Abstract We present a rare case of severe tracheobronchopathia osteochondroplastica (TBO), incidentally discovered in a 65-year-old female following evaluation after a motor vehicle accident. The patient had previously been mildly symptomatic. This case emphasizes the importance of maintaining a broad differential for patients presenting with airway anomalies and illustrates a conservative management approach in the absence of functional impairment. Case Presentation HPI: A 65-year-old female presented to ER on after a MVA where she was a restrained passenger in a T-bone collision. She reported chest discomfort and sustained a seatbelt injury. CT imaging of the C/A/P was obtained. While no acute internal injury was found, imaging revealed abnormalities in the trachea, prompting pulmonary consultation. Patient reported no significant history of pulmonary disease and has been a lifelong nonsmoker, but reported exposure to cleaning chemicals with no associated respiratory symptoms. Initial A& PThe working diagnosis included exertional and positional wheezing, possibly attributable to the observed tracheal abnormalities. A trial of nebulized bronchodilators (albuterol) was recommended to assess symptom responsiveness. Laboratory testing revealed mildly elevated eosinophils. Despite a history of cleaning product exposure, the patient remained largely asymptomatic and had no allergic history. patient underwent elective bronchoscopy under general anesthesia after sternal fracture healing was sufficient.Examination revealed extensive, calcified, nodular lesions consistent with tracheobronchopathia osteochondroplastica (TBO), involving the left vocal cord, multiple tracheal rings, the carina, and extending into the mainstem bronchi. The posterior tracheal membrane was notably spared. The lesions did not appear malignant or consistent with HPV. Due to the rigidity of the calcified nodules, cryoprobe biopsy was limited. Standard forceps biopsy and bronchoalveolar lavage (BAL) were performed. BAL fluid was sent for cultures, including TB/AFB. The remaining bronchial segments appeared normal. The patient tolerated the procedure well and was extubated without complication. Discussion (TBO) is a rare benign disorder characterized by submucosal osteocartilaginous nodules within the tracheobronchial tree, sparing the posterior membrane. It is often incidentally discovered and can range from asymptomatic to causing significant airway obstruction. Our patient presented with a unique incidental diagnosis following trauma-related imaging, highlighting the importance of detailed airway evaluation. The disease course in this case is notable for the extensive nature of the lesions and their proximity to the vocal cords, without significant symptom burden. Conclusion such as TBO, even in asymptomatic patients. In the absence of obstructive symptoms, conservative observation is a reasonable and safe management strategy. This abstract is funded by: none
Ghaly et al. (Fri,) studied this question.