Abstract :Purpose: Tracheobronchopathia Osteochondroplastica is a rare benign disease characterized by calcified sub mucosal nodules in large airways. Treatment is usually palliative with more options (laser ablation or surgical treatment) in severe symptomatic cases. No definitive treatment for this disease has been introduced yet. In current study we report a new technique of endobronchial pneumatic lithotripsy in a symptomatic case of Tracheobronchopathia Osteochondroplastica
Method: Patient was a 28-year-old woman presented with dyspnea to the referral center for pulmonary diseases in Tehran, Iran. She underwent bronchoscopy during which submucosal obstructing nodules were recognized. Pathologic evaluation of biopsies was compatible with diagnosis of Tracheobronchopathia Osteochondroplastica. As patient was reluctant to undergo surgical treatments or laser therapy, we suggested a novel procedure of applying pneumatic lithotripsy device through rigid bronchoscope in order to fragment the obstructing nodules and carefully explained the details to patient. She agreed to undergo this treatment.
Results: During the procedure pneumatic lithotripsy probe reached to obstructed segments through rigid bronchoscope channel and repeated oscillatory movements of probe by air pressure resulted in fragmentation of obstructing sub mucosal nodules. No complications were observed and patient reported symptom improvement within the first week. Spirometry demonstrated improved pattern compared to truncated flow volume loop prior to the intervention.
Conclusion: This current technique may offer a new, safe and minimally invasive treatment option for severe cases of Tracheobronchopathia Osteochondroplastica. Patients with comorbidities in whom surgery is considered high risk would benefit the most from this new method.