A Promising Treatment for Broncholith Removal Using Cryotherapy during Flexible Bronchosopy: Two Case Reports

Abstract

Broncholiths are defined as calcified materials that occur in a tracheobronchial tree or in a cavity communicating with that. Broncholith has variable clinical features. The therapeutic options to remove broncholiths are so variable that clinicians need to select the most safe and effective methods by mass size, mobility, and location. As yet, there is no consistent guideline removing a broncholith. We report 2 successful cases of removing a fixed broncholith by flexible bronchoscopy guided cryoadhesion. With repeated technique of thawing and freezing with ryoprobe, we could extract the fixed broncholith safely. This method is promising as a way to remove broncholith in the future.

Broncholithiasis presenting as bronchiectasis and recurrent pneumonias

“…Other possible aetiologies include other infectious aetiologies such as Cryptococcus , coccidioidomycosis, actinomycosis, aspergillosis, nocardiosis and fungal infections as well as lung abscess, pulmonary infarction, silicosis and inhalation of foreign materials 7. Clinical manifestations of broncholithiasis range from asymptomatic-to-mild coughing, sputum production, haemoptysis, lithoptysis, chest pain, fever, bronchiectasis, atelectasis and broncho-oesophageal fistula 7 8…”

“…Conservative treatment is adequate in the majority of cases 8. The conventional method to remove a broncholith is performed with the use of forceps during bronchoscopy.…”

“…However, this is only applicable for broncholiths that are not firmly attached to the bronchial wall 8. Hesitation in removing a broncholith is secondary to fear of massive haemorrhage and bronchial injury 5 13.…”

“…When a broncholith is not amenable to removal by bronchoscopy alone, laser therapy has been used to fragment mobile broncholiths that would otherwise be too hard or large to be removed by bronchoscopy 6. This method can also induce life-threatening haemoptysis if the broncholith is adjacent to a vessel 8. Lastly, surgical interventions, such as lobectomy, segmentectomy or pneumonectomy, can be performed but are rarely needed 8.…”

“…This method can also induce life-threatening haemoptysis if the broncholith is adjacent to a vessel 8. Lastly, surgical interventions, such as lobectomy, segmentectomy or pneumonectomy, can be performed but are rarely needed 8. Recurrent and persistent haemoptysis, bronchiectasis, bronchial stenosis, development of broncho-oesophageal or aortotracheal fistula and obstructive pneumonia are indications for surgery.…”