Broncholithiasis

• • 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)

Symptoms and Signs

• • Hemoptysis

  • Lithoptysis (30%)

  • Cough, sputum production, pleuritic chest pain

  • Fever, chills

  • Wheezing

  • Pneumonia may occur from obstructive broncholith

Imaging Findings

• • Chest film: Hilar calcification, segmental atelectasis, pneumonia

• • Diagnosis is confirmed with lithoptysis or presence of broncholith

• • Chest film

  • Bronchoscopy to identify stone

• • Treat underlying pulmonary disease

  • Treatment directed at removal of stone

Surgery

• • 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

Indications

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

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

Complications

• • Hemoptysis, may be massive

  • Midesophageal traction diverticular

  • Tracheoesophageal fistula

Prognosis

• • Excellent after surgery

References