Tracheobronchopathia osteochondroplastica is a rare condition of unknown aetiology, characterized by tracheal and central bronchial luminal narrowing. Submucosal nodularity and sparing of the posterior wall is characteristic of this pathological condition. It has to be differentiated from other causes of tracheobronchial narrowing.

A 55-year-old man came with history of cough and wheezing since six months. Since the past two months, he had developed stridor, and had received ayurvedic treatment with no relief.

Pulmonary function test was suggestive of severe expiratory outflow obstruction.

CT scan was then performed, which showed nodular thickening of the anterior and lateral tracheal wall, sparing of the posterior tracheal wall, with luminal narrowing. It was seen to involve the entire length of the trachea and the main bronchi. Calcification of few of the submucosal nodules was seen. There was no evidence of lymphadenopathy and the pretracheal and paratracheal soft tissues were normal.

Tracheopathia osteochrondroplastica is an uncommon abnormality of the cartilaginous tracheal wall, characterized by the presence of osteocartilaginous calcified nodules within the submucosa, with variable degree of diffuse tracheal narrowing.1 The disorder is usually asymptomatic and most of the cases have been diagnosed incidentally at autopsy or during bronchoscopy.2 However, a small number develop severe airway stenosis. Symptoms may include dyspnoea, hoarseness, cough, haemoptysis, and recurrent pneumonia.2,3

Plain chest X-ray films are often unremarkable but may demonstrate atelectasis, consolidation, tracheal nodularity, or narrowing.3

CT scans show thickening of the interstitial structures of the trachea and central bronchi. Multiple calcified submucosal nodules are seen. The trachea and central bronchi appear distorted, and narrowed, with variation in caliber along their lengths. The posterior membranous wall of the trachea is spared, because it does not contain cartilage, as is seen in our case. This helps to differentiate tracheobronchopathia osteochondro-plastica from amyloidosis, where the posterior membrane is also involved.4,5 The other differential diagnoses of nodular excrescences include endobronchial sarcoidosis, calcifying lesions of tuberculosis, papillomatosis and tracheobronchial calcinosis. Awareness of the condition as a differential diagnosis to neoplasms is important, to avoid unnecessary surgery or chemotherapy.6