A 58 year old male presented with wheezing.

1. What is the diagnosis?

2. Which is a  finding  that is critical to narrow your differential:

3. Relapsing Polychondritis (which has a similar look), differs from this entity by? 

Correct answer:

1. What is the diagnosis? 

Tracheobronchopathia Osteochondroplastica (TBO) . It is rare airway disease characterized by the

presence of nodules on the trachea and bronchial walls.

2. Which is a  finding  that is critical to narrow your differential: 

Sparing of the posterior membrane

3. Relapsing Polychondritis (which has a similar look), differs from this entity by? 

Smooth Thickening (instead of bumpy nodules)


KEY FEATURES

• Spares the posterior membrane.

• You have development of cartilaginous and osseous nodules within the submucosa of the tracheal and bronchial walls.

• Classically involves the lower 2/3rds of the trachea and proximal portions of the bronchi.

• Most patients are asymptomatic, and it's an incidental findings. (Sometimes they ulcerate & bleed → hemoptysis in the setting of infection).

• DDx:

• Relapsing Polychondritis - Also spares the posterior membrane. But, has smooth narrowing (not nodules). These guys have symptoms, and get systemic cartilage issues & recurrent pneumonia.

• Amyloid - Can involve the trachea, but typically does involve the posterior membrane.

• Wegeners - The trachea is often involved. Does involve the posterior membrane.

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