Bronchoscopic Broncholithotripsy

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Broncholithiasis involving intra- or periluminal areas of the tracheobronchial tree generally results in respiratory symptoms such as cough, hemoptysis, lithoptysis, or localized wheeze. Most patients with symptomatic broncholithiasis will require either bronchoscopic or surgical removal of the stone. We describe the case of a 33-year-old woman who presented with chronic cough, wheezing, and exertional dyspnea secondary to a large broncholith tightly impacted in the bronchus intermedius. Because of her underlying medical conditions, which included chronic renal failure requiring periodic hemodialysis, rejection of renal transplant, and hepatitis C, she was considered to be in the high-risk category for thoracotomy. Initial attempts at rigid bronchoscopic extraction of broncholith was unsuccessful because of bleeding and adherence of the stone to the bronchial walls. Under general anesthesia, we introduced a rigid bronchoscope through which a flexible bronchoscope carrying an electrohydraulic lithotripsy probe or a pulsed dye laser fiber was inserted to deliver electrohydraulic and laser energy to fragment the broncholith. The entire stone was thus successfully removed by bronchoscopy. There was minimal hemorrhage associated with the procedure. This novel method of bronchoscopic therapy of large broncholiths should be considered an alternative to thoracotomy, particularly in patients considered to be poor candidates for surgery.

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