Classification of broncholiths and clinical outcomes

Fleischner Society: Glossary of Terms for Thoracic Imaging

Members of the Fleischner Society have compiled a glossary of terms for thoracic imaging that replaces previous glossaries published in 1984, 1996, and 2008, respectively. The impetus to update the previous version arose from multiple considerations. These include an awareness that new terms and concepts have emerged, others have become obsolete, and the usage of some terms has either changed or become inconsistent to a degree that warranted a new definition. This latest glossary is focused on terms of clinical importance and on those whose meaning may be perceived as vague or ambiguous. As with previous versions, the aim of the present glossary is to establish standardization of terminology for thoracic radiology and, thereby, to facilitate communications between radiologists and clinicians. Moreover, the present glossary aims to contribute to a more stringent use of terminology, increasingly required for structured reporting and accurate searches in large databases. Compared with the previous version, the number of images (chest radiography and CT) in the current version has substantially increased. The authors hope that this will enhance its educational and practical value. All definitions and images are hyperlinked throughout the text. Click on each figure callout to view corresponding image. © RSNA, 2024 Supplemental material is available for this article. See also the editorials by Bhalla and Powell in this issue.

Case of uncontrolled asthma with Ceriporia lacerata-related broncholithiasis

An 81-year-old Japanese male patient was treated for asthma. He complained of persistent cough and wheezing. Chest computed tomography scan revealed atelectasis in the right middle lobe. Fiberoptic bronchoscopy was performed. Results showed a calcified stone with filamentous fungi with septa in the right middle lobe bronchus, which was subsequently removed. Ceriporia lacerata was detected repeatedly on sputum culture. Thus, the filamentous fungi were suspected as C. lacerata. Broncholithiasis possibly caused mucous membrane damage owing to C. lacerata colonization, resulting in allergic airway inflammation. Herein, we report a rare case of C. lacerata-related broncholithiasis associated with asthma exacerbation.

Asymptomatic Broncholithiasis and Aspergillus Infection: A Case Report and Literature Review

Broncholithiasis coupled with Aspergillus infection is a rare disease of the respiratory system with complex pathogenesis and non-specific clinical manifestations that can be easily confused with other types of infectious diseases of the respiratory system. The lack of pertinent clinical manifestations in patients increases the risk of clinical misdiagnosis, omission, and incorrect treatment plan selection, which can result in permanent lung structural alterations and lung function decompensation and ultimately harm the lung. We report a rare case of asymptomatic broncholithiasis coupled with Aspergillus infection that was treated at our hospital and discuss the pathophysiology, diagnosis, differential diagnosis, and prognostic follow-up course. Furthermore, relevant studies from China and other countries, including this case, were reviewed. We gathered eight reports, summarized their significant diagnoses and treatments for broncholithiasis and broncholithiasis coupled with Aspergillus infection, and discussed their clinical features. Our study may help improve physicians' awareness of these types of diseases and serve as a resource for future diagnosis and treatment.

Broncholithiasis mimicking lung cancer

A 64-year-old female patient was admitted to our outpatient clinic with pleuritic chest pain, non-productive cough, and dyspnea. She expectorated three stones (lithoptysis) before bronchoscopy. She underwent positron emission tomography-computed tomography, which revealed a hyper metabolic mass in the right upper lobe of her lung. Three months later, the mass formation appeared as a patchy consolidation in the first control thoracic computed tomography examination. In conclusion, postobstructive consolidation due to broncholithiasis, which is very rare, should be kept in mind in the differential diagnosis of hyper metabolic mass. The simplest incidental diagnostic finding of broncholithiasis is the rare lithoptysis.

Broncholithiasis: Treatment Evaluation in 63 Patients

BACKGROUND

Broncholithiasis is a rare disease defined as the presence of calcified material (broncholith) within the tracheobronchial tree. We described our experience in broncholithiasis to provide a more effective clinical basis for the management of this condition.

METHODS

We retrospectively reviewed the clinical characteristics, treatments, and outcomes of patients with broncholithiasis at Xiangya Hospital in China from May 2009 to November 2019.

RESULTS

Sixty-three patients were enrolled in this study with a median age of 57 years. Cough (57.1%) was the most common symptom of broncholithiasis, followed by hemoptysis (23.8%). Tuberculosis was the most common comorbidity (38%), while 21 patients (30.0%) did not exhibit underlying diseases. Broncholiths within the bronchus led to airway dilation (19.0%), obstructive atelectasis (46.0%), and pneumonia (30.2%). The condition of most patients improved after undergoing endoscopic removal (76.5%) of the broncholiths. The condition of three patients (100%) improved after the surgical removal of the broncholiths. Of the 38 patients (60.3%) who failed to receive removal of broncholiths, 16 received anti-infection treatment, and the other 22 received observation. Most patients (50.0%) who were treated with anti-infectives showed an improvement, whereas the condition of 33.3% of patients who did not receive treatment worsened.

CONCLUSION

Broncholithiasis is a benign bronchial disease that can cause complications. Endoscopic removal of broncholiths is considered as initial therapy and surgical removal is suggested as a second-line treatment. Treatment with anti-infectives is required for patients who fail to receive removal of broncholiths.

Therapeutic bronchoscopy in a lung abscess secondary to broncholithiasis

A 60-year-old woman developed a pulmonary abscess due to broncholithiasis. It was treated by bronchoscopic broncholithectomy after antibiotic administration. Broncholithiasis is a rare disease and various treatment options are available, which include bronchoscopic broncholithectomy and surgery. Bronchoscopic broncholithectomy has proved to be more useful because it can be used to easily extract the broncholith by using a balloon and haemostasis can be obtained at the same time.

