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Chronic cough with dual pathologies of pulmonary ossification
  1. Simon Proctor1,
  2. Helen Crocker1,
  3. Virginia Au2 and
  4. Vinod Aiyappan1
  1. 1Respiratory and Sleep Services, Flinders Medical Centre, Bedford Park, South Australia, Australia
  2. 2Division of Medical Imaging, Flinders Medical Centre, Bedford Park, South Australia, Australia
  1. Correspondence to Dr Simon Proctor; simonjamesproctor{at}gmail.com

Abstract

An 81-year-old man presented with chronic cough, which did not respond to the initiation of combined bronchodilator/inhaled corticosteroid therapy. CT of the chest revealed calcified nodules throughout the trachea sparing the posterior membrane, and tiny peripheral parenchymal nodules with basal interlobular septal thickening and calcification. Flexible bronchoscopy demonstrated endobronchial nodularity from the proximal trachea to the mid-sections of both main bronchi, sparing the posterior membrane. Histopathology revealed submucosal fibrous connective tissue and benign bone, confirming a diagnosis of tracheobronchopathia osteochondroplastica. CT was consistent with a concurrent diagnosis of dendriform pulmonary ossification. These two rare phenomena often present with non-specific symptoms, and the diagnosis can be made with imaging in both conditions. There is a role for bronchoscopy in the diagnosis of tracheobronchopathia osteochondropastica, and the endobronchial appearance could be diagnostic. The concurrence of both phenomena in our case might represent activity of a common cellular pathway of ossification in both sites.

  • radiology
  • respiratory medicine

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Footnotes

  • Contributors SP was directly involved with the care of the case. He prepared the manuscript including text and figures. He submitted the manuscript for publication. HC was directly involved with the care of the case. She provided supervision and critical editing of the manuscript. She helped produce bronchoscopic images. VAu provided critical editing of the manuscript and expert advice regarding radiologic image interpretation. She helped develop radiographic images. VAi was directly involved with the care of the case. He provided overall supervision of the drafting and submission. He provided critical editing of the manuscript and drafted the outcome and follow-up section in the template.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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