대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Broncholithiasis with organizing pneumonia

Radiologic Findings

Chest radiograph shows dense nodular opacity in right hilar area, suggesting calcified lymph node. A subtle dense nodular lesion is noted at infrahilar portion. Precontrast thin-section CT scan at the level of left atrium shows nodular opacity with spotty calcification medial to the segmental bronchi of right lower lobe. On tracing the bronchi of right lower lobe, medial basal segmental bronchus of right lower lobe is obstructed by the lesion.

On bronchoscopy, the segmental bronchus was obstructed by the nodular mucosal lesion. Right lower lobectomy was performed. Pathology revealed dilated bronchi of medial segment of right lower lobe filled with brownish necrotic material. Proximal to the dilated bronchi, there was partially calcified peribrochial lymph node eroding into the bronchus.

Brief Review

Broncholithiasis is defined as a condition in which calcified or ossified material is present within the bronchial lumen. Radiographic findings of broncholithiasis include airway obstruction such as atelectasis, mucoid impaction, bronchiectasis, and expiratory air trapping. Some authors expanded the definition to include those cases in which peribronchial calcified lymph nodes distort the bronchial tree without extrusion of the lymph node into the bronchus. Broncholithiasis is strongly suggested at computed tomography (CT) when an endobronchial or peribronchial calcified nodule is associated with findings of bronchial obstruction. Volume data acquisition by means of helical CT with sections less than 3 mm in thickness and multiplanar reformation along the bronchial tree are helpful in confirming the endobronchial location of the calcified material. The most common cause of broncholithiasis is erosion by and extrusion of a calcified adjacent lymph node into the bronchial lumen, a finding usually associated with tuberculosis or histoplasmosis. Other causes of broncholithiasis include (a) aspiration of bone tissue or in situ calcification of aspirated foreign material and (b) erosion by and extrusion of calcified or ossified bronchial cartilage plates. Primary endobronchial infections with dystrophic calcification, calcified endobronchial tumors, tracheobronchial diseases with mural calcification, and hypertrophied bronchial artery with intramural protrusion may mimic broncholithiasis. An awareness of the typical imaging findings of broncholithiasis, along with a knowledge of its various causes, help in establishing an accurate diagnosis to ensure proper case management.

References

1. Conces DJ Jr, Tarver RD, Vix VA. Broncholithiasis: CT features in 15 patients. AJR Am J Roentgenol 1991; 157:249?53.

2. Seo JB, Song KS, Lee JS, Goo JM, Kim HY, Song JW, Lee IS, Lim TH. Broncholithiasis: Review of causes with radiologic-pathologic correlation. Radiographics 2002; 22: S199-S213

Keywords

Lung, Airway, Non-infectious inflammation,