Osteochondroplastic tracheobronchopathy: Four case reports. / Traqueobroncopatía osteocondroplástica: reporte de cuatro casos clínicos.

Introduction: Osteochondroplastic tracheobronchopathy is a rare benign chronic disease of unknown etiology. Bronchoscopy remains the gold standard for diagnosing osteochondroplastic tracheobronchopathy. Its typical findings are described as a cobblestone, rock garden, mountainscape, or stalactite cave appearance. The present work aims to show the main clinical features of this rare pathology. Clinical cases: The clinical data of four middle-aged patients, three men and one woman, were analyzed. The main clinical symptoms were chronic cough, dyspnea, and dysphonia. The patient's preliminary diagnosis was made by computed axial tomography of the chest, confirmed by bronchoscopy and histopathological examination. Treatment included medication for symptoms and, in one case, cryosurgery and argon plasma coagulation. Discussion: Diagnosing osteochondroplastic tracheobronchopathy was not easy, given its uncommon nature and non-specific symptoms often found in other pathologies. No case series articles on this pathology have been published in Peru. Therefore, we used the original articles published in other countries to reference our findings. Conclusion: Osteochondroplastic tracheopathy is a benign disease that typically affects adults. Men are more likely to be affected. Its clinical manifestations are non-specific and frequently of pharyngeal origin, and the cause is not yet defined. Chest computed axial tomography combined with bronchoscopy are the main diagnostic procedures. There is no standard treatment with consistent therapeutic effects.

Introducción: La traqueobroncopatía osteocondroplástica es una rara enfermedad crónica benigna de etiología desconocida. La broncoscopía sigue siendo el estándar de oro para el reconocimiento de traqueopatía osteocondroplástica. Sus hallazgos típicos se describen como un empedrado, un jardín de rocas, una apariencia de paisaje montañoso o de una cueva con estalactitas. El objetivo del presente trabajo es mostrar las principales características clínicas de una patología poco conocida. Casos clínicos: Se analizaron los datos clínicos de cuatro pacientes de mediana edad, tres fueron hombres y una mujer. Los principales síntomas clínicos fueron tos crónica, disnea, disfonía. Los pacientes tuvieron un diagnóstico preliminar mediante tomografía axial computarizada de tórax, confirmado por examen video broncoscópico e histopatológico. El tratamiento incluyó medicamentos para los síntomas y en un solo caso criocirugía y coagulación con argón plasma. Discusión: El diagnóstico de traqueobroncopatía osteocondroplástica no fue sencillo por ser una entidad rara, cuyos síntomas son inespecíficos y muy frecuentes en otras patologías. En Perú no se han publicado artículos de serie de casos sobre esta patología. Por lo tanto, tomamos como referencia artículos originales publicados en otros países para compararlos con nuestros hallazgos. Conclusión: La traqueopatía osteocondroplástica es una enfermedad benigna que predispone a los adultos, los hombres tienen más probabilidades de verse afectados. Sus manifestaciones clínicas son inespecíficas; frecuentemente de origen faríngeo y la causa no está aún definida. La tomografía axial computarizada de tórax combinada con video broncoscopía son los principales procedimientos para el diagnóstico. No existe un estándar de tratamiento con efectos terapéuticos consistentes.

Tracheal injury following robotic thyroidectomy: A literature review of epidemiology, etiology, diagnosis, and treatment and 3 case reports.

Robotic thyroidectomy is one of the most advanced surgical procedures used to manage benign and malignant thyroid nodules. However, complication risks such as tracheal injury still exists. Tracheal injury in robotic thyroidectomy is difficult to detect and is one of the life-threatening complications. This study reviews the current literature on the tracheal injury following robotic thyroidectomy and also discusses our findings on 2060 cases of robotic thyroidectomy via Da Vinci Surgical System performed in our department and finally presents 3 cases treated in our center. PubMed and Web of Science database were searched using Medical Subject Headings (Mesh) related to "tracheal injury" and "robotic thyroidectomy". The search was conducted without publication date limits. We reviewed the literature and summarized common causes, diagnosis and therapeutic options of tracheal injury in robotic thyroidectomy, which has been described in comparison studies or retrospective studies. Tracheal injury is often diagnosed when patients suffer from dyspnea and usually leads to severe postoperative consequences. Tracheal injury can be suspected in all patients having subcutaneous emphysema, pneumomediastinum, pneumothorax or dyspnea after robotic thyroidectomy. Tracheoscopy is necessary to determine the location and size of tracheal injury. In patients whose condition is stable and the injury is contained, conservative treatment is feasible. Certainly, primary closure or tracheotomy is necessary for patients with serious respiratory difficulty or pneumothorax.

