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Background: Given the rarity of tracheobronchopathia osteochondroplastica (TO), many young doctors in primary hospitals are unable to identify TO based on bronchoscopy findings., Objectives: To build an artificial intelligence (AI) model for differentiating TO from other multinodular airway diseases by using bronchoscopic images., Design: We designed the study by comparing the imaging data of patients undergoing bronchoscopy from January 2010 to October 2022 by using EfficientNet. Bronchoscopic images of 21 patients with TO at Anhui Chest Hospital from October 2019 to October 2022 were collected for external validation., Methods: Bronchoscopic images of patients with multinodular airway lesions (including TO, amyloidosis, tumors, and inflammation) and without airway lesions in the First Affiliated Hospital of Guangzhou Medical University were collected. The images were randomized (4:1) into training and validation groups based on different diseases and utilized for deep learning by convolutional neural networks (CNNs)., Results: We enrolled 201 patients with multinodular airway disease (38, 15, 75, and 73 patients with TO, amyloidosis, tumors, and inflammation, respectively) and 213 without any airway lesions. To find multinodular lesion images for deep learning, we utilized 2183 bronchoscopic images of multinodular lesions (including TO, amyloidosis, tumor, and inflammation) and compared them with images without any airway lesions (1733). The accuracy of multinodular lesion identification was 98.9%. Further, the accuracy of TO detection based on the bronchoscopic images of multinodular lesions was 89.2%. Regarding external validation (using images from 21 patients with TO), all patients could be diagnosed with TO; the accuracy was 89.8%., Conclusion: We built an AI model that could differentiate TO from other multinodular airway diseases (mainly amyloidosis, tumors, and inflammation) by using bronchoscopic images. The model could help young physicians identify this rare airway disease.

Background: Tracheobronchopathia osteochondroplastica (TO) is a rare idiopathic disease with a stable course that involves the mucous membrane of the tracheobronchial tree. Most cases present no specific symptoms, and there are currently no established guidelines for diagnosis and treatment. In this report, we discuss a single case of a patient with TO who was diagnosed based on clinical imaging and histopathology., Case Summary: A patient with a history of smoking and alcohol consumption, but no specific clinical symptoms, was diagnosed with TO after undergoing fiber-optic bronchoscopy. Nodular processes with smooth surface mucosa and detached bronchial mucosa were observed. The presence of TO was confirmed by pathological examination., Conclusion: The diagnosis of TO is difficult, and early fiber-optic bronchoscopy and pathological examination should be performed to facilitate the diagnosis.

Tracheobronchopathia osteochondro-plastica (TPO) is a rare disorder of yet unknown etiology. The common clinical features include cough with expectoration, breathing difficulty, hemoptysis, and recurrent airway infections, which can lead to a misdiagnosis as another chronic respiratory illness in a large number of cases due to the rare nature of TPO. Here we present a 25-year-old lady who was misdiagnosed as bronchial asthma for many years, and was found to have TPO after difficulty in intubation for administering general anesthesia prior to a surgical procedure.

Amyloidosis is a systemic disease involving abnormal extracellular deposition of amyloid and autologous fibrillar protein material in β-pleated sheets. Accumulation of this abnormal protein leads to organ dysfunction, although respiratory tract involvement is rare. We present two cases of tracheobronchial amyloidosis successfully treated with surgery and radiation.

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It usually affects mucous membranes of the nose, nasopharynx, and ocular conjunctiva. Cutaneous, laryngeal, tracheal, genital, and bony dissemination is rare. Laryngotracheal involvement poses many diagnostic and therapeutic challenges. A 45-year-old South Indian man presented with complaints of a mass in both nostrils for 2 years, associated with progressive hoarseness of voice and difficulty in breathing for 6 months. Rhinosporidial lesions were seen bilaterally in the nasal cavity. Telescopic and fiberoptic laryngoscopic examinations showed reddish, strawberry-like masses with whitish spots on their surface involving the larynx and trachea. Computed tomography of the head and neck revealed soft-tissue mass lesions involving the bilateral nasal cavities and nasopharynx, extending to the oropharynx and involving the larynx and trachea. A preliminary tracheostomy was performed, followed by direct laryngoscopic excision of the laryngeal lesions and rigid-bronchoscopy-guided excision of the tracheal lesions. The patient was prescribed dapsone and advised to take it for 2 years. At 2 years of follow-up, there was no recurrence.

