Chest Imaging

Tracheobronchopathia osteochondroplastica

unusual benign disease of unknown aetiology involving the trachea and major bronchi that is characterized by formation of multiple submucosal osteocartilaginous growths within the anterior and lateral walls. As they contain no cartilage, the posterior walls are spared. Rarely, the larynx is affected. Pathologically, the nodules are hard and irregular in size and shape, typically 2-5 mm. They are composed of submucosal islands of hyaline cartilage with areas of lamellar bone and occasional marrow elements. The mucosal surface is intact and the perichondrium is in connection with the inner tracheal cartilage perichondrium, suggesting that the lesions arise from native cartilage. Although most patients are adults older than 50 years at diagnosis, the disease can affect patients of all age groups. Men are affected three times more often than women. Symptoms include dyspnoea, cough, sputum production and haemoptysis.

The radiographic abnormalities include a spectrum of findings ranging from normal to marked nodular narrowing of the tracheal air column, depending on the severity of the disease. Calcifications within the nodules may be revealed. On CT scans, the tracheal cartilages are thickened and contain irregular calcifications. Multiple sessile or polypoid nodules with or without calcifications may be seen protruding into the lumen from the anterior and lateral walls. Generally, a long segment of the trachea is involved. Extension to the main stem bronchi may be present.

PG