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