Management of broncholithiasis: is thoracotomy necessary?

Endoscopic treatment of broncholithiasis is controversial. From 1953 through 1984, 66 operations were performed on 40 patients with broncholithiasis in an endemic area for histoplasmosis. They are reviewed here retrospectively. All patients had cough; wheeze, hemoptysis, and lithoptysis were present in 60%, 45%, and 26%, respectively. Bronchoscopic stone removal was successful in 19%, whereas 21% of patients required no treatment. The 25 patients who were affected more severely required thoracotomy and operations varying from simple lung wedge resection to repair of a bronchoesophageal fistula. Optimum preservation of lung function was a major treatment guideline. All survived, and most have returned to normal preoperative activity. For selected patients, bronchoscopy and stone removal may be all that is required for broncholithiasis.