病例报告：气管支气管骨软骨发育不良伴支气管肺泡灌洗液检出铜绿假单胞菌

文献信息

中文摘要

背景： 气管支气管骨软骨发育不良（TO）是一种少见的良性病变，特征为骨性和/或软骨性黏膜下结节，主要累及气管支气管前侧壁。本病例展示了多模式诊断以及对合并下气道细菌检出的审慎解读。
病例介绍： 一名63岁男性，表现为咳嗽和少量白色黏液痰3个月。计算机断层扫描（CT）显示部分钙化的前侧壁气管支气管结节，后壁相对受累较轻，右肺斑片状磨玻璃影，以及多发肺结节。回顾性气道测量显示，同一水平最小气管腔面积为179.4 mm²，最小直径为10.0 mm。支气管镜检查显示气管和近端支气管存在坚硬黄白色结节；活检显示成熟板层骨，支持TO。在经验性开始哌拉西林/他唑巴坦后获取的双侧混合支气管肺泡灌洗标本培养出铜绿假单胞菌，菌量>10⁴ CFU/mL，对哌拉西林/他唑巴坦和左氧氟沙星敏感。患者接受5天静脉哌拉西林/他唑巴坦治疗，随后9天口服左氧氟沙星及气道廓清治疗，症状改善。他完成了口服疗程，未报告不良反应。出院约3个月后门诊随访时，他无症状。治疗医生将随访CT与基线图像比较，显示肺部磨玻璃影消退、气道结节无变化、肺结节稳定。未重复培养。
结论： 一致的CT、支气管镜和支持性组织病理学发现确立了TO的诊断模式。临床和影像学改善支持合并呼吸道感染，但该微生物的致病作用以及TO的任何因果贡献仍未得到证实。这一区分支持保守气道管理和持续监测，而不将所有肺部异常归因于TO。

英文摘要

BACKGROUND: Tracheobronchopathia osteochondroplastica (TO) is an uncommon benign disorder characterized by osseous and/or cartilaginous submucosal nodules involving predominantly the anterolateral tracheobronchial walls. This case illustrates multimodal diagnosis and cautious interpretation of concomitant lower-airway bacterial recovery.
CASE PRESENTATION: A 63-year-old man presented with a 3-month history of cough and scant whitish mucoid sputum. Computed tomography (CT) demonstrated partially calcified anterolateral tracheobronchial nodules with relative posterior-wall sparing, a right-sided patchy pulmonary opacity, and multiple pulmonary nodules. Retrospective airway measurements showed a minimum tracheal luminal area of 179.4 mm2 and a minimum diameter of 10.0 mm at the same level. Bronchoscopy revealed hard yellow-white nodules involving the trachea and proximal bronchi; biopsy showed mature lamellar bone, supporting TO. A pooled bilateral bronchoalveolar lavage specimen obtained after empirical piperacillin/tazobactam had been started yielded Pseudomonas aeruginosa at >10⁴ CFU/mL, susceptible to piperacillin/tazobactam and levofloxacin. The patient received 5 days of intravenous piperacillin/tazobactam followed by 9 days of oral levofloxacin and airway-clearance treatment, with symptomatic improvement. He completed the oral course without reported adverse effects. At an outpatient visit approximately 3 months after discharge, he was asymptomatic. The treating clinician's comparison of follow-up CT with baseline images showed resolution of the pulmonary opacity, unchanged airway nodules, and stable pulmonary nodules. Repeat cultures were not obtained.
CONCLUSION: Concordant CT, bronchoscopic, and supportive histopathologic findings establish the diagnostic pattern of TO. Clinical and radiologic improvement supported a concomitant respiratory infection, but the organism's causal role and any causal contribution of TO remained unproven. This distinction supports conservative airway management and continued surveillance without attributing every pulmonary abnormality to TO.