Hemoptysis as the Initial Presentation of Broncholithiasis: A Case Report.

SESSION TITLE: Bronchology/Interventional Student/Resident Case Report Posters IISESSION TYPE: Medical Student/Resident Case ReportPRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PMINTRODUCTION: A broncholith is a calcified material in the bronchus. As a result of the relatively low incidence of this disease, broncholithiasis has often been neglected in the differential diagnosis of hemoptysis. As a result, patients have been wrongly tagged with more common diseases causing bronchial obstruction, thereby losing the benefit of prompt diagnosis and therapy. We present a case of broncholithiasis presenting with hemoptysis.

CASE PRESENTATION: A 51 year old African American female referred to the pulmonary clinic with complaints of chronic cough and hemoptysis for about 6 months. She was in no respiratory distress without any findings on chest exam. Chest X-ray showed calcified left hilar lymph nodes consistent with previous granulomatous disease. Computed tomography of Chest performed afterwards showed same findings in addition to fluid filled dilated bronchi in posterior basal segment of the left lower lobe consistent with bronchiectasis. Due to the findings of bronchiectasis on the left lung, a suspicion of an obstructive lesion was raised. On flexible bronchoscopy, a whitish hard broncholith was seen at the entrance of the superior segment of the left lower lobe. Attempts to remove the broncholith were unsuccessful and patient was referred to thoracic surgery.DISCUSSION: Broncholithiasis is an important cause of hemoptysis especially when radiographic investigations are inconclusive. Broncholiths are usually a result of erosion of peribronchial calcified lymph node into the tracheobronchial tree.1 Tuberculosis is the most common cause worldwide, but histoplasmosis is the most common in endemic areas like southeastern, mid-atlantic, and central United States.2 Symptoms associated with broncholithiasis include non-specific chronic cough, hemoptysis, and lithoptysis, chest pain, and wheezing. Our patient had chronic cough and hemoptysis. Diagnosis can be made with a fair amount of surety when calcifications are seen in the large airways on radiographic studies. Bronchoscopy can be used for definitive diagnosis and removal in broncholithiasis. Thoracic surgery may be needed if bronchoscopy is unsuccessful.3CONCLUSIONS: Hemoptysis in the setting of calcifications on radiological studies should raise the suspicion of brocholithiasis. Histoplasmosis is the commonest cause in endemic areas. Removal of broncholiths is usually safe and successful with bronchoscopy. Surgery may be needed for irremovable broncholiths.Reference #1: Cerfolio RJ, Bryant AS, Maiscalco L. Rigid bronchoscopy and surgical resection for broncholithiasis and calcified mediastinal lymph nodes. J Thorac Cardiovasc Surg 2008;136:186-90.Reference #2: Baum GL, Bernstein IL, Schwarz J. Broncholithiasis produced by histoplasmosis. Am Rev Tuberc 1958;77:162-7.Reference #3: Menivale F, Deslee G, Vallerand H, Toubas O, Delepine G, Guillou Pj, Lebargy F. Therapeutic management of broncholithiasis. Ann Thorac Surg 2005; 79:1774-1776DISCLOSURE: The following authors have nothing to disclose: Bimaje Akpa, Jeffrey Shehane, Calvin Smith, Jason MartinNo Product/Research Disclosure Information.