Tracheopathia osteochondroplastica: a case report illustrating the importance of imaging in this rare disorder

Tracheopathia osteochondroplastica (TPO) is an uncommon and benign abnormality of the cartilaginous tracheal wall. It is characterized by multiple calcified nodules in the submucosa of the trachea and main bronchi. This disorder can present as a wide range of nonspecific symptoms; therefore, TPO is usually found as an incidental finding during bronchoscopy. However, it does pose a risk for complicated intubations and recurrent respiratory infection. The etiology of the disease is unknown, and treatments are often only for symptomatic relief, if necessary. In this report, we present a case of a 71-year-old woman who presents with chest pain and dyspnea on exertion. She has a history of takotsubo cardiomyopathy, and the symptoms have been persistent since the diagnosis over 6 months ago. A chest computed tomography (CT) demonstrated possible endobronchial lesions and minimal fibrosis. A bronchoscopy was completed following this observation, and it revealed nodular lesions on the cartilaginous rings of the trachea. She was diagnosed with TPO. The patient also has a history of gastroesophageal reflux disease (GERD) and reports relief from chest pain and dyspnea post-esophageal dilation for dysphagia. This case illustrates the relationship between esophageal, cardiac, and pulmonary symptoms, and highlights the role of imaging in the diagnosis of TPO. It also demonstrates a possible treatment option for symptomatic TPO that hasn't previously been discussed.