Broncholithiasis

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.

The efficacy and safety of bronchoscopy for treating transluminal broncholiths

We aim to reveal the clinical features of transluminal broncholiths and to evaluate the efficacy and safety of bronchoscopy for treating transluminal broncholiths. Patients with transluminal broncholiths were enrolled in this retrospective study in Lanzhou University Second Hospital between January 2010 and December 2018. Then age, gender, symptoms, and signs, imaging characteristics, treatment methods, outcomes as well as complications were retrospectively analyzed. Twenty-eight patients with 36 pieces of transluminal broncholiths were diagnosed using chest CT and bronchoscopy, of which two patients underwent broncholiths removal via an elective surgical procedure and six patients were treated with one-time removal of broncholiths by bronchoscopy. Among the six patients who received one-time removal of stones by bronchoscopy, two underwent massive hemorrhage and one suffered from bronchial wall laceration in the process of broncholiths removal, all of the three patients received surgical treatment eventually. No serious complications occurred in the other 20 patients who underwent broncholiths removal via repeated bronchoscopy. Removal of transluminal broncholiths by bronchoscopy are effective and safe with less complications. When it is difficult to remove the transluminal broncholith completely at one time, repeated bronchoscopy could be chosen: First, to remove the portion which causes airway obstruction; and then to remove the remaining part by repeated bronchoscopy during the follow-up period. In case that severe distal lung tissue injury, massive hemoptysis or bronchial wall laceration occurs or the diagnosis of broncholiths is unclear, surgical treatment is required.

Management of broncholithiasis

Broncholithiasis is a condition in which calcified material has entered the tracheobronchial tree, at times causing airway obstruction and inflammation. Broncholiths generally originate as calcified material in mediastinal lymph nodes that subsequently erode into adjacent airways, often as a result of prior granulomatous infection. Disease manifestations range from asymptomatic stones in the airway to life-threatening complications, including massive hemoptysis and post-obstructive pneumonia. Radiographic imaging, particularly computed tomography scanning of the chest, is integral in the evaluation of suspected broncholithiasis and can be helpful to assess involvement of adjacent structures, including vasculature, prior to any planned intervention. Management strategies largely depend on the severity of disease. Observation is warranted in asymptomatic cases, while therapeutic bronchoscopy and surgical interventions may be necessary for cases involving complications. Bronchoscopic extraction is often feasible in cases in which the broncholith is freely mobile within the airway, whereas partially-embedded broncholiths represent additional challenges. Surgical intervention is indicated for advanced cases deemed not amenable to endoscopic management. Complex cases involving complications such as massive hemoptysis and/or bronchomediastinal fistula formation are best managed with a multidisciplinary approach, utilizing expertise from fields such as pulmonology, radiology, and thoracic surgery.

Post-primary pulmonary TB haemoptysis - When there is more than meets the eye

Haemoptysis is concerning for both patient and healthcare provider and points to the presence of severe underlying lung disease warranting investigation. Approximately 8% of patients with pulmonary tuberculosis (PTB) infection will experience haemoptysis at some point during their life ^[1;2]. The aetiology of haemoptysis in the setting of PTB is diverse and may occur during active or following prior PTB infection due to pulmonary complications. We describe the case of a 33-year-old female who presented with massive haemoptysis on two separate occasions within a five-month period. Her background history included PTB 6 years prior and subsequent post-TB bronchiectasis with a destroyed left lung, and the development of apical mycetoma's. Despite numerous pre-existing aetiologies that could account for haemoptysis in this patient, on this admission, a newly identified ruptured Rasmussen's aneurysm was identified by angiography and successfully treated with arterial embolization. This report serves to highlight the multitude of reasons for haemoptysis in a patient with post PTB lung destruction and the associated diagnostic challenges that may be present. In particular, we highlight the Rasmussen's aneurysm, a rare entity, as a hidden cause of haemoptysis, where despite extensive parenchymal lung disease identified on chest radiography, specialised imaging is needed to confirm the diagnosis.

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.

Broncholithiasis with recurrent lithoptysis: a case report

OBJECTIVE

To report a case of broncholithiasis with different types of calculi in the tracheobronchial tree.

CLINICAL PRESENTATION AND INTERVENTION

A 50-year-old male who suffered from hemoptysis presented with recurrent broncholith expectoration due to past tuberculous middle lobe syndrome. Bronchoscopic examination revealed loose and embedded broncholiths located at two different bronchi. A surgical resection was suggested, but he refused.

CONCLUSION

The diagnosis of broncholithiasis should be kept in mind in patients who had hemoptysis and calcified mediastinal lymph nodes on thorax computerized tomography, and diagnostic bronchoscopy should be done to prove the relationship of the tracheobronchial tree with a broncholith.