LAUSR

Learning Objectives: Recurrent Respiratory Papillomatosis is a benign disease of upper aerodigestive tract caused by exposure to human papilloma virus type 6 and 11 at birth. It is transmitted through passage from contaminated maternal birth canals. Most patients present as juvenile onset, commonly occurring as squamous cell papilloma of larynx. However, occurrence of recurrent papilloma in trachea in adulthood is very rare. We are presenting one such case in an adult patient which presents as recurrent nodular growth creating moderate to marked tracheal stenosis requiring multiple bronchoscopic removal. Methods: 63-year-old male with PMH of COPD and HTN presented with productive cough with blood tinged sputum, left sided sharp chest pain, dyspnea and weight loss. Vitals were stable except for hypoxia, physical examination showed bilateral crackles. CXR Portable showed left basilar and retro cardiac opacity. CT chest angiogram was done to rule out pulmonary embolism and revealed irregular opacity in upper thoracic trachea occupying a significant portion of tracheal lumen with debris in posterior lower lobe bronchus. CT chest also revealed dense left lower lobe consolidation, which prompted diagnosis of community acquired pneumonia and initiation of antibiotics. Previous patient records revealed reports of bronchoscopic debridement and biopsy of tracheal mass, which revealed fragments of squamous papiloma with focal moderate squamous dysplasia.Tracheal mass ablation with Yag Laser had been done repeatedly to make the airway patent. Patient didnt have any signs of airway obstruction during the hospital stay, hence pneumonia was treated with antibiotics and discharged home eventually. We also instructed the patient to follow up with cardiothoracic surgery for further management. Results: Recurrent Respiratory Papillomatosis is a rare benign growth found in upper trachea. Though rare, it may be seen in adults. Patient presenting with chronic cough, hoarseness of voice, and irregular opacity in upper tracheal region should raise suspicion.Tendency to obstruct airway and malignancy transformation makes its diagnosis clinically important.