Abstract Background Tracheobronchopathia osteochondroplastica (TPO) is a rare, benign disorder of the large airways, characterized by multiple osseous and cartilaginous nodules arising from the submucosa of the trachea and main bronchi. These nodules typically spare the posterior membranous wall of the trachea. Most patients are asymptomatic, and it is usually an incidental finding. The true prevalence is likely underestimated due to its indolent nature and frequent misdiagnosis as asthma or chronic obstructive pulmonary disease (COPD). Case report An 80-year-old man presented with stridor for 8 years, which progressively worsened for 6 months. He had a history of early-stage Chronic lymphocytic leukemia (CLL), obstructive sleep apnea, and a cervical discectomy 25 years ago. He was a non-smoker. On physical exam, the patient had a longitudinal scar in the anterior left lower neck and stridor at rest. Computed tomography of the chest and bronchoscopy showed focal stenosis of the extra-thoracic trachea. Also, several endoluminal nodules arising from the anterior cartilaginous rings that spared the membranous portion of the carina and main bronchi were found. These lesions were pathognomonic of TPO. The patient is being monitored, and his symptoms remain stable, so no intervention has been necessary. Figure 1: CT chest showing focal stenosis of the trachea. Figure 2: Bronchoscopy showing focal stenosis of the extra-thoracic trachea. Figure 3: Several endoluminal nodules arising from the anterior cartilaginous rings of the trachea, sparing the membranous portion of the carina. Discussion Tracheal injury may occur due to direct trauma during cervical spine surgeries with anterior approaches. Additionally, tracheal stenosis has been reported as a rare complication. It is possible that the use of a tracheal retractor during an anterior approach for a cervical discectomy caused tracheal stenosis related to the underlying TPO condition. Most patients remain asymptomatic, and the diagnosis is often made incidentally. Due to nonspecific findings, patients are frequently misdiagnosed with chronic obstructive pulmonary disease or asthma. Treatment is usually symptomatic, and surgery is only considered when initial measures fail. The prognosis for TPO is favorable, with patients showing minimal progression over long periods. Only a few patients have died from severe respiratory infections related to the disease. This abstract is funded by: None
Umashankar et al. (Fri,) studied this question.