Broncholithiasis is a condition in which peribronchial calcified nodal disease erodes into or distorts an adjacent bronchus. The underlying abnormality is usually granulomatous lymphadenitis caused by Mycobacterium tuberculosis or fungi such as Histoplasma capsulatum. A few cases have been reported with silicosis. Calcified material in a bronchial lumen or bronchial distortion by peribronchial disease results in airway obstruction. This leads to collapse, obstructive pneumonitis, mucoid impaction or bronchiectasis. Symptoms include cough, hemoptysis, recurrent episodes of fever and purulent sputum. Broncholithiasis is more common on the right, and obstructive changes particularly affect the right middle lobe.

On chest radiographs, three major types of changes may be seen:

• Disappearance of a previously identified calcified nidus;

• Change in position of a calcified nidus; and

• Evidence of airway obstruction, including segmental or lobar atelectasis, mucoid impaction, obstructive pneumonitis, obstructive oligaemia with air trapping.

Calcified hilar or mediastinal nodes are a key feature.

CT and fibreoptic bronchoscopy complement each other in this condition. Broncholithiasis is recognised at CT by the presence of a calcified endobronchial or peribronchial lymph node, associated with bronchopulmonary complication due to obstruction (including atelectasis, pneumonia, bronchiectasis and air trapping), in the absence of an associated soft-tissue mass.

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