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Query: UMLS:C0032285 (pneumonia)
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A calcified hilar or mediastinal lymph node can compress or erode the tracheobronchial tree and cause a variety of problems, including the "spitting of stones," hemoptysis, pneumonia, atelectasis, and bronchoesophageal fistula. From 1955 to 1975, 43 patients were evaluated for broncholithiasis. Nonsurgical management was carried out in 10 patients, whereas the remaining 33 underwent thoracotomy for the pathological process. Five patients had bronchoesophageal fistula as a result of the broncholith. Segmentectomy was the surgical resective procedure most commonly used. Conservation of pulmonary tissue is recommended when dealing with this problem. Surgical complications were minimal and no deaths occurred. The surgeon must be versatile in his technical approach and be prepared to carry out bronchoplastic procedures when indicated. A clinical awareness of the symptomatology of broncholithiasis leads the examiner to carry out the appropriate diagnostic studies of laminagraphy, bronchoscopy, bronchography, and esophagography. Early diagnosis and treatment will prevent the severe complications that can occur from continued observation.
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PMID:The surgical implication of broncholithiasis. 118 71

A broncholith is a calcified lymph node which partially or completely erodes into the bronchial lumen. Its manifestations are non-specific and may result in life-threatening complications. In Taiwan, pulmonary tuberculosis, one of the most common etiologies of broncholithiasis, is common. To our knowledge, no report on broncholithiasis can be found in literature in this country. We herein present three cases of broncholithiasis experienced in the past 11 years in Chang Gung Memorial Hospital. The presenting manifestations are obstructive pneumonia in two cases, and hemoptysis in the other one. In two of them, the broncholiths were located in the right side. Fiberoptic bronchoscopy was performed, and the stones were visible in all of them. Bronchoscopic removal of stone was successful in two cases, and the other coughed up stones spontaneously after bronchoscopies. In the absence of significant symptoms or complications, only observation is necessary. For the symptomatic borncholiths, we advocate that bronchoscopic removal is worth trying to eliminate the necessity of thoracotomy unless complications are present, which indicate surgical intervention such as massive hemoptysis, fistula formation between tracheobronchial trees and esophagus or vessels, recurrent pulmonary infection or suspicion of malignancy.
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PMID:Broncholithiasis: a neglected bronchial disease in this country. Illustration of three cases. 158 38

Broncholithiasis, a disease that is probably much more common than has been reported, is most often associated with pulmonary infections, for example, tuberculosis and histoplasmosis. Stones originate from calcified peribronchial lymph nodes that erode into the tracheobronchial tree, but lithoptysis occurs infrequently. The most common symptoms are persistent cough and hemoptysis, sometimes followed by findings of obstructive pneumonia (fever, chills, and purulent sputum). Physical findings are nonspecific, and radiologic findings are varied. Complications include formation of a fistula between the respiratory tract and the esophagus or aorta and obstructive pulmonary symptoms. Treatment ranges from conservative management (simple observation) to thoracotomy for patients in whom complications from stone erosion develop. The prognosis of patients with broncholithiasis is generally excellent.
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PMID:Coughing up a stone. What to do about broncholithiasis. 334 60

In order to determine the present clinical spectrum of broncholithiasis and the impact that chest computed tomographic (CT) scans, laminograms , and fiberoptic bronchoscopy ( FOB ) have had on the diagnosis and treatment of this entity, we reviewed our experience between 1970 and 1982. Nineteen patients were identified with this diagnosis. Cough, hemoptysis, and obstructive pneumonia were the most common presentations. Lithoptysis occurred in only 3 patients. The chest radiographic findings were nonspecific, but in 8 of the 19 patients, laminograms or chest CT scans helped establish the diagnosis; FOB was performed on 18 patients and was abnormal in each case, with 8 intrabronchial calcifications identified. However, FOB has limited therapeutic indications in this disorder. Depending on the patient's clinical status and underlying lung disease, observation, bronchoscopic removal of the stone, or surgical resection may be indicated.
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PMID:Advances in the diagnosis and treatment of broncholithiasis. 673 45

