Diffuse tracheobronchial thickening: Interesting diagnostic considerations

Relapsing polychondritis is a rare inflammatory disorder of cartilaginous and proteoglycan-rich tissues, commonly affecting the nasal and auricular cartilages, joints, tracheobronchial cartilage, cardiovascular system, as well as a number of other organ systems. The etiology of relapsing polychondritis is unknown, but an immune-mediated mechanism may be responsible. The diagnosis of relapsing polychondritis requires evidence of recurrent inflammation of the major organ systems affected by the disease such as the ears, eyes, nose, and airways with or without confirmation of cartilage inflammation on biopsy. The diagnosis of relapsing polychondritis may also be enabled by the demonstration of thoracic computed tomography findings characteristic of the disorder, including thickening and increased attenuation of the anterior two thirds of the trachea and bronchi, with sparing of the posterior one third of these structures, with or without stenosis. Excessive airway collapse on expiratory imaging or imaging performed during a forced vital capacity maneuver is characteristic of this disease.