C44-10 Broncholithiasis Mimicking Malignancy

Abstract Introduction Broncholithiasis, the erosion of calcified material into the bronchial lumen, is an uncommon entity that can mimic endobronchial malignancy radiographically and clinically. It often results from granulomatous infections such as tuberculosis or histoplasmosis. Recognition is essential, as timely bronchoscopic intervention can prevent complications such as recurrent pneumonia or postobstructive atelectasis. Case Presentation A 63-year-old woman with a history of gastric sleeve surgery complicated by a saddle pulmonary embolism, hypothyroidism, and anxiety, with no history of smoking or cardiac disease, presented with chronic cough and dull left-sided chest discomfort. She denied hemoptysis, fevers, or weight loss apart from expected postoperative weight loss. A follow-up CT was done for the evaluation of mediastinal lymphadenopathy, which revealed a broncholith in the left upper lobe bronchus and worsening mediastinal lymphadenopathy. A PET CT revealed no hypermetabolic activity. Due to concern for malignancy, bronchoscopy was done, which showed a partially obstructing, freely mobile calcified mass within the apical segment of the left upper lobe bronchus. Using biopsy forceps, the mass was extracted in two large fragments. Mild mucosal oozing was controlled. Pathology confirmed calcified material consistent with a broncholith without evidence of malignancy. Discussion Broncholithiasis is a rare condition, with an incidence of less than 0.5% among pulmonary diseases, typically resulting from calcified lymph nodes eroding into the bronchial lumen. Most cases occur secondary to prior granulomatous infections such as tuberculosis or histoplasmosis. Radiographically, broncholithiasis may appear as an irregular calcified endobronchial lesion with adjacent atelectasis or pneumonia- features that can mimic bronchogenic carcinoma or metastatic disease, especially when associated with mediastinal lymphadenopathy. PET-CT may further obscure diagnosis due to inflammatory FDG uptake, emphasizing the need for bronchoscopic evaluation. Clinically, patients may present with cough, hemoptysis, recurrent pneumonia, or be asymptomatic. Management depends on symptoms and accessibility; bronchoscopic extraction is favored when feasible and can be curative, while surgical resection is reserved for complicated or inaccessible lesions. This case highlights the importance of considering broncholithiasis in the differential diagnosis of calcified endobronchial masses to avoid unnecessary oncologic workup and to achieve symptom resolution through minimally invasive removal. This abstract is funded by: None