Bone and Blood and Broncholithiasis

Document Type

Conference Proceeding

Publication Date

5-2024

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Patient is an 87 year old female with past medical history of hypertension and coronary artery disease who presented to the hospital for hemoptysis. She had been doing relatively well until the week prior to admission when she noted a productive cough with “bloody debris” and dyspnea which progressed to the point of limiting her exertional tolerance despite a course of antibiotics and steroids. In the hospital, CT chest was significant for a calcified mass causing a post-obstructive right upper lobe pneumonia which did not respond to a second round of antibiotics. As the patient was clinically deteriorating, the decision was made to proceed with a bronchoscopy. During the procedure, the entire right side of tracheobronchial tree was noted to be friable and edematous with the right upper lobe revealing a large and occluding foreign body which was solid, concentric and a mixture of black and yellow. The mass was rock-like in nature and removed after which copious amounts of purulent and inspissated bloody mucus were suctioned. Pathology confirmed the mass to be what was suspected on visualization which was a broncholith. On further questioning, patient denied international travel, reported no exposure to tuberculosis or history of recurrent infections. However, the history was noted to be significant for travel to Ohio five years prior where she visited an urgent care after “choking on a chicken bone”. No intervention was taken at the time although the patient admitted to feeling as if there was something stuck in her chest for weeks. To identify the etiology of the broncholith, the patient was tested for histoplasma, mycobacteria, actinomyces, coccidioidomycosis, and cryptococcosis. Serology was positive for histoplasma antibodies and the patient improved with piperacillin/tazobactam after removal of the mass. Interestingly in this case, it is unknown whether the broncholithiasis resulted from infection with histoplasma or if it was from the aspirated bone as both are known risk factors. This behooves the importance of recognizing this rare cause of pneumonia and intervening as residual stones can dislodge, become embedded in the bronchial wall, or cause fistulas. In more severe causes, parenchymal destruction would necessitate segmental pulmonary resection.

Volume

209

Issue

Suppl

First Page

A6313

Comments

International Conference of the American Thoracic Society, May 17-22, 2024, San Diego, CA

DOI

10.1164/ajrccm-conference.2024.209.1_MeetingAbstracts.A6313

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