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Broncholithiasis: An uncommon disease with life-threatening complications
1 Radiology Resident, Department of Radiology, Mohammed VI Center for Research & Innovation, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
2 Assistant Professor of Radiology, Mohammed VI Center for Research & Innovation, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
3 Professor of Radiology, Mohammed VI Center for Research & Innovation, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
4
Professor of Radiology, Mohammed VI Center for Research & Innovation, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco.
*El Mehdi Mniai and Nawal Bouknani are co-first authors as they contributed equally to this paper.
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Article ID: 100072Z09EM2023
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How to cite this article
Mniai EM, Nawal B, Mahi M, Amal R. Broncholithiasis: An uncommon disease with life-threatening complications. J Case Rep Images Med 2023;9(1):1–3.ABSTRACT
No Abstract
Keywords: Bronchial diseases, Lithiasis, Lithiasis/diagnostic imaging, Pulmonary, Tuberculosis
Case Report
A 60-year-old woman of Morocco consulted for a chronic dry cough evolving during the last five years. She did not relate any episode of fever, hemoptysis or weight loss. The patient was not vaccinated against tuberculosis. She reported a history of pulmonary tuberculosis during youth age, pharmacologically treated for six months. Physical examination was normal. Computed tomography (CT) scan revealed calcified material within the lumen of the bronchus in the left upper lobe (Figure 1) (white arrow) associated with distal bronchiectasis (Figure 2) (white arrow) and mucoid impaction (Figure 3) (black arrow). No segmental pulmonary collapse nor mediastinal lymphadenopathy were found. This CT finding was suggestive of broncholithiasis. Bronchoscopy confirmed the diagnosis by showing intraluminal broncholithiasis with mucosal edema and airway distorsion. Regarding minimal clinical presentation, conservative management was decided with observation.
Discussion
Broncholithiasis (BL) is a condition in which calcified material is present within the bronchial lumen resulting in partial or total airway obstruction [1]. Broncholithiasis is generally caused by a calcification-producing process such as histoplasmosis or tuberculosis. This explains its low prevalence in developed countries.
Clinical presentation ranges from asymptomatic patients to massive hemoptysis. Main symptoms are cough, wheezing and hemoptysis. Lithoptysis (coughing up of broncholith) is a specific symptom, but is rarely found [1]. Broncholithiasis can be a serious condition with life-threatening complications. Most serious presentations are massive hemoptysis and acute airway obstruction [1],[2].
The diagnosis relies mainly on imaging with typical CT findings [1],[2],[3]. Broncholithiasis is evoked in front of intraluminal calcified material with features of airway compression. The major signs of airway obstruction are distal lung collapse, bronchiectasis, and airway distortion. The fingers in glove sign have also been reported as a consequence of mucoid impaction. Mucoid impaction appears as a branching tubular opacity (Figure 3). It refers to airway filling by mucoid secretions subsequent to the obstructive phenomenon [1],[4]. Main differential diagnosis are calcified endobronchial tumors and endobronchial infections with calcified component such as aspergilloma.
Bronchoscopy plays an important role in both confirming the diagnosis and in the management process. It can show the broncholithiasis, the airway obstruction phenomenon and can evaluate the bronchial wall inflammation.
There are multiple management options for patients with BL, including observation, endoscopic removal, and surgery. However, there are no established guidelines [1]. Asymptomatic and minimally symptomatic patients can be managed conservatively with observation. Surgical or endobronchial BL removal are generally indicated for symptomatic or complicated patients [4].
Conclusion
Broncholithiasis (BL) is a condition in which calcified material is present within the bronchial lumen resulting in partial or total airway obstruction. Broncholithiasis can be a serious condition with life-threatening complications. The diagnosis relies mainly on imaging with typical CT findings. Early diagnosis avoids serious complications and an appropriate treatment.
REFERENCES
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Seo JB, Song KS, Lee JS, et al. Broncholithiasis: Review of the causes with radiologic-pathologic correlation. Radiographics 2002;22 Spec No: S199–213. [CrossRef]
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Jin YX, Jiang GN, Jiang L, Ding JA. Diagnosis and treatment evaluation of 48 cases of broncholithiasis. Thorac Cardiovasc Surg 2016;64(5):450–5. [CrossRef]
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SUPPORTING INFORMATION
Author Contributions
El Mehdi Mniai - Conception of the work, Design of the work, Acquisition of data, Drafting the work, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Bouknani Nawal - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Mohamed Mahi - Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Rami Amal - Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
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