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Clinical Challenge
May 2016

A Case of Diffuse Calcified Airway Nodules

Author Affiliations
  • 1Bobby R. Alford Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
JAMA Otolaryngol Head Neck Surg. 2016;142(5):501-502. doi:10.1001/jamaoto.2015.3952

A woman in her 40s had an 8-year history of progressive dyspnea associated with nonproductive cough. Her medical history was notable for dyspepsia, hypertension, and diabetes. She had no history of smoking, type B symptoms, angiotensin-converting enzyme-inhibitor use, or known cardiac pathologic abnormalities. Findings from a complete head and neck examination were within normal limits aside from laryngeal findings. Flexible laryngoscopy with videostroboscopy revealed right vocal fold polyp and left vocal fold desquamation, with bilateral linear bands along the vocal folds. Initial treatment with proton pump inhibitors and evaluation by the gastroenterology unit did not improve her symptoms, so further workup was undertaken. Noncontrast computed tomography (CT) revealed numerous calcified subglottic and tracheal nodules extending from the cricoid to the left mainstem bronchus (Figure, A). She underwent direct laryngoscopy and bronchoscopy with biopsies. On induction, subglottic firm mass consistent with calcification prevented passage of an endotracheal tube, and the patient’s airway was secured with a rigid bronchoscope. Further examination revealed edema of the vocal folds with multiple submucosal masses in the subglottis and upper trachea (Figure, B-D). The lesions were varying sizes, and not all were calcified. They affected the anterior cartilaginous trachea and the posterior membranous portion. Biopsy specimens of representative lesions revealed amorphous, eosinophilic material with calcification, metaplastic ossification, and multinucleated foreign-body giant cells. The disease was treated with debulking of scattered lesions from the glottis through to both main stem bronchi and airway dilation, which provided symptomatic relief.

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