CTICasesPulmonary Histoplasmosis-Related Broncholithiasis
Imaging findings
CT chest shows calcified hilar and mediastinal lymph nodes, associated with localized bronchial wall thickening, bronchiectasis, and tree-in-bud nodular opacities in the distal right lower lobe. The patient had a chronic cough and a history of travel to endemic regions, with biopsy showing chronic bronchiolitis and obstructive broncholithiasis.
Key takeaways
Broncholithiasis is a condition where a calcified adjacent lymph node (most commonly secondary to histoplasmosis or tuberculosis) erodes into a bronchus. This causes bronchial obstruction, post-obstructive bronchiectasis, mucus plugging, and chronic tree-in-bud bronchiolitis, which can be misattributed to active fungal infection.
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