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 #Broncholithiasis #Differential #Diagnosis #pulmonary
