Acute Airway Obstruction Secondary to Bilateral Broncholithiasis

doi:10.1378/chest.117.4.1205

Chest

Volume 117, Issue 4, April 2000, Pages 1205-1207

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We report a case of acute airway obstruction secondary to bilateral broncholiths. Successful management was achieved with rigid bronchoscopy.

Section snippets

Case Report

An 80-year-old woman presented initially with a history of nonproductive cough and symptoms clinically consistent with asthma of approximately 28 months’ duration. Her pulmonary function test revealed a FEV₁ of 1.03 L (62%); FVC, 1.81 (85%); and FEV₁/FVC, 57%. Predicted values were FEV₁ of 1.6 L; FVC, 2.09 L; and FEV₁/FVC, 76%. One year prior to presentation, she experienced a 2-month history of hemoptysis followed by an episode of broncholithoptysis. A chest radiograph revealed a calcified

Discussion

Broncholiths most frequently result from erosion of a contiguous calcified granuloma through the bronchial wall, accelerated by the constant motion of respiration and cardiac movement.² The cause of broncholithiasis is usually infection and involves Histoplasma capsulatum and Mycobacterium tuberculosis. Other infections healing with multiple residual calcifications include cryptococcosis, nocardiosis, actinomycosis, and coccidiodomycosis.⁴ Silicosis is the only documented noninfectious cause of

References (7)

TR McLean et al.
Massive hemoptysis due to broncholithiasis
Ann Thorac Surg
(1991)
TB Ferguson
Bacterial infection of the lung
FH Cole et al.
Management of broncholithiasis: is thoracotomy necessary?
Ann Thorac Surg
(1991)

There are more references available in the full text version of this article.

Cited by (15)