A case of tracheobronchial amyloidosis with emphasis on differential diagnosis.

Tracheobronchial amyloidosis is a manifestation of amyloidosis of the respiratory tract characterized by focal or diffuse deposition of amyloid in the submucosa of the trachea and proximal bronchi. Tracheobronchial amyloidosis is not associated with systemic amyloidosis or pulmonary parenchymal involvement. It affects predominantly men aged over fifty. Depending on the part of the tracheobronchial tree that is affected, stenosis of the airways causes a variety of unspecific symptoms. Diagnosis is reached by means of typical presentation in CT scan followed by bronchoscopy and histopathological confirmation. Tracheobronchial amyloidosis should be borne in mind in the differential diagnosis of patients with chronic cough and/or dyspnea or recurrent respiratory infections.

Incidental Tracheocele as an Unusual Presentation of Pneumomediastinum in the Trauma Setting.

BACKGROUND Tracheocele are rarely encountered air cysts formed due to tracheal wall outpouching through a weak vantage point. The majority are acquired in the adult population and are associated with conditions that weaken the tracheal wall. Most tracheoceles are diagnosed incidentally since many are asymptomatic or present with nonspecific symptoms. Multidetector computed tomography (MDCT) scans are the most common imaging modality for diagnosis of silent tracheal cysts. Tracheocele have been very rarely documented in the trauma setting; therefore, in the setting of multiple body trauma diagnosis can be challenging. CASE REPORT We report a case of an acquired tracheocele after a high-impact blunt thoracic trauma with an admission diagnosis of suspected tracheal perforation. MDCT of the neck and chest demonstrated an irregularly multicystic-shaped air collection at the right posterolateral trachea upon evaluation. Flexible laryngoscopy and bronchoscopy results were unremarkable. CONCLUSIONS Tracheocele are rare and asymptomatic pseudo-diverticulum of the tracheal wall. Many are diagnosed incidentally with imaging studies for other conditions. Nevertheless, in the trauma setting its diagnosis can be challenging and misleading. Consideration of conditions such as tracheocele is important to prevent any unwarranted treatment modalities.

Median Sternotomy for Innominate Artery Compression Syndrome and Distal Tracheal Stenosis.

We present a case of a premature infant who had an initial diagnosis of an innominate artery compression syndrome. This was approached by a median sternotomy for an aortopexy. However, the patient was found to have a distal tracheal stenosis due to a tracheal cartilage deficiency and was treated by a tracheal resection and primary anastamosis.

Tracheobronchopathia osteochondroplastica: clinical, bronchoscopic, and comorbid features in a case series.

BACKGROUND: Tracheobronchopathia osteochondroplastica (TO) is a rare condition of unknown etiology. TO is characterized by submucosal nodules, with or without calcifications, protruding in the anterolateral walls of the trachea and proximal bronchi. The objective of this study was to describe TO features and associated comorbidities in a series of patients. METHODS: Patients suffering from TO were retrospectively included by investigators from the Groupe d'Endoscopie Thoracique et Interventionnelle Francophone (GETIF). Demographic, clinical, comorbidities, bronchoscopic, functional, and radiological characteristics, and outcomes were recorded and analyzed. RESULTS: Thirty-six patients were included (69% male with a mean of 65 ± 12 years). Chronic symptoms were described by 81% of patients including cough (74%) and dyspnea on exertion (74%). TO was associated with COPD in 19% of the cases and gastroesophageal reflux disease in 6%. A mild to severe airflow obstruction was present in 55% of the cases. CT scan showed tracheal submucosal nodules in 93% of patients and tracheal stenosis in 17%. Bronchoscopy identified TO lesions in the trachea in 65% of the cases, and 66% of them were scattered. A bronchoscopic reevaluation was performed in 7 cases, 9 ± 14 months [1-56] after initial diagnosis, and showed the stability of lesions in all cases. Three patients underwent interventional bronchoscopic treatment. CONCLUSION: The diagnosis of TO relies on typical bronchoscopic findings and can be evoked on a CT scan. Histologic diagnosis can be useful in atypical cases for differential diagnosis. Given its low consequences in terms of symptoms, lung functions, and evolution, no treatment is usually required.

Specialists' approach to tracheal collapse: survey-based opinions on diagnostics, medical management, and comorbid diseases.

