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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

BroncholithiasisBroncholithiasis

Broncholithiasis. Left: Coronal reconstruction of CT of the chest demonstrates a calcified broncholith (white arrow) within the right middle lobe bronchus. It is producing partial atelectasis of the right middle lobe (yellow arrow). Right: Axial CT image demonstrates broncholiths within bronchus (white arrow) with associated parenchymal disease.
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Broncholithiasis: CT Features in 15 Patients. DJ Conces, Jr.; RD Tarver and VA Vix. AJR 157:249-253, August 1991

 

Broncholithiasis: Review of the Causes with Radiologic-Pathologic Correlation. JB Seo, Koun-Sik Song, JS Lee, JM Goo, HY Kim, Jae-Woo Song, IS Lee, and Tae-Hwan Lim. RadioGraphics 2002; 22:S199–S213