Broncholithiasis: A Review
2019, Chest
Citation Excerpt :
Bronchiectasis is frequently reported12,40 and is observed in 20% to 30% of patients.3,6 Other rare complications include empyema,41 mediastinal abscess,42 acute airway obstruction,43,44 chronic lung abscess, bronchoceles,3 and middle lobe syndrome. The latter is characterized by recurrent atelectasis, pneumonias, or bronchiectasis in either the right middle lobe or the lingula.45
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.
An unusual respiratory tract foreign body: A case report of pediatric broncholithiasis
2016, International Journal of Pediatric Otorhinolaryngology Extra
Citation Excerpt :
The time course in our case was even shorter, which was less than 3 weeks. In addition, it has been reported that most broncholiths were located in the right bronchial tree [9]. In this case, however, we found the broncholiths blocked in the upper main trachea, during the second bronchoscopic broncholithectomy.
Tracheobronchial foreign body aspiration is one of the most life-threatening diseases in children. Its symptom is non-specific sometimes; therefore the distinction with some similar clinical presentation pulmonary disease should be performed. Here, we reported a 5-year-old girl who was misdiagnosed with foreign body aspiration twice based on the broncho-obstructive symptom and radiologic finding. Finally, the diagnosis of broncholithiasis was confirmed by finding broncholiths in the respiratory tract through bronchoscopy. It is replied that bronchoscopy should be performed in the children with unexplained airway obstruction symptom. Furthermore, it is the first report about the broncholiths located at the upper main trachea.
Broncholithiasis: Six cases
2007, Revue de Pneumologie Clinique
La broncholithiase est une pathologie rare, caractérisée par la présence de concrétions calcaires dans la lumière bronchique. Nous rapportons les observations de 6 patientes atteintes de broncholithiase. L’âge moyen était de 41 ans. Les manifestations révélatrices de la broncholithiase étaient une hémoptysie (n = 5), une toux (n = 5), une fièvre (n = 1) et des infections respiratoires basses récidivantes (n = 1). L’examen physique montrait des râles ronflants chez 2 patientes et était normal chez les 4 autres. La radiographie du thorax montrait une opacité parenchymateuse de tonalité calcique dans 1 cas, une atélectasie dans 2 cas et des images aréolaires dans 3 cas. L’endoscopie bronchique montrait un broncholithe dans 1 cas, un caillot sanguin endobronchique chez une patiente présentant une hémoptysie abondante, un bourgeon endoluminal simulant une tumeur chez 2 patientes, un aspect inflammatoire chez une patiente et était normale chez une patiente. La tomodensitométrie thoracique mettait en évidence le broncholithe dans 3 cas.
Le traitement consistait en une lobectomie dans 5 cas. L’étude anatomopathologique de la pièce opératoire confirmait la broncholithiase chez ces patientes et montrait des lésions caséo-folliculaires des ganglions hilaires dans un cas. Un traitement antituberculeux était prescrit chez cette patiente. L’abstention thérapeutique avec une surveillance était décidée chez la patiente présentant une broncholithiase non compliquée.
La broncholithiase est une pathologie rare et potentiellement grave. Le diagnostic de certitude repose sur la combinaison de la tomodensitométrie haute résolution et de l’endoscopie, mais la broncholithiase peut demeurer une découverte chirurgicale.
Broncholithiasis is an exceptional condition characterized by the presence of stony formations in the bronchial lumen. We report six cases.
Mean age was 41 years. Revealing signs were hemoptysis (n = 5), cough (n = 5), fever (n = 1) and recurrent lower respiratory tract infections (n = 1). Physical examination found sonorous rales in two patients and was normal in four. The chest x-ray showed a parenchymal opacity suggestive of calcification in one patient, atelectasia in two, and alveolar images in three. Bronchial endoscopy demonstrated broncholithiasis in one patient, an endobronchial blood clot in one patient with abundant hemoptysis, an endoluminal bud simulating a tumor in two, an inflammatory aspect in one, and was normal in one. Thoracic computed tomography demonstrated broncholithiasis in three patients.
Treatment consisted in lobectomy in five patients. The pathology specimen confirmed broncholithiasis in all five and in one revealed caseofollicular lesions of the hillar nodes. Anti-tuberculosis treatment was prescribed for this patient. Therapeutic abstention with regular surveillance was chosen for one patient with an uncomplicated broncholithiasis.
Broncholithiasis is an exceptional condition with potentially serious consequences. Certain diagnosis is based on high-resolution computed tomography and endoscopic findings but can nevertheless be a surgical discovery.
Calcium stone lithoptysis in primary ciliary dyskinesia
2007, Respiratory Medicine
Citation Excerpt :
This report cited eleven prior Japanese cases of idiopathic bronchiectasis with pulmonary calcification secondary to “retained mucus”. Broncholithiasis as a result of calcium deposition in bronchiectatic airways in this cohort of PCD patients was not associated with severe complications of broncholithiasis previously reported.12,16–19 Broncholithiasis has been associated with chronic cough and recurrent pneumonia13,20,21 both of which are invariably associated with PCD.
An association between lithoptysis and primary ciliary dyskinesia (PCD) has not been previously reported. However, reports of lithoptysis from 2 older patients (>60 yr) prompted a study of this association.
We performed a prospective study of all PCD patients presenting to our institution between August 2003 and March 2006, seeking the symptom of lithoptysis or calcium deposition on radiology. A retrospective analysis of all PCD patients presenting prior to August 2003 was also performed. Patients age⩾40 previously reviewed were recontacted. If a history of lithoptysis or calcium deposition was present, we further reviewed radiographic, microbiologic, and biochemical data, including serum calcium and phosphate. Broncholiths were analyzed by light and electron microscopy- and electron-dispersive X-ray analysis.
