A Bumpy Ride Through a Turbulent Airway: But Not Always-A Case Report of Tracheobronchopathia Osteochondroplastica

Tracheobronchopathia osteochondroplastica (TPO) is a rare, benign condition characterized by the presence of submucosal cartilaginous and osseous nodules protruding into the anterior and lateral walls of the tracheobronchial lumen, sparing the posterior membranous wall. These nodules are incidentally discovered on imaging and bronchoscopy performed for unrelated respiratory symptoms. The exact etiopathogenesis is unclear, with various hypotheses proposed. The most widely accepted one is that chronic inflammation leads to cartilaginous and osseous metaplasia of the tracheobronchial submucosa. TPO is rare, with the prevalence further underestimated due to the incidental nature of the diagnosis. Clinically, patients may be asymptomatic or can have nonspecific symptoms such as chronic cough, dyspnea, and recurrent respiratory infections. Suspicion of the diagnosis arises upon incidental identification of nodules in the tracheobronchial lumen. Diagnosis is established through bronchoscopic visualization of characteristic nodular lesions sparing the posterior wall and can be confirmed by histopathologic examination showing submucosal cartilage formation and ossification. Management is generally conservative, focusing on symptomatic relief and treatment of infections. Severe cases with significant airway obstruction may warrant advanced bronchoscopic procedures or surgical interventions. Despite its benign nature, TPO can mimic other serious tracheal diseases. Awareness of this condition is essential for accurate diagnosis and appropriate management. We present a case of a 65-year-old asymptomatic chronic smoker who was found to have tracheal nodules on thoracic imaging. Bronchoscopic evaluation was consistent with TPO, with histopathology reaffirming the diagnosis.