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  • • Presence of broncholiths (calculi) in tracheobronchial tree

    • Causes include:

    • -Calcified parabronchial lymph node eroding into bronchial wall lumen (most common)

      -Severely inspissated mucus may calcify

    • Broncholiths may remain attached to bronchial wall, lodge in bronchus, or be expectorated (lithoptysis)

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Symptoms and Signs

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  • • Hemoptysis

    • Lithoptysis (30%)

    • Cough, sputum production, pleuritic chest pain

    • Fever, chills

    • Wheezing

    • Pneumonia may occur from obstructive broncholith

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Imaging Findings

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  • Chest film: Hilar calcification, segmental atelectasis, pneumonia

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  • • Diagnosis is confirmed with lithoptysis or presence of broncholith

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  • • Chest film

    • Bronchoscopy to identify stone

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  • • Treat underlying pulmonary disease

    • Treatment directed at removal of stone

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Surgery

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  • • Bronchoscopy successful 20% of time to remove stone

    • -Risk is massive

      -Hemorrhage if attached to wall or use excessive force to remove

    80% require surgery: Bronchotomy and stone extraction or segmentectomy/ lobectomy

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Indications

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  • • Unable to remove via bronchoscopy (80% of cases)

    Tracheoesophageal fistulas: Repair with intercostals muscle flap between airway and esophagus to prevent recurrence

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Complications

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  • • Hemoptysis, may be massive

    • Midesophageal traction diverticular

    • Tracheoesophageal fistula

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Prognosis

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  • • Excellent after surgery

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References

Galdermans D et al. Broncholithiasis: present clinical spectrum. Respir Med. 1990;84:155.  [PubMed: 2371439]
Martinez S. et al. Mucoid impactions: finger-in-glove sign and other CT and radiographic features. Radiographics. 2008 28(5):1369-82.  [PubMed: 18794313]

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