The previously recognized customs of therapy for symptomatic broncholithiasis are broncholithectomy via surgery or bronchoscopy A 46-year-old woman with bilateral partial bronchial obstruction was treated with Nd-YAG laser with out and out resolution of symptoms and of airway obstruction.

The previously recognized customs of therapy for symptomatic broncholithiasis are broncholithectomy via surgery or bronchoscopy A 46-year-old woman with bilateral partial bronchial obstruction was treated with Nd-YAG laser with out and out resolution of symptoms and of airway obstruction. (CHEST 1998; 113:240-42)

Key words: bronchial diseases; laser surgery; lung diseases

Broncholithiasis is defined as the vicinity of calcified material within the bronchial lumen or compressing the tracheobronchial tree The usual presenting symptoms are cough hemoptysis, feculent sputum, fever, chest pain, dyspnea, and wheezing. Although lithoptysis is pathognomonic for broncholithiasis, it is rarely seen Not all cases of broncholithiasis require treatment. However, if symptoms persist or if a bronchoesophageal or a bronchoarterial fistula or malignant tumor is suspected, intervention is necessary, either according to removal of the broncholith [i]or[/i] part of to the other bronchoscopy, which remains controversial, or by means of surgical resection.

CASE REPORT

A 46-year-old female bus driver with a history of allergic rhinitis for 22 years was referr for evaluation of wheezing, cough productive of clear sputum and exertional dyspnea for 6 month prior to her visit. She also reported not long ago expectorating two small stones that were 1 to 2 mm in diameter. Her medical history disclosed anemia. Her physical examination revealed scattered wheezing from beginning to end both lung fields with a continue lengthen in timeed expiratory phase but was otherwise normal. The chest x-ray film and a CT scan of the thorax revealed bilateral perihilar adenopathy with calcification (Fig 1) Values for the remainder of her laboratory studies were within normal ranges omit for a hemoglobin level of 86 g/dL which was determined to be secondary to heavy mense A purified protein derivative skin standard and histoplasma antibody titers were negative. Pulmonary function testing showed moderate obstructive disease with an FVC of 33 L and [FEVsub1] of 19 L The patient reported that she had a favorite parakeet for 5 years as a child and also noted a exposure to chickens, ducks, and pigeons. She denied travel to the San Joaquin or Mississippi River valleys.

[Figure 1 ILLUSTRATION OMITTED]

The patient's respiratory symptoms improved after therapy with prednisone, inhaled albuterol, and inhaled beclomethasone, moreover 6 months later she reported a the having recourse of wheezing and productive cough as well as hemoptysis and lithoptysis. Flexible fiberoptic bronchoscopy demonstrated pedunculated granulation tissue in the left mainstem bronchus partially obstructing the lumen as well as a similar lesion in the intermediate bronchus (Figs 2 and 3) Biopsy of these lesions showed alone granulation tissue with inflammatory and epithelial confined apartments It was concluded that the patient's symptoms were caused at bilateral broncholithiasis possibly as a end of prior exposure to Histoplasma capsulatum although this could not be conclusively determined. Nd-YAG laser photoradiation therapy was chosen for coagulation of the granulation tissue. This treatment was performed with a fiberoptic bronchoscope (Olympus BF 1T10) with the patient receiving local anesthesia and conscious sedation. one as well as the other masses were removed and further laser coagulation was applied to the stalk and the area of insertion at the bronchial wall plain At this point, there was no evidence of calcifications at the treatment cincture As a result of this single proceeding the patient experienced complete resolution of her respiratory symptoms. after review bronchoscopy failed to demonstrate the having recourse of the obstructing granulation tissue (Figs 4 and 5) in the following 4 years. Spirometric values answered to normal while the patient remained asymptomatic.

[Figures 2-5 ILLUSTRATION OMITTED]

DISCUSSION

Broncholithiasis is a rare disease. in the greatest degree commonly, it is caused by dint of a calcified hilar or peribronchial lymph node eroding into the tracheobronchial tree Respiratory mental actions cause their migration into the bronchus and induce urgency atrophy of the bronchial wall, and as a conclusion of this process, erosion and obstruction of the intrabronchial lumen takes place,[1] Calcification of the lymph nodes appears frequently as a result of tuberculosis or histoplasmosis[2,3] if it were not that can occur secondary to other disorders including silicosis.[3] However, broncholithiasis also can be caused by way of calcification of aspirated food or tissue or as a proceed of obstruction by calcified bronchial cartilage secondary to necrosis.[4] Broneholithiasis has a predilection for the fight bronchial tree on the contrary shows no predilection for either sex and may meet the eye in patients of any age.

The diagnosis of broneholithiasis is established in virtually 100% of eases using the combined modalities of a CT scan and flexible fiberoptic bronchoscopy The optimal treatment of broneholithiasis is controversial. couple therapeutic approaches utilized at existing are surgical resection and removal of the broncholith by way of bronchoscopy. Several authors[2,3,5] have argued that endoscopic stone removal, preferably by way of rigid bronchoscopy, can be attempted if no complications of stone erosion like massive hemoptysis, fistulas, lung abscesses, or bronchiectases are not absent especially if the broncholith is unfasten and mobile within the bronchial lumen Other authors[1,6] argue that given the risk of pulmonary artery erosion by means of the broncholith, even when minimal hemoptysis is not past nor future surgical intervention should be the action of choice. Surgical procedures range from simple removal of the broncholith within thoracotomy to lobectomy, with conservation of as a great deal pulmonary tissue as possible. With the latter practice resection of all the tissue affected by the agency of broneholithiasis is performed.

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