Pulmonary Procedures |

Broncholithiasis Presenting as Fever of Unknown Origin FREE TO VIEW

Furqan Siddiqi, MD; Melissa Dakkak, MD; James Cury, MD
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Pulmonary and Critical Care Medicine, University of Florida Jacksonville, Jacksonville, FL

Chest. 2014;146(4_MeetingAbstracts):788A. doi:10.1378/chest.1993061
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SESSION TITLE: Bronchology/Interventional Student/Resident Case Report Posters II

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: A Broncholith is a calcified lymph node in the bronchial wall which may present with recurrent pneumonia and hemoptysis. Depending on the location of the broncholith, management can be challenging

CASE PRESENTATION: 61 year old Hispanic female with past medical history of hypertension, hypertrophic obstructive cardiomyopathy with placement of an AICD, and hypertension, presented to the ED for a one day history of shortness of breath and pleuritic chest pain, and one episode of cough with blood streaked sputum. Physical examination was normal except fever 100.4 F and bibasilar crackles. The patient had prior similar admissions with prolong fevers and all infectious workup was negative. Due to hemoptysis CT of chest was done for further evaluation (Fig 1 and 2). Fiber optic bronchoscopy was done and showed an endobronchial calcified, partially mobile nodule consistent with a broncholith which subtotally ocludded the left upper lobe. The pt finihsed 3 weeks of antibiotics and was seen in outpatient pulmonary clinic with resolution of symptoms. Pt was referred to cardiothoracic surgery but was deemed not a surgical candidate for the removal of broncholith due to her hypertrophic obstructive cardiomyopathy.

DISCUSSION: Therapeutic options for Broncholithiasis should be determined by mass, size, mobility, location and patient’s symptoms. The success rate in of removal of broncholiths with flexible bronchoscopy is reported to be 30%, whereas removal with rigid bronchoscopy is 67-87%. Surgical intervention such as lobectomy, segmentectomy, pneumonectomy are rarely needed.1

CONCLUSIONS: Broncholiths are not an uncommon cause of recurrent hemoptysis and pneumonias but much less likely to cause recurrent post obstructive pneumonias and bronchiestasis. However in patients with atypical presentation, like ours with recurrent prolonged fevers without hemoptysis, the diagnosis can be delayed.

Reference #1: Lee, J. H., Ahn, J. H., Shin, A. Y., Kim, S. J., Kim, S. J., Cho, G.-M., Oh, H. J, Kim, I. H, Kim, J. S. (2012) A Promising Treatment for Broncholith Removal Using Cryotherapy during Flexible Brochoscopy: Two Case Reports. The Korean Academy of Tuberculosis and Respiratory Disease: Vol 73, No. 5, 282-287

DISCLOSURE: The following authors have nothing to disclose: Furqan Siddiqi, Melissa Dakkak, James Cury

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