An uncommon cause of chronic cough - a case of tracheobronchopathia osteochondroplastica

Introduction. Tracheobronchopathia osteochondroplastica (TO) is an exceptionally rare disorder with unknown aetiology. Because its symptoms are nonspecific and radiologic findings may be subtle, TO is frequently overlooked, leading to repeated evaluations before the correct diagnosis is established. Case presentation. A 67-year-old woman experienced a chronic cough lasting six months and recurrent respiratory tract infections. Initial imaging and spirometry were inconclusive, therefore multiple differential diagnoses were explored. Despite several computed tomography (CT) examinations, characteristic airway abnormalities were not recognized until retrospectively reviewed. Bronchoscopy revealed firm cartilaginous nodules throughout the trachea and main bronchi, arising from the cartilaginous rings and sparing the posterior membranous wall. Biopsy by forceps was technically challenging. Histological examination of the specimen revealed only mild chronic inflammatory changes without osseous or cartilaginous tissue. The combination of endoscopic findings, clinical presentation and retrospective imaging review supported the diagnosis of TO. The patient was managed conservatively, as no significant airway obstruction was present. Conclusions. TO should be considered in patients with chronic cough, recurrent infections or other unexplained respiratory symptoms. Improved awareness among clinicians may enable earlier recognition, minimise unnecessary testing, and reduce the risk of complications.