0
Allergy and Airway |

Not Everything That Wheezes Is Asthma

Paula Duran, MD; Juan Sanchez, MD
Author and Funding Information

Scott and White Healthcare. Texas A&M College of Medicine, Temple, TX


Chest. 2013;144(4_MeetingAbstracts):61A. doi:10.1378/chest.1704798
Text Size: A A A
Published online

Abstract

SESSION TITLE: Bronchology Student/Resident Case Report Posters

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Wheezing is a nonspecific symptom that usually heralds obstructive airway disease. We present a case of airway obstruction due to broncholithiasis mimicking asthma.

CASE PRESENTATION: A 58-year-old woman was seen due to asthma exacerbations and recurrent left lower lobe pneumonia. She complained of wheezing and dry cough, without triggers. Her asthma was treated with inhaled corticosteroids and albuterol without control. History of hypertension, hyperlipidemia and seasonal allergies and she was nonsmoker. Exam: BP 118/65, HR 64, RR 17, Temp 97°F, Sat 97% on room air. Pulmonary auscultation with central wheezing. Spirometry FVC: 2.43(79%), FEV1: 1.52 (62%) and FEV1/FVC: 63%. Diagnosed with chronic persistant asthma and salmeterol/fluticasone was initiated without symptom control. The patient then was admitted to the hospital with left lower lobe pneumonia, the chest radiograph revealed a left lower lobe consolidation, multiple calcified granulomata and calcified mediastial and hilar adenopathy. CT scan of the chest revealed a calcified mass within the left main bronchus, a left lower lobe infiltrate, and multiple bilateral calcified granulomas. Flexible bronchoscopy confirmed a broncholith in the distal left mainstem bronchus obstructing the left lower lobe. A rigid bronchoscopy and broncholithectomy was performed without complications. Evaluation for granulomatous disease was unrevealing. Gross pathology showed a 2x1.2x1cm broncholith. The patient’s symptoms completely resolved 3 months after endoscopic broncholithectomy and bronchodilators were discontinued due to complete symptom resolution.

DISCUSSION: Broncholithiasis in the US is most commonly due to Histoplasmosis. The patient presented with symptoms of recurrent pneumonia in the left lower lobe and wheezing. CT scan of the chest revealed pulmonary parenchymal and lymph node calcifications. Broncholiths are best removed surgically especially if causing hemoptysis or fistula with adjacent structures. Endoscopic removal is reserved for lose endobronchial lesions that can be easlily retrieved by flexible or rigid bronchoscopy.

CONCLUSIONS: Broncholithiasis is an uncommon condition mostly caused by granulomatous infection but can be due to other conditions previously described in the literature. In our case, the patient had been treated for asthma for several years without paying much attention to her chest imaging studies. Imaging studies can provide with clues regarding possible causes of airway obstruction.

Reference #1: Anwer M, Venkatram S. J Bronchology Interv Pulmonol. 2011 Apr;18(2):181-3.

Reference #2: Menivale F, Deslee GF, Vallerand H, Toubas O, Delepine G, Guillou PJ, Lebargy F. Ann Thorac Surg 2005;79:1774-6.

Reference #3: Cerfolio RJ, Bryant AS, Maniscalco L. J Thorac Cardiovasc Surg. 2008 Jul;136(1):186-90.

DISCLOSURE: The following authors have nothing to disclose: Paula Duran, Juan Sanchez

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543