Broncholithiasis

Jud W. Gurney, MD, FACR

Key Facts

Terminology

Calcified or ossified material within bronchial lumen, usually due to erosion from adjacent lymph nodes

Imaging Findings

Endobronchial or peribronchial calcified nodule at CT associated with signs of bronchial obstruction
Most common right middle lobe and anterior segmental bronchi upper lobes
Broncholith
- Distorts adjacent airway, which is narrowed but remains patent (50%) or
- Calcified lymph nodes completely obstructs lumen (50%)
- Majority of lymph node calcified, soft tissue component < 10%
- Usually solitary, rarely multiple
- Extraluminal air nearly diagnostic of erosion into bronchus

Top Differential Diagnoses

Pathology

Clinical Issues

Lithoptysis: Expectoration of calcified material (15%)
Bronchoscopy: Calcified material usually not evident (50%), obscured by inflammatory tissue

Coronal CECT shows a calcified subcarinal mass

and narrowing of the bronchus intermedius

. The majority of the mass is calcific material.

Axial CECT shows a subcarinal mass with large coarse calcifications

. The bronchus intermedius is narrowed

, and a tiny fleck of extraluminal air

is noted in this patient with broncholithiasis.

TERMINOLOGY

Definitions

Calcified or ossified material within bronchial lumen, usually due to erosion from adjacent lymph nodes
- Includes aspiration of bone or calcified material, erosion of calcified cartilage into airway, migration of calcified material from distant site such as pleural plaque or gallstone

IMAGING FINDINGS

General Features

Best diagnostic clue: Endobronchial or peribronchial calcified nodule at CT associated with signs of bronchial obstruction
Patient position/location
- Most common right middle lobe and anterior segmental bronchi upper lobes
- Right-sided > left-sided (2:1)
Size: 2-15 mm
Morphology
- Irregular shape and angular
- Majority of lymph node calcified, soft tissue minimal

CT Findings

Broncholith
- Peribronchial lymph node either
  - Distorts adjacent airway, which is narrowed but remains patent (50%) or
  - Calcified lymph nodes completely obstructs lumen (50%)
- Majority of lymph node calcified, soft tissue component (< 10%)
- Extraluminal air nearly diagnostic of erosion into bronchus
- Usually solitary, rarely multiple
- Does not enhance with intravenous contrast
Signs of bronchial obstruction
- Atelectasis (66%)
- Postobstructive pneumonia (33%)
- Bronchiectasis (33%)
- Air-trapping (5%)
Location
- Right-sided > left-sided (2:1)
- Anywhere from trachea to subsegmental airway, most common along lobar to segmental airways
- Right middle lobe and anterior segmental bronchi upper lobes most common
- Rarely peripheral in lung

Radiographic Findings