Articles

A 42-year-old man presented with hemoptysis after a bicycle accident. Computed tomographic scanning revealed a calcified mediastinal lymph node close to the right mainstem bronchus (Panel A, arrow). Fiberoptic bronchoscopy revealed a bleeding endobronchial mass (Panel B, arrow). Virtual bronchoscopy demonstrated that the mass represented mucosa overlying a calcified lymph node (Panel C, arrow). The patient was given a diagnosis of broncholithiasis. The patient's medical history revealed an episode of severe community-acquired pneumonia in western Illinois 20 years earlier, when histoplasmosis was suspected. He had no further hemoptysis, and resection was considered to be unnecessary. Mycobacterium tuberculosis is the most common cause of broncholithiasis worldwide; histoplasmosis is the most common cause in the United States. Hemoptysis occurs in 37 to 85 percent of cases and may be the sole presenting symptom. In our patient, hemoptysis may have been precipitated by traumatic injury.