[Hemoptysis in a patient with post-obstructive pneumonia due to a broncholith]

A case of a 51-year-old man admitted to the hospital for hemoptysis after a three-week history of fever and cough is presented. The chest x-ray film revealed consolidation in the left upper lobe. Because microbiologic studies of the bronchial lavage showed the grew of Pseudomonas aeruginosa, the patient was treated with piperacilline and pefloxacin. Haemoptysis and abnormal temperature was persistent for several days. Revaluation of the chest x-ray permitted to discover a little calcified nodule of 1 mm diameter. CT scan of the thorax confirmed the consolidation of the left upper lobe and the little calcification. A second fiberoptic bronchoscopy was performed in 10th day, using a bronchoscope with a smaller diameter; it was possible to observe the occlusion of the subsegment bronchus LB 1&2 due to a mobile protruding mass. The mass was gentle removed by the use of alligator bioptic forceps; it presented as a grey, hard, 2 mm diameter body with irregular surface like a "floating mine". On microscopical examination of the mass, aspergillus hyphae appeared as broad septate filaments. Culture of the samples were negative. Haemoptysis and fever stopped after FOB. Chest x-ray in 19th day was negative: consolidation and calcification were absent.