Background <p>Tracheobronchopathia osteochondroplastica (TO) is a rare multinodular airway disease that is frequently misdiagnosed clinically as other conditions with similar presentations, such as tracheobronchial amyloidosis, tracheobronchial papillomatosis, or lymphoma. Given the significant differences in treatment strategies and prognoses among these diseases, accurate diagnosis is essential for developing the most effective therapeutic approach. This study investigates the diagnostic utility of chest CT and bronchoscopy in distinguishing TO from other multinodular airway diseases and evaluates the combined diagnostic efficacy of these two modalities.</p> Methods <p>This study enrolled 112 patients with multinodular airway diseases, divided into a TO group and a non-TO group. A retrospective analysis was conducted on demographic data, clinical symptoms, chest CT results, and bronchoscopy findings for 34 patients diagnosed with tracheobronchopathia osteochondroplastica and 78 patients diagnosed with tracheobronchial amyloidosis, tracheobronchial papillomatosis, sarcoidosis involving the airways, or lymphoma involving the airways. The characteristics of patients in the TO and non-TO groups were evaluated, and statistical analyses were performed to assess differences in various parameters. Additionally, receiver operating characteristic (ROC) curve analysis was conducted to differentiate TO from other multinodular airway diseases based on these parameters.</p> Results <p>In the analysis of data from 112 patients with multinodular airway diseases, no significant differences were observed in demographic characteristics, clinical symptoms between the TO and non-TO groups. However, imaging features revealed four independent predictors for differentiating tracheobronchopathia osteochondroplastica from other multinodular airway diseases: nodular high-density shadows in the airway walls on chest Computed tomography (CT), a higher percentage of airway wall area to total airway area in the left lower lobe bronchus, absence of membranous wall involvement on bronchoscopy, and involvement of the upper trachea. A digital diagnostic model constructed using these predictive factors demonstrated excellent performance, with an AUC value of 0.989, specificity of 96.2%, and sensitivity of 97.1%.</p> Conclusion <p>The digital diagnostic model developed by integrating the features of chest CT and bronchoscopy exhibits outstanding diagnostic performance. This model can be clinically utilized to aid in distinguishing tracheobronchopathia osteochondroplastica from other multinodular airway diseases.</p>