Broncholithiasis

Abstract

A 47 year old female who had past history of incomplete treatment for pulmonary tuberculosis presented with increased breathlessness, generalized swelling and loss of ap-petite for last one month. X-ray chest PA view showed bilateral fibrocalcific opacities with blunting of costophrenic angle on both sides. She underwent bronchoscopy to collect bronchial wash to rule out relapse of tuberculosis. On bronchoscopy a loose broncholith with sharp and speculated margins were detected in right middle lobe bronchus. This broncholith was successfully removed through flexible bronchoscope without any complications.

Broncholithiasis with Recurrent Lithoptysis: A Case Report

“…Granulomatous lymphadenitis caused by mycobacterial infections is the most common cause of broncholithiasis all over the world. Silicosis, malignancy and granulomatous fungal infections are other rare causes [ 1 ]. In our case, although he had no current or past history of tuberculosis, the middle lobe syndrome was due to tuberculous lymphadenitis.…”

“…The most common complications of the disease are related to bronchus obstruction such as hyperinflation, atelectasis, bronchiectasis and obstructive pneumonia. Rarely, bronchogenic dissemination of tuberculous lymphadenitis and lung abscesses secondary to bronchoesophageal and bronchomediastinal fistulas may be seen [ 1 , 3 ]. In our case, while all complications were seem to be related to the broncholith located at the bronchus of RML, the other one at the RUL was the most likely responsible for recurrent lithoptysis.…”

Tombs of Aspergillus: A missed cause of recurrent respiratory infections in allergic bronchopulmonary aspergillosis

“…Broncholithiasis refers to the presence of calcified or ossified material within the lumen of the bronchus. [ 1 ] The most common mechanism of the formation of a broncholith is by erosion and extrusion of an adjacent, calcified lymph node into the bronchial lumen, usually secondary to the long-standing foci of necrotizing granulomatous lymphadenitis. Rarely, aspiration of bones and other foreign bodies or an eroded and extruded bronchial cartilage may give rise to these broncholiths.…”

Management of broncholithiasis

“…Less common infectious etiologies include tuberculosis, actinomycosis, coccidioidomycosis, and cryptococcosis (3). Due to airway anatomy and normal lymph node distribution, the most commonly affected bronchi are the proximal right middle lobe bronchus, the bronchus intermedius, and the origin of the anterior segment right upper lobe bronchus, in order of frequency (1,(3)(4)(5).…”

“…Other etiologies of broncholithiasis are less common. Broncholiths can arise as extrinsic calculi from aspirated foreign material (4), such as aspirated fragments of bone or foreign debris which calcifies in situ within the airway over time. Calcified cartilage rings in the airway wall can also extrude and become sequestered inside the lumen of the bronchus forming broncholiths.…”