NEJM
Broncholithiasis
|
Meyer and O'Regan 348 (4): 318, Figure 1 January 23, 2003 |
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.