Abstract Introduction Tracheobronchopathia osteochondroplastica (TBO) is a rare, often underdiagnosed disorder of unclear etiology, characterized by multiple cartilaginous and/or osseous submucosal nodules projecting into the tracheobronchial lumen, typically sparing the posterior membranous wall. Involvement of the larynx or subglottic region is exceedingly uncommon. We present a rare case of TBO extending into the larynx, associated with bilateral vocal cord immobility and critical airway obstruction requiring tracheostomy. Case Presentation A 48-year-old man with diabetes presented with progressive hoarseness, stridor, and dyspnea over one year, with a prior hospitalization for presumed tracheal stenosis. ENT was consulted and a flexible laryngoscopy revealed bilateral vocal cords fixed in a paramedian position with a markedly narrowed glottic airway. Workup for potential causes of vocal cord fixation, including imaging and laboratory studies, was unremarkable. CT of the neck and chest demonstrated nodular thickening and calcification of the larynx and trachea extending into the proximal bronchi, sparing the posterior wall, along with bilateral ground-glass opacities and mild mediastinal lymphadenopathy. Serologic testing, including ANA and PR3/MPO-ANCA, was negative. Due to critical airway narrowing, an awake tracheostomy was performed. The tracheal cartilage was markedly thickened, firm, and calcified. Bronchoscopy revealed multiple sessile, whitish nodules along the anterolateral tracheal walls, sparing the posterior wall. Histopathology showed cartilage and dense fibrous tissue with marked ossification and focal bone marrow formation, consistent with TBO. Postoperatively, the patient was briefly managed in the medical intensive care unit for tracheostomy care and suctioning. He was also treated for community-acquired pneumonia due to Klebsiella pneumoniae, with good response to intravenous antibiotics. He was discharged home with ENT follow-up. Discussion CT imaging is the most reliable noninvasive screening tool for TBO, although early disease may be missed. Bronchoscopy remains the gold standard for diagnosis, while histopathologic confirmation is useful for excluding conditions such as tracheal amyloidosis, relapsing polychondritis, or papillomatosis that mimic TBO. There is no definitive treatment for TBO. Management is guided by symptom severity and degree of airway obstruction, ranging from inhaled corticosteroids to bronchoscopic debulking or surgical intervention for critical stenosis. Importance Our case demonstrates that TBO may extend to the laryngeal regions and may be associated with vocal cord immobility—an association warranting further study. Clinicians should consider TBO in the differential diagnosis of chronic upper airway obstruction, as early recognition and monitoring can help prevent severe complications, including the need for tracheostomy. This abstract is funded by: None
Pragya et al. (Fri,) studied this question.