Abstract Introduction Tracheobronchopathia osteochondroplastica (TPO) is a rare, benign condition characterized by the presence of osseous and cartilaginous nodules projecting into the tracheal lumen. Often asymptomatic, TPO is typically discovered incidentally during bronchoscopic examinations performed for unrelated indications. Although usually nonprogressive, TPO can occasionally contribute to airway obstruction or complicate respiratory management in critically ill patients. We report a case of TPO incidentally identified in a trauma patient following a severe cervical spine injury, highlighting the diagnostic challenges and implications for long-term pulmonary management. Case Presentation A 50-year-old man presented after an assault with anterior subluxation of C4 on C5, spinal cord compression at C5/C6, and left vertebral artery dissection. He underwent closed reduction, C3-C6 fusion, and decompressive laminectomies at C4-5 (complete) and C6 (partial). Postoperatively, he developed left-sided atelectasis suspected from mucus plugging. Bedside bronchoscopy revealed nodular thickening of the anterior and lateral tracheal walls near the carina and proximal main bronchi, with minimal secretions. Interventional pulmonology evaluation and tracheal biopsies confirmed TPO- benign bronchial epithelium with lamellar bone formation and patchy squamous metaplasia without dysplasia or malignancy. The focus remained on ventilator weaning and multisystem trauma management. Follow-up included pulmonary function testing and periodic respiratory evaluation to monitor for obstruction or infection. Discussion TPO is an uncommon condition of uncertain etiology, characterized bronchoscopically by multiple submucosal nodules along the anterior and lateral tracheal walls, sparing the posterior membrane. In this patient, TPO was unexpectedly discovered during airway evaluation after cervical spine trauma. Although TPO rarely requires acute intervention, its coexistence with prolonged ventilatory dependence raises concern for impaired mucociliary clearance and airway obstruction. In patients with spinal cord injury and recurrent infections, conservative management and vigilant follow-up are appropriate. Pulmonary function testing helps detect progression that might later require therapeutic intervention. Conclusions This case underscores TPO as a rare incidental finding in a trauma patient with respiratory failure. While typically benign, its presence may complicate airway management in those requiring prolonged mechanical ventilation. Multidisciplinary supportive care and ongoing respiratory monitoring are essential to optimize outcomes. This abstract is funded by: none
Kumar et al. (Fri,) studied this question.