Broncholithiasis

 

Broncholiths

 

 

General Considerations

• Uncommon
• Calcification within a bronchus, most commonly from peribronchial nodes that calcify following inflammation
• If adjacent to a bronchus, calcified node may erode into the lumen forming a broncholith
• Usually associated with prior tuberculosis or histoplasmosis
• Some authors have expanded definition to include peribronchial calcification as well
• Rarely may be caused by aspiration of previously calcified object, like a bone fragment
• Bronchoscopy may fail to detect the calcification because it is obscured by the inflammatory process surrounding it

Clinical Findings

• Non-productive cough
• Hemoptysis
• Pain
• Chills and fever from a secondary infection
• Lithoptyis-expectoration of calcified material

Imaging Findings

• Chest radiography usually does not show the calcification or its exact location
• Helical CT is the imaging study of choice
• The right middle lobe bronchus and the anterior segmental bronchi of the upper lobes are favored sites
• Calcified endobronchial or peribronchial lymph node
• No associated soft tissue mass
• Atelectasis is the most common parenchymal finding
• Mucoid impaction
• Post-obstructive infection may result
• Bronchiectasis
• Expiratory air-trapping is uncommon

Differential Diagnosis

• Carcinoid tumor
• Calcification in a fungus ball
• Hamartomas

Treatment

• Symptomatic broncholiths may be surgically removed
• Bronchoscopic attempt at removal of a broncholith still embedded in wall may result in hemorrhage

Complications

• Rarely, bronchoesophageal or broncho-aortic fistulae