August 2018 Imaging Case of the Month: Dyspnea in a 55-Year-Old Smoker

Michael B. Gotway, MD

Department of Radiology

Mayo Clinic Arizona

Scottsdale, AZ USA

Clinical History: A 55–year old woman presented to the emergency room with complaints of shortness of breath and lower extremity swelling. The patient noted her shortness of breath had been worsening over the previous 6 months, especially in the last 3 months. The patient denies cough, fever, chills, and night sweats. The patient admits to some fatigue but has not lost weight recently.

The patient is a current smoker, averaging about 1 pack-per-day for the previous 40 years. Her allergies include penicillin and sulfa drugs, and her prior medical history was remarkable only for hypothyroidism and gastroesophageal reflux. Her only previous surgery was for an ectopic pregnancy. The patient’s mediation list included use of opiates for pain related to a herniated disc in the lower cervical spine following an automobile accident two years earlier.

Her physical examination was unremarkable aside from obesity and mild symmetric lower extremity edema. Her vital signs were within normal limits.

Frontal and lateral chest radiography (Figure 1) was performed.

Figure 1. Frontal (A) and lateral (B) chest radiography.

Which of the following represents the most accurate assessment of the chest radiographic findings? (Click on the correct answer to be directed to the second of ten pages)

1. Chest radiography shows a mediastinal mass
2. Chest radiography shows cavitary pulmonary lesions
3. Chest radiography shows miliary nodules
4. Chest radiography shows an interstitial abnormality consisting of reticular and nodular opacities
5. Chest radiography shows basilar fibrotic opacities

Cite as: Gotway MB. August 2018 imaging case of the month: Dyspnea in a 55-year-old smoker. Southwest J Pulm Crit Care. 2018;17(2):59-69. doi: https://doi.org/10.13175/swjpcc099-18 PDF

Medical Image of the Week: Tracheobronchopathia Osteochondroplastica

Figure 1. View of trachea during bronchoscopy showing submucosal nodules.

Figure 2. H & E staining of cartilage biopsy.

A 52-year-old asymptomatic woman underwent a low dose computed tomography (CT) of chest due to long-standing history of smoking. CT chest revealed a 4 mm right lower lobe pulmonary nodule. Also noted were several nodules throughout the trachea and in the left main-stem bronchus. Bronchoscopy revealed multiple non-obstructing submucosal nodules along the tracheal rings with sparing of the posterior membranous portion of the trachea (Figure 1).  Endotracheal biopsy showed benign cartilage and ciliated epithelium (Figure 2). The patient was diagnosed with tracheobronchopathia osteochondroplastica (TO). Clinical manifestations of TO are nonspecific and include cough, wheezing, hemoptysis, dyspnea, and recurrent lung infections (1). Therapy for TO includes alleviation of symptoms with bronchodilators, treatment of respiratory infections and tracheal dilation.  Therapeutic modalities for tracheal dilation includes surgical resection, laser ablation and vaporization.  CT chest was to be repeated at 12 months for follow-up of the pulmonary nodule. The patient was lost to follow-up.

Benjamin O. Lawson MD¹, Kelechi Abarikwu², and Aditya Gupta MD³

¹Internal Medicine and ³Pulmonary/Critical Care Medicine

HonorHealth Scottsdale Thompson Peak Medical Center

Scottsdale, AZ USA

²University of Arizona Tucson

Tucson, AZ USA

Reference

1. Simmons C, Vinh D, Donovan DT, Ongkasuwan J. Tracheobronchopathia osteochondroplastica. Laryngoscope. 2016 Sep;126(9):2006-9. [CrossRef] [PubMed]

Cite as: Lawson BO, Abarikwu K, Gupta A. Medical image of the week: Tracheobronchopathia osteochondroplastica. Southwest J Pulm Crit Care. 2018;17(2):45-6. doi: https://doi.org/10.13175/swjpcc094-18 PDF