In total, 142 patients ( $n = 28$ age⩾40) were included, 41 in the prospective and 91 in the retrospective study. Lithoptysis was reported in 5 patients (all age⩾40). Chest CT scans identified calcification (4/5), involving bronchiectatic airways in 3 patients and focal nodular calcification in 1 patient. Two other patients (age 46, 59) were identified with airway calcification without lithoptysis. Available broncholiths from 2 of these patients were composed of calcite, whereas a broncholith from 1 patient with focal nodular calcification contained calcium phosphate. Sputum was positive for Pseudomonas aeruginosa in all 7 patients, but negative for mycobacterial and fungal cultures.
There is an association between lithoptysis and PCD in patients age⩾40. We hypothesize that calcite stone formation is a biomineralization response to chronic airway inflammation and retention of infected airway secretions in PCD in a subset of PCD patients.
Broncholithiasis
2006, Revue des Maladies Respiratoires
La broncholithiase est définie par la présence de matériel calcifié dans la lumière bronchique. Le but de notre travail est d’étudier les caractéristiques cliniques, radiologiques et thérapeutiques de la broncholithiase.
Nous rapportons le cas de 6 patients répertoriés sur une période de 14 ans (1990-2004). II s’agit de 4 hommes et 2 femmes dont la moyenne d’âge est de 50 ans. Des antécédents de tuberculose pulmonaire ont été retrouvés dans deux cas. Le motif d’hospitalisation était l’hémoptysie chez 4 patients. La fibroscopie bronchique a été effectuée chez tous les patients, elle a objectivée des broncholithes chez deux. Le scanner thoracique effectué chez 5 patients a montré chez 3 des calcifications hilaires et parenchymateuses faisant évoquer le diagnostic de broncholithiase. Le diagnostic de lithiase bronchique a été retenu chez 2 patients sur les données de l’endoscopie bronchique, chez 2 autres sur la biopsie chirurgicale et sur l’aspect tomodensitométrique chez les 2 derniers. Trois malades ont été opérés: 2 patients dans un but diagnostique et le 3^e dans un but hémostatique. Une tuberculose pulmonaire a été découverte chez 2 patients, dans le premier cas sur la culture de bacille de Koch et dans le deuxième sur les résultats de la biopsie chirurgicale. L’évolution a été favorable chez tous les patients.
La broncholithiase pose un problème de diagnostic différentiel avec d’autres pathologies pulmonaires du fait des aspects cliniques, endoscopiques et radiologiques trompeurs.
Broncholithiasis is defined as the presence of calcified material in the bronchial lumen. The aim of our work was to study the clinical, radiological and therapeutic aspects of broncholithiasis.
We report the histories of 6 patients identified over 14 years (1990-2004). They included 4 men and 2 women with an average age of 50 years. A past history of pulmonary tuberculosis was found in 2 cases. The presenting symptom was haemoptysis in 4 patients. Fibreoptic bronchoscopy was performed in all patients and broncholiths were found in two. Thoracic CT scan was performed in 5 patients and in 3 showed hilar and parenchymal calcification, suggesting the diagnosis of broncholithiasis. The diagnosis was confirmed in 2 patients by bronchoscopy, in 2 others by surgical biopsy and in the remaining 2 by the CT appearances. Three patients were operated on: 2 for diagnosis and the third for haemostasis. Pulmonary tuberculosis was discovered in 2 patients, one by culture and the other by surgical biopsy. The outcome was satisfactory in all cases.
Broncholithiasis presents a problem of differential diagnosis from other pulmonary pathologies on account of misleading clinical, endoscopic and radiological features.
Bronchospasm and hemoptysis. Could have the same cause?
2005, Revista Portuguesa de Pneumologia
Os autores descrevem o caso de um homem de 46 anos, ex-fumador, ex-criador de pombos, seguido na consulta de Imunoalergologia por sibilância refractária à terapêutica instituída.
Na sequência de um episódio de hemoptises é internado no Serviço de Pneumologia do Hospital de São João. Do estudo efectuado, a broncofibroscopia mostrou neoformação vegetante e necrosada que obstruía, quase na totalidade, o brônquio principal direito, cuja histologia não foi conclusiva e implicou a realização de broncoscopia rígida.
Esta técnica permitiu a identificação de um broncolito que foi parcialmente removido, com identificação de uma fístula gânglio-brônquica direita.
Actualmente, o doente mantém-se assintomático, estando a fístula encerrada por tecido cicatricial e sob vigilância na consulta da especialidade.
Inicialmente descrita por Aristóteles, a broncolitíase corresponde à presença de cálculos na árvore brônquica. Não deixa de ser uma patologia rara, com expressão clínica variável, que deve ser considerada se existir sintomatologia respiratória associada a calcificações mediastínicas e hilares.
Rev Port Pneumol 2005; XI (1): 67-72
The authors describe the case of a man, 46 years old, former smoker, former bird breeder, followed in the service of Imunoallergology for bronchospasm whithout response to the treatment.
After experiencing an hemoptysis he was admitted in our service.
He was submited to many exams, which include a flexible bronchoscopy. This technique allows the identification of an endobronquial necrotic mass, which almost obstructed the main right bronchus.
In order to obtain a bigger and more representative sample a rigid bronchoscopy was performed. This technique showed a broncholith, which was parcially removed, and a bronchial fistula.
Actually he is assimptomatic and under annual surveillance.
First described for Aristoteles, the broncholithiasis is defined by the presence of stones in the bronchial tree. It is a very rare pathology, with a variable clinical expression, which must be considered whenever there is respiratory complaints in association with hilar or mediastinic calcifications.
Rev Port Pneumol 2005; XI (1): 67-72

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Chest

Selected ReportsAcute Airway Obstruction Secondary to Bilateral Broncholithiasis

Section snippets

Case Report

Discussion

Ann Thorac Surg

Bacterial infection of the lung

Management of broncholithiasis: is thoracotomy necessary?

Ann Thorac Surg

Selected Reports
Acute Airway Obstruction Secondary to Bilateral Broncholithiasis