Tracheoinnominate fistula is a rare complication of tracheostomy that is associated with high rates of morbidity and mortality. Recently, endovascular stents have been described as a viable treatment option for the management of this condition. We report a case of tracheoinnominate fistula in a 40-year-old man that was successfully managed with endovascular stent placement. Our evaluation included bronchoscopy, arteriography, and computed tomographic angiography. Intraoperative localization of the fistula required selective catheterization of the innominate artery.

Tracheal diverticulum is a rare entity. When it does occur, it is usually discovered incidentally in an asymptomatic patient as an outpouching from the tracheal wall, usually on the right side. It can be either congenital or acquired. A tracheal diverticulum may act as a reservoir for secretions that may spill over into the tracheobronchial tree, predisposing affected patients to cough, dyspnea, stridor, and chronic chest infection. The author describes 4 cases of tracheal diverticulum--3 congenital and 1 acquired--that were discovered on chest x-ray. The congenital form was found incidentally in 3 asymptomatic middle-aged women, and the acquired case (a tracheobronchial diverticulum) was discovered during a workup for chronic cough and fever in a young man. All 4 patients were thoroughly evaluated with conventional chest and neck radiographs, barium-swallow imaging, linear tomography, computed tomography, and magnetic resonance imaging. Resection of these tracheal diverticula was not considered for any patient. The author also reviews the literature on tracheal diverticulum.

Acquired tracheal diverticulum is a rare clinical entity with only limited reports in the literature. We report a case of a tracheal diverticulum that was identified as part of a work-up for a worsening cough. In this case the diverticulum was observed 2 years after surgical management of a retropharyngeal abscess. It was felt that pooling of secretions in the acquired pouch was a contributing factor in the exacerbation of the patient's chronic cough. Because of the patient's extensive comorbidities, observation and serial computed tomography scans were recommended.

Intratracheal ectopic thyroid tissue is a rare abnormality that can cause airway obstruction. The symptoms can easily be confused with those of bronchial asthma. We describe the case of a 40-year-old man with subglottic thyroid tissue and multinodular goiter who had been misdiagnosed earlier with bronchial asthma. After the correct diagnosis was established, the lesion was excised via an external approach. We also discuss the clinical features and management of intratracheal thyroid tissue.

"Inflammatory pseudotumor" is a broad descriptive term used to describe a localized collection of inflammatory and fibroblastic cells. It is an uncommon lesion that can mimic a tumor when it is located intraluminally in the trachea or bronchi. Because an inflammatory pseudotumor has an abundance of polyclonal plasma cells, its etiology (postinflammatory vs immunologic) is still being debated. We report a new case of inflammatory pseudotumor that arose in the trachea of a 20-year-old man. We also review the histologic and clinical characteristics of this lesion.

Although localized laryngotracheobronchial amyloidosis is rare, the otolaryngologist--head and neck surgeon should be familiar with this condition. Its characteristic appearance can suggest its presence in a patient who has the typical initial symptoms. Biopsies during direct laryngoscopy and bronchoscopy can play both a diagnostic and therapeutic role. After an appropriate examination to rule out systemic involvement, the patient should be managed with conservative surgery, although the use of a CO2 laser might be more efficacious than conventional surgery. With appropriate diagnosis and treatment, patients should expect a favorable prognosis. In this article, we describe a new case of localized laryngotracheobronchial amyloidosis in a 67-year-old woman, and we review the literature on this subject.

Tracheobronchopathia osteochondroplastica is characterized by osseocartilaginous submucosal nodules projecting into the lumen of the larynx, trachea, and bronchi. Its etiology is unknown. Most cases are asymptomatic and frequently diagnosed incidentally during intubation or endoscopy. The diagnosis is made on the basis of endoscopy, CT scan, and histopathology. Fragments of adipose tissue, deposits of calcification and ossification often with foci of bone marrow and active hemopoiesis are present in the submucosa. Surgical treatment is indicated for airway obstruction and recurrent infections.

Tracheobronchomegaly, a disorder of uncertain etiology, is manifested by the enlargement of the trachea and mainstem bronchi. While the diagnosis may be suggested on chest radiographs, bronchography in the past has been the definitive diagnostic modality. Recently, however, computed tomography has been used to confirm the diagnosis of TBM. We have now demonstrated TBM using MRI, and, in this patient, have shown it to be as good as CT.

An outline is given of the use of fiberoptic instruments in the management of some respiratory problems in the Intensive Care Ward. In particular, bronchoscopy and inspection of the trachea and larynx prior to closure of tracheostomy are described.