Broncholithiasis

Etiology

  • Histoplasmosis (see [[Histoplasmosis]])
    • Most common cause in US
    • Usually calcified node eroding into airway
  • Tuberculosis (see [[Tuberculosis]])
    • Usually calcified node eroding into airway
  • Coccidioidomycosis (see [[Coccidioidomycosis]])
    • Usually calcified node eroding into airway
  • Cryptococcosis (see [[Cryptococcosis]])
    • Usually calcified node eroding into airway
  • Blastomycosis (see [[Blastomycosis]])
  • Actinomycosis (see [[Actinomycosis]])
    • Usually calcified node eroding into airway
  • Nocardiosis (see [[Nocardiosis]])
  • Silicosis (see [[Silicosis]])
    • Usually calcified node eroding into airway
  • Ossifying Bronchial Carcinoid (see [[Bronchial Carcinoid]])
  • Foreign Body (see [[Foreign Body]])
    • Calcification of foreign body
  • Renal Stone Erosion Into Airway
  • Necrotizing Pneumonia (see [[Necrotizing Pneumonia]])
    • Uncommon etiology
    • Usually calcified cartilage eroding into airway
  • Bronchiectasis (see [[Bronchiectasis]])
    • Uncommon etiology
    • Usually calcified cartilage eroding into airway

Physiology

  • Presence of calcified (85-90% calcium phosphate and 10-15% calcium carbonate: similar to bone) fragment of tissue (either lung tissue or lymph node) within a bronchus
  • May produce partial or complete obstruction

Diagnosis

  • FOB: indicated for hemoptysis, persistent cough, or to rule out other causes
    • Some stones may be removed bronchoscopically
  • CXR/Chest CT: may demonstrate mediastinal adenopathy (with or without calcification)

Clinical

  • Cough with Purulent Sputum (occasional expectoration of stones or gritty material):
  • Hemoptysis (see [[Hemoptysis]])
  • Fever:
  • Symptoms of Airway Obstruction (see [[Obstructive Lung Disease]])

Treatment

  • Supportive:
  • Antibiotics for post-obstructive pneumonia
  • Surgery: may be required for persistent or recurrent cases