Typical case] Mr. Zhao, 54 years old, developed an irritating cough and sputum with chest tightness and shortness of breath 2 months ago, and first took cold medicine and anti-inflammatory drugs to treat the problem, so he went to a nearby hospital. He was diagnosed with “bronchial tuberculosis and pulmonary tuberculosis” by the doctor of the hospital, and was treated with anti-tuberculosis and bronchoscopic cryotherapy for 3 weeks, but the above discomfort was still repeatedly aggravated, and the multiple protrusions on the bronchial wall did not improve and decrease, so he was transferred to our hospital. The results showed that there were multiple small calcified nodules in the trachea and bronchi and they were protruding into the lumen, and the small protrusions were located in the anterior and lateral walls of the trachea. He was given anti-infection, antispasmodic and anti-cough symptomatic treatment instead, and was discharged 10 days later with significant relief of clinical symptoms. The possible causative factors include chronic infection, congenital factors, physical or chemical stimulation, degenerative changes, metabolic disorders, etc. Local cryotherapy is not effective. In contrast, bronchial tuberculosis is a tuberculous lesion of the trachea, bronchial mucosa or submucosa, and bronchial lavage smear with a high rate of positive antacid staining (i.e., looking for tuberculosis bacteria), which is treated with antituberculosis and bronchoscopic cryotherapy with good results. The main reasons for the misdiagnosis of this case are: 1. the clinical symptoms of ossifying tracheobronchial disease lack specificity and are similar to those of bronchial tuberculosis, both presenting with irritating cough, sputum and shortness of breath, while in contrast, bronchial tuberculosis is more common and more frequent, and ossifying tracheobronchial disease is less common and not easily thought of by physicians in the first place; 2. the sensitivity and specificity of ordinary thick-layer CT in diagnosing ossifying tracheobronchial disease The sensitivity and specificity of ordinary thick-layer CT in diagnosing osteoblastic tracheobronchial disease are not high, and it is difficult to detect multiple small nodular calcified shadows in the trachea and bronchi; 3. The bronchoscopic naked eye cannot distinguish whether the multiple small protrusions on the bronchial mucosa are osteoblastic or tuberculosis lesions, 4. The initial bronchoscopic biopsy tissue is too small and fails to detect bone or cartilage tissue, resulting in delayed diagnosis; 5. Clinicians lack knowledge or insufficient awareness of osteoblastic tracheobronchial disease, and although they see Although the protrusions on the bronchial mucosa were distributed on the anterior and lateral walls of the trachea, and the patient had poor anti-tuberculosis and cryotherapy effects, they failed to think that it might be ossifying tracheobronchial disease and still considered it as bronchial tuberculosis without further thin-layer CT and bronchoscopic re-biopsy, resulting in a long misdiagnosis of the patient. Diagnosis】Osseous tracheobronchial disease is rare clinically, and thin-layer CT and bronchoscopy are needed to confirm the diagnosis. Thin-layer CT is sensitive to calcified nodules in the tracheal wall, and multiple small submucosal calcified nodules in the tracheobronchial tubes and protruding into the lumen are the characteristic CT manifestations of ossifying tracheobronchial disease, and these small protrusions are located in the anterior and lateral walls of the trachea, but rarely in the posterior wall. The nodules are usually 1-10 mm in diameter, located in the anterior and lateral walls of the trachea, and are hard and bleed easily when touched. Therefore, clinicians should raise awareness of ossifying tracheobronchial disease, and for unexplained cough and shortness of breath, improve thin-layer CT and bronchoscopy as early as possible and obtain pathology to confirm the diagnosis so that patients can receive timely and correct treatment and avoid long-term misdiagnosis, which aggravates patients’ pain and economic burden.