Chronic cough is a common symptom that often results in exhaustive diagnostic evaluations and therapeutic trials. Bronchoesophageal fistulae secondary to broncholithiasis is a rare cause of chronic cough but has specific therapeutic implications. We reviewed these cases to propose a clinical approach.METHOD: Retrospective chart review of 8 patients admitted to our institution between 1963 and 2002 with bronchoesophageal fistula secondary to broncholithiasis.
The median age of the 8 patients (4 men, 4 women) was 55 years (range 34 to 72 years). All were from the Midwest United States and most were non-smokers. The main presenting symptom was cough worse with drinking (7 of 8 patients). Most patients had a history of recurrent pneumonia. In addition, 5 patients reported lithoptysis. Chest examination findings were variable and non-specific. The diagnosis was established by bronchoscopy in 3 patients, video swallow study in 2, gastrografin swallow in 1, and at surgery in 1 patient. The fistulae were located to the right mainstem bronchus in 3 patients, bronchus intermedius in 2, and the left mainstem bronchus in 2 patients. All patients were managed surgically (attempted endoscopic closure was unsuccessful in 1 patient). Postoperative complications were common. Only 3 of 8 patients had complete resolution of their cough at follow up.CONCLUSIONS: Bronchoesophageal fistula secondary to broncholithiasis should be considered in all patients with chronic cough associated with drinking, lithoptysis or recurrent pneumonias. This condition most commonly affects the right bronchial tree. The diagnosis is most easily established by bronchoscopy or video swallow study. Surgery is required for this condition but postoperative complications are common. Many patients will experience persistent cough.
Focused investigation based on suspicion of bronschoesopahgeal fistula due to broncholithiasis will prevent an exhaustive workup of patients presenting with cough and lithoptysis.
CT chest showing broncholiths at the right bronchus intermedius.
Brochoscopic view of eroding broncholith at the right main stem bronchus.
M.A. Ford, None.