Therapeutic bronchoscopy in broncholithiasis

Bronchoscopy is considered the most important diagnostic test for broncholi thiasis. However, its role in the treatment of broncholithiasis in a large group of patients has not been studied. To evaluate the therapeutic role of bronchoscopy, we retrospectively reviewed the clinical data of patients wi th broncholithiasis who also underwent bronchoscopy at Mayo Clinic. Broncho scopy revealed 127 broncholiths (free or partly eroded calcified material i n the airway lumen) in 95 patients (49 men and 46 women) evaluated between 1954 and 1994. Bronchoscopic removal of 71 (56%) broncholiths was attempted in 48 patients (50.5%) during 61 bronchoscopy sessions. Forty-eight of the broncholiths selected for removal were partly eroding into the tracheobron chial lumen and 23 were free. Forty-eight percent (23 of 48) of the partly eroding broncholiths were successfully removed bronchoscopically, with a gr eater percentage removed with the rigid bronchoscope (67%) than with the fl exible bronchoscope (30%). All free broncholiths were completely extracted regardless of the type of bronchoscope used. Complications occurred in only two patients (4% of the bronchoscopic broncholithectomy group), both with partially eroded broncholiths, and consisted of hemorrhage in one patient r equiring thoracotomy and acute dyspnea in another patient, caused by a loos e broncholith lodged in the trachea. We conclude that flexible and/or rigid bronchoscopic extraction of partly eroded or free broncholiths in the trac heobronchial tree can be considered safe and effective.