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Rigid Bronchoscopy and Surgical Resection for Broncholithiasis and Calcified Mediasitnal Lymph Nodes
R. J. Cerfolio, A. S. Bryant, L. M. Maniscalco. University of Alabama at Birmingham, Birmingham, AL,
BACKGROUND: Patients with calcified mediastinal lymph nodes who have hemoptysis or lithoptysis represent a challenging therapeutic dilemma.
METHODS: A retrospective review of a prospective clinic and operative database between 01/1998 and 12/2006. All patients had calcified mediastinal lymph nodes or symptoms or complications from these nodes.
RESULTS: Fifty patients (23 men) presented with broncholithiasis. Thirty-eight (76%) were symptomatic, which included hemoptysis in 11, persistent cough in 8 and recurrent pneumonia in 5 and all underwent rigid bronchoscopy. Fourteen of the 38 (39%) symptomatic patients had stones eroding into the airway, two had an airway-esophgeal fistula. The most common location of the stone was the bronchus-intermedius (9). Endoscopic stone removal was successful without significant bleeding in 26. Elective thoracotomy with lymph node curettage and/or removal was performed in five patients. These five patients had no significant morbidity or operative mortality and remain symptom-free (median follow-up 2.3 years, range (8 - 42 months). Twelve asymptomatic patients with calcified lymph nodes were followed with serial CT scans and also remain asymptomatic (median follow-up 3.1 years).
CONCLUSIONS: Despite previous reports, endoscopic removal using rigid bronchoscopy is safe in properly selected patients. Complete removal of calcified nodes via thoracotomy is also safe and effective and offers good long-term results. We reserve thoracotomy for patients with symptoms only who fail endoscopic removal and those who can have all calcified nodes removed via one thoracotomy or those with an airway-esophgeal fistula. The presence of calcified nodes in asymptomatic patients is not an indication for intervention and these nodes do not seem to cause symptoms over time.
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