Abstract Introduction Tracheobronchopathia osteochondroplastica (TPO) is a rare, benign disorder characterized by submucosal nodular growths of bone and cartilage within the tracheobronchial wall. Approximately 400-500 cases have been reported worldwide in the literature, highlighting its rarity and the need for heightened clinical awareness. While histopathologically benign, TPO can result in significant complications such as hemoptysis and airway narrowing, underscoring the risks associated with delayed diagnosis. This report describes a case of recurrent hemoptysis secondary to TPO, emphasizing the importance of recognizing such rare conditions to prevent potential airway obstruction. Case Presentation A 58-year-old male with hypertension, hyperlipidemia, diabetes mellitus, sick sinus syndrome, and recent HSV-1 encephalitis presented with two days of right-sided pleuritic chest pain, productive cough, and hemoptysis. He denied shortness of breath, fever, or other upper respiratory symptoms. The patient had no history of smoking, consumed alcohol socially, and was not receiving anticoagulation or antiplatelet therapy. During admission, he experienced five episodes of small-volume hemoptysis. CT angiography of the chest was negative for pulmonary embolism but showed mild right pleural effusion and lower lobe opacities suggestive of atelectasis versus pneumonia. Physical examination demonstrated vesicular breath sounds with bronchial wheezing over the right lower lung region. Bronchoscopy revealed extensive smooth-margin polypoid lesions along the trachea and bilateral main bronchi, with minimal bleeding and some old blood near one lesion. Brushings and endobronchial biopsies were obtained. Tracheal brushings demonstrated metaplastic squamous epithelium, benign respiratory epithelium, and excluded malignancy. Bronchial washings grew Pseudomonas aeruginosa. Histopathology revealed fragments of benign trabecular bone with fatty bone marrow, metaplastic squamous mucosa with fibrosis, and mild chronic inflammation, confirming TPO. Discussion TPO is often overlooked in the differential diagnosis because it is rare, presents with nonspecific respiratory symptoms, and may show subtle findings on imaging that can be misinterpreted. Its clinical presentation can resemble conditions such as asthma, chronic bronchitis, relapsing polychondritis, amyloidosis, or tracheomalacia, making recognition challenging. Careful evaluation of imaging and bronchoscopy is essential. CT may reveal subtle anterior or lateral tracheal nodularity, while bronchoscopy typically shows smooth, polypoid nodules sparing the posterior wall. Histopathology confirms the benign nature and rules out malignancy. This case underscores the importance of considering TPO in patients with unexplained hemoptysis. Recognizing characteristic imaging and bronchoscopic findings can prevent delays in diagnosis and ensure appropriate management. Although TPO is generally benign and often managed supportively, awareness is crucial for monitoring potential airway compromise and planning intervention if obstruction occurs. This abstract is funded by: None
Cherian et al. (Fri,) studied this question.