OBJECTIVE: To describe the current standard of care among specialists for the routine diagnostic evaluation and medical management of stable tracheal collapse in dogs, identifying gaps between practice and scientific evidence to facilitate the development of future prospective studies. A secondary objective was to describe the perceived incidence of selected comorbid disorders in dogs with tracheal collapse and the diagnostic tests performed to evaluate for those disorders. SAMPLE: 180 veterinary specialists in 22 countries. PROCEDURES: An electronic survey was sent to 4 specialty listservs to target diplomates. Respondents completed multiple-choice and free-response questions related to the diagnostic evaluation and treatment of a theoretical stable dog with suspected tracheal collapse. RESULTS: Most respondents routinely utilized radiography, tracheobronchoscopy, and fluoroscopy to diagnose tracheal collapse and performed airway sampling, sedated airway examination, and echocardiograms to rule out comorbidities. The most frequently perceived comorbid disorders included chronic bronchitis, bronchomalacia, and myxomatous mitral valve disease. Respondents most often prescribed opioid antitussives, glucocorticoids, anxiolytics, and antibiotics as treatments. Less frequently, they utilized bronchodilators and nonopioid medications for cough. CLINICAL RELEVANCE: Despite a lack of published guidelines, specialists have similar approaches in their diagnostic and therapeutic approach to a stable dog with suspected tracheal collapse and believe evaluating for comorbid disorders is important. A description of a typical diagnostic approach and knowledge of realistic treatment goals will assist the general practitioner managing dogs with stable tracheal collapse. Additionally, gaps between current practices established via this survey and data supporting those practices exist, specifically concerning the use of antibiotics and nonopioid medications for cough, representing areas for further study.

Tracheobronchopathia osteochondroplastica: A rare case of misdiagnosis and difficult intubation.

Tracheobronchopathia osteochondro-plastica (TPO) is a rare disorder of yet unknown etiology. The common clinical features include cough with expectoration, breathing difficulty, hemoptysis, and recurrent airway infections, which can lead to a misdiagnosis as another chronic respiratory illness in a large number of cases due to the rare nature of TPO. Here we present a 25-year-old lady who was misdiagnosed as bronchial asthma for many years, and was found to have TPO after difficulty in intubation for administering general anesthesia prior to a surgical procedure.

Tracheal Diverticulum as a Cause of Recurrent Infection in Post-Lung Transplant Patients: A Report of 2 Cases.

BACKGROUND: Tracheal diverticulum (TD) is a rare entity in clinical practice, accidentally found by imaging methods. It is a potential factor for the development of chronic respiratory infections, contributing to the progression of preexisting lung diseases and putting the success of lung transplantation at risk. OBJECTIVES: This paper reports 2 cases of TD with atypical clinical presentation in post-lung transplant patients with recurrent infections and aims to present the importance of this differential diagnosis. DISCUSSION: Case 1: A 30-year-old man with terminal lung disease underwent bilateral lung transplantation with a satisfactory postoperative period. He presented with TD as a focus of recurrent infection associated with persistent hemoptysis. Indicated for surgical resection (cervicotomy with resection of tracheal diverticulum), without complications. He evolved uneventfully in the postoperative period and was clinically stable at follow-up. Case 2: A 57-year-old woman with hypersensitivity pneumonia associated with secondary pulmonary arterial hypertension and bronchiectasis underwent bilateral lung transplantation without complications. She presented with TD as a focus of infection associated with esophageal symptoms. Indicated for the surgical approach (cervicotomy with resection of tracheal diverticulum), she was asymptomatic at follow-up. CONCLUSION: Conservative treatment is recommended in elderly and asymptomatic patients. Surgical resection is based on the recurrence of symptoms and failure of clinical therapy and is the preferred approach for reported cases.

The role of MRI in the diagnosis and management of tracheal diverticulum.

BACKGROUND: Multidetector CT is currently the best imaging method for detecting tracheal diverticulum (TD). Compared with CT, MRI is radiation-free and has higher resolution. However, the MRI characteristics of this disease have not been previously reported. The present retrospective study compared the MR and CT imaging features of TD, aiming to examine the role of MRI in TD diagnosis and management. METHODS: Imaging data were collected in 26 TD patients divided into two groups, including the uninfected and infected groups. The MR and CT imaging features (size/wall/channel) of uninfected patients were compared. The performances of MRI and CT in diagnosing and monitoring therapeutic efficacy in infected TD patients were comparatively assessed. RESULTS: The uninfected group comprised 25 cases with 25 lesions confirmed by CT, including 23 lesions (92%) detected by MRI, with an average diameter of 8.5 mm (range from 3 to 15 mm). Meanwhile, the average diameter was 7.8 mm as measured by CT (range from 2.8 mm to 14.7 mm). The lesion diameters of the two cases not detected by MRI were 2.3 mm and 2 mm. MRI detected walls of all the 23 lesions (23/23), while CT detected no wall (0/23). CT showed channels in 18 lesions (18/23) versus3 for MRI (3/23). The infected case presented with a paratracheal abscess; MRI clearly showed a relationship between the abscess and the trachea, while CT could not show the lesion source. MRI also sensitively showed the whole process of lesion absorption. CONCLUSIONS: MRI can be used as a supplementary method for TD diagnosis, providing information about the wall that cannot be obtained by CT. MRI is superior to CT in diagnosing infected TD cases presenting with a paratracheal abscess, and in monitoring therapeutic efficacy in these patients.

