Source: Annual Congress 2003 - Clinical features in tuberculosis - I

Abstract

A 51-yr-old male with 32-pack-yr history of cigarette smoking, known with caseous-ulcerated secondary tuberculosis in the apical segment of the left lower lobe 6 years ago, presented with productive cough, with intermittent bloody sputum in the last year and dyspnea on medium exertion. He also reported the expectoration of stone consistency tawny coloured small broncholiths with 2-3 mm in diameter.
He has no exposure to any occupational hazard.
Physical examination disclose prolonged expire, diminished respiratory murmur, bubbling rales, rare sibilus.
Spirometry show mixed obstructive and restrictive medium ventilatory disfunction (with FEV1=65% of predicted).
Chest radiograph show calcified coalescence area in the left lower lobe, bilateral lung hyperinflation.
The endoscopial appearance on bronchoscopy was normal.
Bronchoalveolar lavage did not reveal M. tuberculosis, malignant cells or fungi.
A CT scan was not performed because during the first days of hospitalization the patient had a massive hemoptysis and he was transfered in the surgical departament where was performed an emergency left lower lobectomy, wich saved the patient’s life. The histopathological examination confimed the diagnose of broncholithiasis.
Conclusion : Brocholithiasis associated or not with lithoptysis is related to infectious aetiologies as tuberculosis. The prognosis can be favourable, restricted to clinical follow-up or invasisve removal of the broncholiths, depending on size or location. Surgery is indicated in selected cases or when the risk of bleeding is lifethreatenig for the pacient.

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Citations should be made in the following way:
I. G. Stoica (Bucharest, Romania). Broncholithiasis and masive haemoptysis – a case report. Eur Respir J 2003; 22: Suppl. 45, 993

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