[Tracheobronchopathia osteochondroplastica].

OBJECTIVE

To describe the clinical manifestations of tracheobronchopathia osteochondroplastica (TO).

METHODS

X-ray film, CT-scanning, lung function, fibro-bronchoscopy and histological examination were performed in all 4 patients. Clinical features were analyzed with reviewing the reported literatures.

RESULTS

From June 1999 to May 2000, 4 cases of TO (male/female: 2/2, age: 35 approximately 60 yrs) were found among the 1 125 cases of fibro-bronchoscopy, with the positive rate of 0.35%. TO was characterized by cartilaginous and /or osseous submucosal nodules in the trachea and the central bronchi. Symptoms included cough (3/4), hemoptysis (2/4), hoarseness (1/4), with one case of entirely symptom free. Radiography showed no use for the diagnosis. Multiple submucosal nodules and plaques that outgrew into the lumen of the trachea were revealed by CT-scanning in 3 of 4 cases. Pulmonary function testing showed normal in 3 patients and mild obstruction in 1 patient. The bronchoscopic appearance of TO presented with multiple whitish, hard nodules projecting into the tracheal lumen from anterior and lateral walls, with sparing of the posterior wall. Pathological examination showed island of bony tissue and cartilage in the submucosa with almost intact respiratory epithelium. The symptoms and mucosal hyperemia were improved in one patient treated with beclomethasone dipropionate and theophylline for 6 months.

CONCLUSIONS

As an uncommon disease, TO is often misdiagnosed or underdiagnosed. Fibro-bronchoscopy and CT scan remain the main methods for the diagnosis of TO.