HEMOPTYSIS AND HEMATEMESIS DUE TO A BRONCHOLITH - GRANULOMATOUS MEDIASTINITIS

A 40-year-old man had new onset of hemoptysis and hematemesis, Broncho scopy revealed red, inflamed mucosa with apparent rich blood supply in the left primary bronchus. Computed tomography revealed calcified sub carinal lymph nodes with a small extension into the left primary bronc hus, Shortly after admission, the patient had an episode of gastrointe stinal bleeding, Esophagogastroduodenoscopy showed a lesion in the pos terior wall of the esophagus, 12 cm from the upper incisors. During ex ploratory thoracotomy, a single piece of irregular-shaped tan tissue m easuring 3.5 x 2.5 x 2.0 cm and engulfing the esophagus, carina, and l eft primary bronchus was dissected, A single stonelike mass,or broncho lith, was found to involve both the trachea and the esophagus. Microsc opic examination showed multiple caseating granulomas with surrounding lymphoid tissue and germinal centers. During 12 months of follow-up, the patient has remained asymptomatic, The chronic inflammation in thi s case suggested granulomatous mediastinitis, a rare disease whose mas s-like effects may contribute to structural compression. The trachea a nd esophagus are rarely involved. Tuberculosis and histoplasmosis are thought to be the two most common causes of granulomatous mediastiniti s, Chronic inflammation leading to calcification and broncholith may i nvade bronchial lumen or esophageal wall, causing life-threatening hem orrhage and necessitating prompt surgical intervention.