Middle lobe syndrome (MLS) is an uncommon lung disorder involving the right middle lobe and/or lingula and is characterized by a spectrum of clinical and pathological lesions ranging from recurrent atelectasis or pneumonias to bronchiectasis. Despite several series reporting the clinical features of MLS, histopathological descriptions are rare. We reviewed the clinical characteristics and pathological findings in 21 patients with MLS who underwent surgical resections. Six male and 15 female patients between the ages of 5 and 80 years (mean, 47 years) were studied. All patients were symptomatic and complained of chronic cough (8), hemoptysis (6), chest pain (4), dyspnea (3), or fever (2). The right middle lobe was involved in 11 patients, the lingula in four patients, and both right middle lobe and lingula in six patients. Chest radiographs, bronchograms, and/or computed tomography scans were available for review in 19 patients and showed consolidation (8), bronchiectasis (9), patchy infiltrates (5), and atelectasis (4) in various combinations. Pathological findings included bronchiectasis in 10 patients, chronic bronchitis/bronchiolitis with lymphoid hyperplasia in seven, patchy organizing pneumonia in six, atelectasis in five, granulomatous inflammation in five, and abscess formation in four. Three patients with granulomatous inflammation had associated atypical mycobacterial infection. Broncholithiasis was confirmed by pathological examination in one patient. No pathological cause for bronchial obstruction was identified in the remaining 20 patients, although one was thought to have had broncholithiasis on the basis of preoperative bronchoscopy. The presence of bronchiectasis, bronchitis or bronchiolitis, organizing pneumonia, or atelectasis in specimens from the right middle lobe or of lingula in the absence of an identifiable cause of bronchial obstruction should suggest a diagnosis of MLS.
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PMID:Middle lobe syndrome: a clinicopathological study of 21 patients. 789 Feb 82

236 cases with middle lobe syndrome were examined with fibrobronchoscope. The total rate of positive finding was 92.8% (219/236). Inflammation (167 cases), lung cancer (47 cases), tuberculosis (17 cases) accounted for most of the cases. The diagnostic rate for the three above-mentioned diseases were 97.6%, 87.2% and 58.8% respectively. Fibrobronchoscopy was also of significant diagnostic value in determining other uncommon cases such as broncholithiasis, lipoid pneumonia, lung infiltration in leukemia, etc. The etiology, chest X-ray (including CT) presentations of this middle lobe syndrome and the diagnostic value of fibrobronchoscopy were discussed. Our experience suggests that this procedure is both safe and effective in the diagnosis of patients with middle lobe syndrome.
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PMID:[Fibrobronchoscopy in the diagnosis of middle lobe syndrome]. 817 89

Histoplasmosis is a common infection in the central United States and is acquired through inhalation of airborne spores. The majority of infected persons have an asymptomatic, self-limiting illness. Clinical pneumonia occurs in those with exposure to a large number of infecting spores. Resolution of the pneumonia often leaves calcified pulmonary nodules, calcified mediastinal lymph nodes, or splenic calcifications. Chronic disease, which mimics tuberculosis, may develop in those with underlying emphysema. In patients with deficient cell-mediated immunity, Histoplasma capsulatum may disseminate throughout the body; this often is fatal. Delayed manifestations arise months or years after the primary infection. Broncholithiasis occurs when peribronchial calcific nodes produce bronchial obstruction. Mediastinal granuloma is the continued proliferation of fibrous tissue in draining mediastinal lymph nodes. These granulomas may obstruct adjacent veins, arteries, or airways and lead to various clinical symptoms.
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PMID:Pulmonary histoplasmosis. 866 68

A 61-year-old man who had been treated for pneumonia several times was examined because radiographs and computed tomograms disclosed a mass-like shadow associated with a cavity in the left lingular segment. The lesion was resected by video-assisted thoracoscopic surgery because it was suspected of being a lung abscess that had caused repeated episodes of inflammation. The resected specimen revealed a severely dilated peripheral bronchus due to broncholithiasis. It is often difficult to diagnose a lesion as broncholithiasis on the basis of secondary changes or calcification without bronchoscopic data. We emphasize that broncholithiasis should be suspected when a shadow resembling a lung abscess associated with symptoms of recurrent infection is found.
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PMID:[Bronchial dilatation due to broncholithiasis mimicking lung abscess]. 1021 49

We report a case of a 32-year-old woman who, after passage of broncholiths, developed a mediastinal abscess that required surgical drainage for treatment. Previously reported infectious complications resulting from broncholiths include obstructive pneumonitis and recurrent aspiration pneumonitis secondary to bronchoesophageal fistulas. Because radiographic evidence of abnormal calcification in the chest is common, but rarely is associated with broncholithiasis, the patient's history of lithoptysis was crucial to determining the underlying etiology of her abscess.
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PMID:Mediastinal abscess due to passage of a broncholith. 1179 70

A case is reported of broncholithiasis in a 29-year-old female factory worker presenting with cough and lithoptysis. Broncholithiasis is a rare disorder characterized by calcified perihilar and mediastinal lymph nodes eroding into the tracheobronchial tree. Although cough, hemoptysis, lithoptysis, pneumonia and bronchoesophageal fistula formation have been reported, broncholithiasis may also result in potentially life-threatening conditions such as airway obstruction from endobronchial polypoid granulation masses, and massive hemorrhage from an aorto-tracheal fistula or erosion of a pulmonary artery branch.
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PMID:Broncholithiasis: a case report. 1248 15


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