO) is an orphan disease of the tracheobronchial tree without any known etiological attributes. There are several case reports published on this condition, yet the available information about the TO is discrete and of little clinical value. This scoping review is the first large-scale review on TO that collates individual patient data from the published case reports and descriptively analyses the clinicopathological features of this unique condition along with its management approaches and therapeutic outcomes. The objective was to synthesize comprehensive literature review on TO that can aid clinical practice and further research. An electronic search conducted in five large databases, including PubMed, EMBASE, CINAHL, CENTRAL, and Web of Science, for the published articles of TO yielded 1072 items. After screening, the individual patient data of 371 TO cases from 228 eligible articles were included and analysed in this scoping review.
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.
Tracheobronchopathia osteochondroplastica (TBO) is a rare disease with unknown etiology characterized by ossifying nodules in the trachea and bronchial walls without involvement of the posterior wall of trachea. A 35-year-old woman admitted to Second Xiangya Hospital, Central South University, in August 2018 was diagnosed as TBO. She complained of dyspnea for over two years, worsening in autumn and winter, and was detected with tracheal ossification via bronchoscopy and biopsy. The patient received no special treatment, and no improvement or deterioration of symptoms was observed during the 3-month follow-up. We reviewed 60 TBO cases and found that 60% of them were female, with ages of 20-80 (53.62±15.97) years. The involved lesion sites were from the vocal cords to the bronchial segments, mainly in the trachea and bilateral main trachea, and the lower part of the trachea was more common. Combined respiratory symptoms were common. The diagnosis mainly depends on bronchoscopy and biopsy. Symptomatic treatment is the main strategy for symptomatic TBO patients, including endoscopic intervention and surgery. It is generally believed that the short-term prognosis of TBO is good, but the long-term prognosis still needs to be further studied.
