Broncholithiasis: Diagnostic and Therapeutic Insights From a Contemporary Case Series of Five Patients

Broncholithiasis refers to the presence of calcified or ossified material within the tracheobronchial tree. This rare condition is more frequently reported in regions endemic for tuberculosis and histoplasmosis, where necrotizing granulomatous lymphadenitis may lead to dystrophic calcification and eventual erosion of calcified lymph nodes into the bronchial lumen. Clinical presentation is heterogeneous and ranges from incidental findings to hemoptysis, chronic cough, recurrent infection, and post-obstructive complications. We conducted a retrospective review of five patients diagnosed with broncholithiasis at our tertiary care center. Clinical records were reviewed for demographic characteristics, presenting symptoms, imaging findings, bronchoscopic interventions, microbiologic data when available, and short-term follow-up outcomes. Two patients presented primarily with hemoptysis, one with chronic cough and severe infectious complications, one with recurrent pneumonia and lobar collapse, and one was incidentally referred with an obstructing broncholith. All five cases were managed bronchoscopically using combinations of rigid or flexible bronchoscopy, forceps, balloon dilation, cryotherapy, topical hemostatic measures, and argon plasma coagulation when needed. Two patients also required video-assisted thoracoscopic surgery for empyema management rather than for broncholith extraction itself. Where available, microbiologic findings included Actinomyces and mixed molds, highlighting the risk of post-obstructive infection. These cases underscore the heterogeneous clinical spectrum of broncholithiasis and support bronchoscopy as the primary diagnostic and therapeutic modality in appropriately selected patients. Early recognition, multidisciplinary management, and attention to associated infectious complications may improve outcomes.