Abstract

In the population of patients who do not smoke, do not take an angiotensin-converting-enzyme inhibitor, and have a normal chest radiograph, upper airway cough syndrome, asthma, gastroesophageal reflux disease and chronic bronchitis are responsible for approximately 99% of cases of chronic cough. The diagnosis is often based upon the patient’s response to empiric therapy; nevertheless, there still remains 1% with an undiagnosed etiology. We report a case of a 76 year old female who had presented with persistent cough for roughly four decades requiring hospitalizations on multiple occasions. Despite receiving empiric therapy and the standard of care management for bronchial asthma, her symptoms were progressively getting worse. Physical examination and laboratory workup were unremarkable. Pulmonary function test was abnormal; the flow volume loop demonstrated a flattening of the inspiratory phase, which resulted into why an extrathoracic obstruction was suggested to require further workup. A chest computed tomography revealed a proliferation of bone and cartilage in the anterior and lateral walls of the trachea sparing the posterior wall. Multiple submucosal sessile cartilaginous nodules were detected by flexible bronchospy. Tissue sampling resulted in a mucosal squamous metaplasia, all findings consistent with tracheobronchopatia osteochondroplastica. The patient was treated with laser therapy with physiological and clinical response.

Key words: Tracheobronchopatia osteochondroplastica, extrathoracic obstruction, osteocartilaginous nodules, central airway obstruction, chronic cough