Coughing up a stone. What to do about broncholithiasis.

Broncholithiasis, a disease that is probably much more common than has been reported, is most often associated with pulmonary infections, for example, tuberculosis and histoplasmosis. Stones originate from calcified peribronchial lymph nodes that erode into the tracheobronchial tree, but lithoptysis occurs infrequently. The most common symptoms are persistent cough and hemoptysis, sometimes followed by findings of obstructive pneumonia (fever, chills, and purulent sputum). Physical findings are nonspecific, and radiologic findings are varied. Complications include formation of a fistula between the respiratory tract and the esophagus or aorta and obstructive pulmonary symptoms. Treatment ranges from conservative management (simple observation) to thoracotomy for patients in whom complications from stone erosion develop. The prognosis of patients with broncholithiasis is generally excellent.