Broncholithiasis - Differential Diagnosis Framework



 • Also known as: Lung stones, pulmoliths, pneumoliths, bronchial calculi

 • Bronchial inflammation or obstruction resulting from broncholiths which originate from adjacent calcified mediastinal lymph nodes.

 • Broncholiths are calcified structures or hard concretions that have eroded into the tracheobronchial tree

 • Calcification of mediastinal lymph nodes occurs late in the course of Histoplasmosis and generally after host control of the infection



Broncholithiasis Epidemiology:

 • M=F

 • Median age of 50 years at presentation.



Broncholithiasis - Clinical Presentation:

 • Nonspecific chronic cough,

 • Hemoptysis (30-85 percent of patients)

 • Lithoptysis (less than 20 percent of patients),

 • Chest pain

 • Wheezing

 • Fever



Broncholithiasis Complications:

 • Recurrent pneumonia,

 • Bronchiectasis

 • Massive hemoptysis can occur if there is erosion into the aorta or pulmonary artery

 • Bronchoesophageal or bronchoaortic fistula



Broncholithiasis Diagnosis:

 • Chest Xray - Chest radiography often fails to show the calcification within the bronchus

 • Chest CT

 • Bronchoscopy - Diagnostic and therapeutic

	- Bronchoscopy can miss the calcified endobronchial material - often obscured by overlying bronchial wall inflammation or is distal to inflamed and narrowed airways rendered inaccessible to bronchoscopy

 • Thoracotomy



Broncholithiasis - Infectious Causes:

 • Mycobacterium Tuberculosis

 • Histoplasmosis

 • M. Kansasii

 • B. Dermatitidis

 • C. Immitis

 • Cryptococcus neoformans

 • Actinomyces israelii

 • Nocardia asteroides



Broncholithiasis - Noninfectious Causes:

 • Pulmonary silicosis

 • Sarcoidosis

 • Aspiration of bone tissue in food

 • In situ calcification of aspirated foreign material

 • Erosion by and extrusion of calcified or ossified bronchial cartilage plates

 • Calcified material from distant sites (such as the kidneys) that migrated to a bronchus



Mimics:

 • Primary Endobronchial Infection

 • Calcified Endobronchial Tumor

 • Tracheobronchial Diseases with Mural Calcification

 • Endobronchial hamartoma

 • Hypertrophied Bronchial Artery with Intraluminal Protrusion



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