Three endobronchial white trees in a patient with mild hemoptysis: A rare case of broncholithiasis

Key message

Broncholithiasis is a rare and most often ignored condition characterized by the presence of calcified or ossified materials in the bronchus. The patient can be asymptomatic or commonly present with coughing. It is important to correctly identify this disease because in many cases it can cause hemoptysis and rarely lithoptysis.

Broncholithiasis is a rare condition that can be ignored or misinterpreted by pulmonologist. In our opinion, it is important to know this disease because it is associated in many cases to hemoptysis. Etiology is unknown and after our research in the literature, we found no other cases of broncholithiasis in which the cultural examination resulted positive for Providencia rettgeri.

CLINICAL IMAGE

Broncholithiasis is defined as the presence of calcified or ossified materials named broncholiths within the tracheobronchial tree. ¹ The pathology is rare and there are no certain data of incidence and prevalence. It is usually geographically distributed in areas where tuberculosis is endemic with equal frequency of males and females affected. Aetiology of the disease is uncertain but it seems related to infectious diseases. The image is of a 58‐year‐old patient, former smoker (80‐pack‐year) with a history of chronic respiratory failure, COPD, alcoholism and chronic hepatitis HBV‐related. Previous cultural examinations of bronchoaspirate resulted positive for Pseudomonas aeruginosa (2 years ago) and Providencia rettgeri (1 year ago), both treated with antibiotics. CT scan is the most important radiological examination to diagnose the disease while bronchoscopy allows the identification of broncholiths and to evaluate their relation with the bronchial wall. Therapy depends on the patient's condition and there are still no guidelines. If the patient is stable and asymptomatic or mildly symptomatic, as in the case of our patient, it is suggested to follow‐up without a surgical/endoscopic approach; if the disease reduces quality of life or compromises the patient's clinical condition, an endoscopic approach is recommended and thoracotomy as a second line (Figure 1). ²

FIGURE 1.

CT‐scan shows multiple calcification (A). Broncholith in the anterior segment of superior lobe before (B) and after aspiration (C). Segments of superior lobe (D). Broncholith in the posterior segment of superior lobe (E). Broncholith in the inferior lobe (F).

AUTHOR CONTRIBUTION

Cosimo Carlo De Pace and Donato Lacedonia were responsible for producing the initial draft of the paper. Cosimo Carlo De Pace and Massimo Selmi performed the procedure. Pasquale Tondo and Gianluca Libero Ciliberti provided written comments and feedback during manuscript development. All authors contributed to the article and approved the submitted version.

CONFLICT OF INTEREST STATEMENT

None declared.

ETHICS STATEMENT

The authors declare that appropriate written informed consent was obtained for the publication of this manuscript and accompanying images.

De Pace CC, Tondo P, Ciliberti GL, Selmi M, Lacedonia D. Three endobronchial white trees in a patient with mild hemoptysis: A rare case of broncholithiasis. Respirology Case Reports. 2023;11:e01095. 10.1002/rcr2.1095

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.