Broncholithiasis presenting as bronchiectasis and recurrent pneumonias

Abstract

A broncholith is defined as the presence of calcified material within a bronchus or within a cavity communicating with a bronchus. It is most frequently caused by Histoplasmosis or tuberculosis (TB) spp. Bronchial distortion, irritation and erosion by broncholiths can cause bronchiectasis, recurrent pneumonias and haemoptysis. We present a case of recurrent pneumonia due to a broncholith, which resolved conservatively with antibiotics. Owing to recurrent fevers and post obstructive pneumonias, a lobectomy or rigid bronchoscopic removal were considered but the patient was deemed not to be a candidate for general anaesthesia due to her comorbidities. Broncholiths are an uncommon cause of bronchiectasis and recurrent pneumonias. However, the wide range of symptoms and low clinical suspicion are the main reasons why a diagnosis can be delayed. Various treatment options are available and the choice of therapy should be made depending on the broncholith's size, mobility, location and local surgical expertise.

Figure 1

Chest radiograph posteroanterior and lateral views showing cardiomegaly, bilateral hilar calcifications and an increased left upper lobe density partially obscured by the patient's implantable cardiac defibrillator.

Figure 2

CT angiography of the chest (axial view) showing collapse of a segment of the left upper lobe with distal bronchiectatic changes (top row) as well as proximal calcified lymph nodes in the superior aspect of the left hilum (bottom row).