Polypoidal Trachea: A Clinician's Predicament

Published:November 30, 2018DOI:
      A 44-year-old asymptomatic female patient with no known comorbidities was scheduled for donor kidney harvesting for her husband. During intubation, the anesthetist found multiple polypoidal lesions just below the vocal cords, studding the tracheal wall. A diagnosis of multiple tracheal papillomatosis was made, and the patient was referred to the Otorhinolaryngology Department for further evaluation. Flexible bronchoscopic assessment revealed multiple submucosal calcified nodules distributed along the anterolateral tracheal wall, sparing the posterior membranous wall (Figure A). Further, narrow-band imaging (NBI) did not reveal any vascular pattern typical of papillomas (Figure B), excluding the possibility of tracheal viral papillomatosis. A prompt imaging diagnosis of tracheobronchopathia osteochondroplastica (TO) was made using NBI assistance. Endoscopic biopsy was performed, which demonstrated submucosal chondroid tissue as well as foci of ossification, confirming the clinical diagnosis. Contrast-enhanced computed tomography (CECT) of the chest was performed preoperatively to assess the airway lumen and to estimate the possible size of endotracheal tube to be used during intubation (Figure C and D). The anesthetist was made aware of the benign nature of the condition, and the patient underwent successful surgery without any intubation difficulty using a smaller size endotracheal tube (6.5 mm).
      FigureFiber-optic bronchoscopic image showing multiple submucosal nodules characteristically sparing posterior membranous (A). Narrow-band imaging not showing the intraepithelial capillary loop pattern with dark brown dots (B). Axial and coronal scan depicting calcifications within the tracheal lumen (C and D).
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