CTICasesBroncholithiasis
Imaging findings
Serial chest radiographs show progressive volume loss and collapse of the left upper lobe, with cephalad displacement of a calcified granuloma (shifting granuloma sign). Chest CT confirms left upper lobe atelectasis and demonstrates a large, calcified broncholith completely obstructing the origin of the left upper lobe bronchus. The pet scan showed hypermetabolism in the post-obstructive segment, and pathology confirmed broncholithiasis without malignancy.
Key takeaways
Broncholithiasis occurs when a calcified mediastinal or hilar lymph node (typically from prior histoplasmosis or tuberculosis infection) erodes into and obstructs an adjacent airway. Obstruction leads to lobar collapse and post-obstructive pneumonia, which can simulate bronchogenic carcinoma on imaging and PET. The 'shifting granuloma sign' on serial radiographs is a useful clue to lobar volume loss, and surgical resection may be necessary for hemoptysis.
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