Letters to the Editor
To the Editor:
Tracheopathia osteochondroplastica (or osteoplastica; TPOC) is a benign disorder that results in an unusual finding on bronchoscopy or radiographic imaging. Its reported incidence varies from 2 to 7 per 1000 individuals.1 Initially described in 1855 by Rokitansky and in 1856 by Luschka, it was originally reported as a tumoral growth.2–4 Later case reports determined the benign course of this entity.5–7 It has been described that more aggressive stages of TPOC can prompt the development of symptoms: shortness of breath or stridor is attributed to narrowing of the lower airway. In severe cases in which antitussives do not relieve symptoms, dilation or laser excision may be required for palliation.
TPOC may be diagnosed on chest computed tomography in which smooth, hyperdense areas underlie the mucosa (Fig. 1). In mild cases with fewer and smaller nodulations, the diagnosis is often made on bronchoscopic evaluation. These nodules originate from the tracheal rings and are not found on the posterior wall of the trachea. These areas are firm in contrast with tracheomalacia and tracheomegaly, in which the tissues appear weakened or soft. At times, the number, location, or appearance of these submucosal nodulations may trigger confusion in the bronchoscopist. Inexperienced bronchoscopists may perform unnecessary biopsies. Histologic findings will yield benign results: fragments of metaplastic cartilaginous and bony tissue (if the biopsy is deep enough) underlying normal and intact mucosa.
To aid in diagnosis and prevent complications from unnecessary biopsies, we describe the autofluorescence pattern of TPOC. The principle of autofluorescence bronchoscopy relies on the use of blue light for illumination, causing the mucosal appearance to change. Two wavelength images are recorded: malignant or highly perfused areas (red appearance) can be easily distinguished from normal nearby tissues (green). As expected, the mucosal appearance is benign; throughout the tracheobronchial tree there is a smooth, continuous green mucosal appearance (Fig. 2), provided that there is no induced airway trauma.
Gustavo Cumbo-Nacheli, MD
Thomas R. Gildea, MD, MS
Respiratory Institute Cleveland Clinic Foundation Cleveland, OH
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