CRA93 LITHOPTYSIS: A RARE MANIFESTATION OF BRONCHOLITHIASIS

Aldo Yulian¹, Russilawati¹, Oea Khairsyaf², Herudian Ahmadin³, Dimas Bayu Firdaus²

¹Department of Pulmonology and Respiratory Medicine, Faculty Medicine Andalas University, Padang, West Sumatera-Indonesia
²Department of Pulmonology and Respiratory Medicine, Dr. M. Djamil General Hospital, Padang, West Sumatera-Indonesia
³Department of Pulmonology and Respiratory Medicine, Dr. H. A. Rotinsulu Pulmonary Hospital, Bandung, West Java-Indonesia

Introduction
Broncholithiasis arises from calcification process within the hilar lymph nodes or parenchyma due to chronic lymphadenitis associated with bacterial or fungal infections. Lithoptysis represents a rare symptom of expectorating broncholiths.

Case Report
46-year-old woman presented with a history of hemoptysis approximately 100cc. She had a confirmed history of pulmonary tuberculosis at the age of 17 and history of cough with sand-like sputum mixed with stones five years prior. Chest X-ray revealed bronchiectasis and calcification of the right lung parenchyma with left lung bullae. CT-Scan examination showed bilateral bronchiectasis, left lung bullae, and multiple perihilar broncholiths. Subsequent bronchoscopy did not reveal any broncholith, but most of the mucosal appeared edematous and hyperemic. Bronchial lavage bacterial culture showed Enterobacter Aerogens infection, and fungal culture showed Candida.sp infection, no Mycobacterium tuberculosis growth detected in MGIT. Hemoptysis ceased after four months of observation and antifungal therapy, although sand-like cough persisted. CT-Scan evaluation showed amount reduction of broncholiths.

Discussion
Broncholithiasis is a rare condition with an incidence of 0.1-0.2% of all respiratory system diseases cases. Chronic lymphadenitis caused by TB or fungi is the most common cause of lymph node calcification. Most cases are asymptomatic, but the most common presenting symptom is hemoptysis, while lithoptysis was exceedingly rare.

Conclusion
The patient recovered successfully, with only minor impact on daily life activities. Hemoptysis resolved following antifungal treatment, with imaging showing a reduction in broncholiths, though sand-like sputum persisted.

Keywords: Broncholithiasis, lithoptysis