Last revised by Liz Silverstone on 6 Mar 2024

Broncholith refers to focal calcified endobronchial material which usually follows erosion by a granulomatous peribronchial lymph node (e.g. TB) 13. This can cause distal atelectasis, bronchiectasis or mucoid impaction.

  • dry cough

  • hemoptysis

  • fever, chest pain, rigors: due to obstructive pneumonia

  • lithoptysis: coughing up of broncholith(s)

    • rarely

A broncholith is usually formed by erosion by and extrusion of a calcified adjacent lymph node into the bronchial lumen and is usually associated with long-standing foci of necrotizing granulomatous lymphadenitis. Other causes of broncholithiasis include 

  • aspiration of bone tissue or in situ calcification of aspirated foreign material

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

  • migration to a bronchus of calcified material from a distant site, e.g. pleural plaque or the from the kidney (nephrobronchial fistula)

Calcified opacity within a bronchus. There may be associated distal lung collapse or airway dilatation / mucoid impaction.

Broncholithiasis is more common on the right, and obstructive changes particularly affect the right middle lobe.

In some cases they may be left alone while in other cases, they can be removed safely by rigid bronchoscopy with the aid of Nd-YAG laser photocoagulation 9.

Imaging differential considerations include 4

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