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.

Clinical presentation

• dry cough

• haemoptysis

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

• lithoptysis: coughing up of broncholith(s)

  • rarely

Pathology

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 necrotising 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)

Radiographic features

CT

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.

Treatment and prognosis

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.

Differential diagnosis

Imaging differential considerations include ⁴

• endobronchial infections with calcified fungus ball: aspergilloma

• calcified endobronchial tumours

• tracheobronchial diseases with mural calcification: most commonly tracheobronchial amyloidosis

• hypertrophied bronchial artery with intraluminal protrusion

See also

• thoracoliths