The surgical implication of broncholithiasis.

A calcified hilar or mediastinal lymph node can compress or erode the tracheobronchial tree and cause a variety of problems, including the "spitting of stones," hemoptysis, pneumonia, atelectasis, and bronchoesophageal fistula. From 1955 to 1975, 43 patients were evaluated for broncholithiasis. Nonsurgical management was carried out in 10 patients, whereas the remaining 33 underwent thoracotomy for the pathological process. Five patients had bronchoesophageal fistula as a result of the broncholith. Segmentectomy was the surgical resective procedure most commonly used. Conservation of pulmonary tissue is recommended when dealing with this problem. Surgical complications were minimal and no deaths occurred. The surgeon must be versatile in his technical approach and be prepared to carry out bronchoplastic procedures when indicated. A clinical awareness of the symptomatology of broncholithiasis leads the examiner to carry out the appropriate diagnostic studies of laminagraphy, bronchoscopy, bronchography, and esophagography. Early diagnosis and treatment will prevent the severe complications that can occur from continued observation.