Broncholithiasis: A Review

The term "broncholithiasis" is defined as the presence of calcified or ossified materials within the tracheobronchial tree. The report of the condition dates back to 300 bc when Aristotle first described a symptom of "spitting of stones." The process of calcification usually starts within either the mediastinal, hilar, or peribronchial lymph nodes. The impetus is typically initiated by a granulomatous process such as TB or histoplasmosis; however, it can also been seen following exposure to other fungal or occupational elements. The exact mechanism of the calcified material (broncholith) entering the endobronchial tree remains unknown. It is hypothesized, however, that the calcified tissues gradually erodes and/or breaks loose in the airways as a result of repetitive movements of respiration or cardiac pulsations. The broncholiths are often found in the airways without any signs of erosion, however. The most common symptoms of broncholithiasis include cough, hemoptysis, and wheezing as a result of irritation of the airways and the surrounding tissues. The diagnosis is typically suspected on chest radiographs and confirmed by using bronchoscopy. Depending on the severity of the disease, management options range from simple observation to surgical resection. Despite the potential for major complications, the overall disease prognosis is good if timely and appropriate management is provided.

Diagnosis of pulmonary aspergillosis-related broncholithiasis in a child undergoing bronchoscopy: A case report

RATIONALE

Broncholithiasis is a rare disease and is characterized by calcification in the tracheobronchial tree. This disease has a predilection in the adult and occurrence is rare in children. Considering its infrequency, we report a rare clinical case, with the aim of sharing our experience during the diagnosis and treatment procedures.

PATIENT CONCERNS

We report a 9-year- and 6-month-old girl who complained of chronic cough and recurrent wheeze for 2 months.

DIAGNOSIS

Bronchialithiasis were found under bronchoscope. Pathologic examination revealed aspergillosis.

INTERVENTIONS

The stone and surrounding granulation tissue were removed using a bronchoscope and the patient was treated with antifungal therapy.

OUTCOMES

The patient was in good general health without any clinical symptoms during the follow-up period.

LESSONS

Pulmonary Aspergillus infection can cause bronchiolithiasis. Stones were removed under bronchoscope, and anti-Aspergillus therapy was effective.

Cough in pulmonary tuberculosis: Existing knowledge and general insights

Cough is a prominent symptom of pulmonary tuberculosis (TB), one of the oldest and most prevalent infectious diseases. Coughing probably has a pivotal role in transmission of the causative organism Mycobacterium tuberculosis. Despite this, little research to date has addressed this subject. Current knowledge of the mechanisms of cough in TB and how exactly coughing patterns predict infectiousness is scant, but this is changing. This overview summarises the existing evidence for the infectiousness of cough in TB, clinical correlates, and possible causes of cough in TB. Potential unique characteristics of cough in the disease are discussed, as is treatment and the subjective awareness of coughing in the disease.

Broncholithiasis associated with lower airway inflammation and subsequent pyothorax in a cat

Case summary

A 12-year-old female spayed domestic shorthair cat presented with history of a long-term chronic cough that had worsened during the previous 2 months. Thoracic radiographs revealed numerous mineral opacities throughout the lung fields. Multiple bronchial plugs of pale yellow material were present on bronchoscopy, consistent with broncholithiasis. Bronchoalveolar lavage cytology revealed a mild neutrophilic inflammation and bacterial culture was negative. The cat was diagnosed with chronic inflammatory lower airway disease and broncholithiasis, suspected to be due to mineralisation of secretions in the bronchial lumen. The cat was treated for 6 years with oral prednisolone and responded well to treatment. Six years later, the cat developed severe respiratory distress and died. Post-mortem examination identified chronic multifocal broncholithiasis, pulmonary abscessation and pyothorax.

Relevance and novel information

Broncholithiasis is a very rare condition in feline medicine; however, we are reporting a new case and it should be considered as a differential diagnosis for chronic coughing in cats, especially when other common causes have been ruled out and the radiographic findings are suggestive of it. We hypothesise that pathogenesis of the pulmonary abscessation and pyothorax in our patient was, at least partially, due to broncholithiasis. Pleural disease should be considered a complication of broncholithiasis.

Cryotherapy: A viable tool to remove broncholiths under flexible bronchoscopy

Broncholithiasis is the presence of calcific material within the tracheobronchial tree. Asymptomatic patients can be managed with observation only, whereas symptomatic disease requires surgery, rigid or flexible bronchoscopic removal. Recent reports have shown that flexible bronchoscopy can be a safe and effective option for removal of loose in addition to partially imbedded broncholiths. We present a case of a 65-yearold man with chronic cough that underwent successful cryotherapy assisted bronchoscopic removal of an imbedded broncholith. We will also review current literature regarding the management broncholithiasis.

Tombs of Aspergillus: A missed cause of recurrent respiratory infections in allergic bronchopulmonary aspergillosis

Broncholithiasis is an often overlooked condition and has been associated with symptoms such as cough, hemoptysis, and recurrent respiratory infections. The most common mechanism of a broncholith formation is the enlargement and subsequent erosion of a lymph node into an adjacent airway. Here, we describe this entity in a patient with advanced allergic bronchopulmonary aspergillosis, with chronic hypercapnic respiratory failure, and with frequent infective exacerbations. These frequent exacerbations were initially attributed to the poor lung function of the patient and the inability to cough out the secretions. The diagnosis of broncholithiasis was eventually established on bronchoscopy, when the patient was intubated and mechanically ventilated. In this patient, the mixed broncholiths were not associated with mediastinal lymphadenopathy and with biopsy showing Aspergillus with no lymph node tissue indicating its bronchial origin. A high index of suspicion should be kept in patients with recurrent infective exacerbations of pulmonary diseases, especially when computed tomography images show calcifications in the vicinity of airways even in the absence of lymphadenopathy, as most of these can be treated with routine bronchoscopic interventions.