Broncholithiasis: CT features in 15 patients

Broncholithiasis is a disorder characterized by peribronchial calcific nodal disease that either erodes into an adjacent bronchus or distorts the bronchi. The key radiologic finding is a calcified endobronchial or peribronchial lymph node. To determine the CT findings of broncholithiasis, we retrospectively reviewed the chest radiographs and CT scans of 15 patients with proved broncholithiasis. Ten patients had endobronchial nodes as proved by bronchoscopy, surgery, or lithoptysis. Broncholiths were identified on bronchoscopy in only five cases. Five patients had peribronchial nodes with associated bronchial distortion. Collimation of the CT scans varied; 1.0-cm-, 0.6-cm-, and 0.5-cm-thick sections were obtained. Three patients had both 1.0-cm- and 0.5-cm-thick sections. The calcified lymph node was identified on CT in all 15 patients. CT correctly localized six of 10 endobronchial nodes and four of five peribronchial nodes. Findings due to bronchial obstruction also were seen on CT; atelectasis (n = 11), infiltration (n = 4), bronchiectasis (n = 4), and air trapping (n = 1). An associated soft-tissue mass was not seen in any case. Difficulty in determining the relationship between lymph node and bronchus is due to volume averaging, which can be decreased by scanning thinner sections. CT can suggest the diagnosis of broncholithiasis and is useful when bronchoscopy does not show a broncholith.