Obstructive fibrinous pseudomembrane tracheitis after double-lumen tube intubation -a case report.

BACKGROUND: Obstructive fibrinous pseudomembrane tracheitis (OFPT) is a rare complication of endotracheal intubation. CASE: We describe the case of a 73-year-old woman who underwent short-term intubation for video-assisted thoracoscopic surgery and developed an acute life-threatening stridor two days after extubation. The patient required an emergency tracheostomy to maintain airway patency and a microscopic direct laryngoscopy procedure was performed thereafter with removal of the obstructive pseudomembrane. Subsequently, the patient also suffered a non-ST-elevation myocardial infarction. The patient successfully recovered, and the tracheostomy was subsequently decannulated two months later. Histological examination revealed mucosal ulcerations and inflammatory changes. CONCLUSIONS: OFPT is an uncommon cause of life-threatening airway obstruction after extubation that is not often recognized immediately but can usually be treated with early bronchoscopic intervention or microscopic direct laryngoscopy.

Tracheobronchopathia Osteochondroplastica: A Case Report.

BACKGROUND: Tracheobronchopathia osteochondroplastica (TO) is a rare idiopathic disease with a stable course that involves the mucous membrane of the tracheobronchial tree. Most cases present no specific symptoms, and there are currently no established guidelines for diagnosis and treatment. In this report, we discuss a single case of a patient with TO who was diagnosed based on clinical imaging and histopathology. CASE SUMMARY: A patient with a history of smoking and alcohol consumption, but no specific clinical symptoms, was diagnosed with TO after undergoing fiber-optic bronchoscopy. Nodular processes with smooth surface mucosa and detached bronchial mucosa were observed. The presence of TO was confirmed by pathological examination. CONCLUSION: The diagnosis of TO is difficult, and early fiber-optic bronchoscopy and pathological examination should be performed to facilitate the diagnosis.

Diagnóstico de divertículo traqueal por broncoscopia / Diagnosis of tracheal diverticulum by bronchoscopy

Introducción: Las anomalías congénitas de la tráquea son un grupo heterogéneo de alteraciones que se producen durante el desarrollo y crecimiento del sistema respiratorio y guarda relación con el período embrionario. En esta etapa del desarrollo, pueden presentarse malformaciones que son incompatibles con la vida. Objetivo: Presentar un caso de divertículo traqueal. Presentación del caso: Se presenta el caso de una paciente oncológica diagnosticada de un divertículo traqueal, también conocido como traqueocele. El diagnóstico se obtuvo de manera incidental, cuando a la paciente, en estudios de control por cáncer de mama, se le indicó una radiografía de tórax posteroanterior y se evidenció una lesión nodular en el vértice del pulmón derecho. Se le realizó broncoscopia y se diagnosticó divertículo traqueal. Conclusiones: El divertículo traqueal es una entidad infrecuente que puede cursar de manera asintomática. Su diagnóstico se puede realizar por tomografía axial computarizada o broncoscopia(AU)

Introduction: Congenital anomalies of the trachea are a heterogeneous group of alterations that occur during the development and growth of the respiratory system and they are related to the embryonic period. At this stage of development, malformations, which are incompatible with life, may occur. Objective: To report a case of tracheal diverticulum. Case report: The case of an oncological patient diagnosed with a tracheal diverticulum, also known as a tracheocele, is reported here. The diagnosis was made incidentally. When the patient, in control studies for breast cancer, received a postero-anterior chest X-ray and a nodular lesion was evidenced in the apex of her right lung. She underwent a bronchoscopy and a tracheal diverticulum was diagnosed. Conclusions: Tracheal diverticulum is a rare entity that can occur asymptomatically. Its diagnosis can be made by computerized axial tomography or bronchoscopy(AU)