broncholith is an uncommon medical problem . when considering broncholiths from a therapeutic standpoint , the role of bronchoscopy has been somewhat controversial .
we report here on two cases of successful removal of broncholith that were done without any clinically significant complications by using flexible bronchoscopy .
a 65-year - old male patient was admitted to the hospital for the evaluation of atelectasis , and he had a history of recurrent hemoptysis and pneumonia for a few years .
the broncholith was impacted at rb9 , and there was inflammation of the surrounding mucosa on bronchoscopy .
we removed the broncholith using a tripod forcep and the inflammation subsided afterwards ( figure 1 ) .
a 37-year - old female patient was referred from a general hospital due to a calcified lymph node from an unknown cause that was discovered on computerized tomography during the treatment for her pneumonia and parapneumonic effusion .
we removed the broncholith using a balloon catheter and tripod forcep after antifungal treatment ( figure 2 ) .
a 65-year - old male patient was admitted to the hospital for the evaluation of atelectasis , and he had a history of recurrent hemoptysis and pneumonia for a few years .
the broncholith was impacted at rb9 , and there was inflammation of the surrounding mucosa on bronchoscopy .
we removed the broncholith using a tripod forcep and the inflammation subsided afterwards ( figure 1 ) .
a 37-year - old female patient was referred from a general hospital due to a calcified lymph node from an unknown cause that was discovered on computerized tomography during the treatment for her pneumonia and parapneumonic effusion .
we removed the broncholith using a balloon catheter and tripod forcep after antifungal treatment ( figure 2 ) .
broncholiths are calcified peribronchial lymph nodes that encroach upon the adjacent airways and they cause clinical and roentgenographic abnormalities1 ) .
mycobacterial and fungal granulomatous lymphadenitis are the most frequently cited infections that are responsible for tissue calcification , although silicosis is a less commonly associated noninfectious cause .
the most common infectious complication resulting from broncholithiasis appears to be bacterial pneumonia that is generally due to airway obstruction by a broncholith and also to the associated airway inflammation and edema .
lung abscesses along with bronchoesophageal and bronchomediastinal fistulas are potentially more serious complications arising from symptomatic broncholithiasis , and these complications are responsible for cases of prolonged or recurrent infection2 ) . in our case , both patients had recurrent and prolonged pneumonia .
bronchoscopy is considered the most important diagnostic test for broncholithiasis . however , its role in the treatment of broncholithiasis is controverial .
olson and his coworkers3 ) reported that 100% of their patients with loose ( free in the airway ) broncholiths underwent flexible and rigid bronchoscopic extraction attempts without severe complications .
massive life - threatening hemoptysis secondary to fistula or rupture of aorta or pulmonary arteries is a possible complication , but generally , massive hemoptysis caused by broncholithiasis is a rare complication3 - 5 ) . as
compared with the morbidity and mortality associated with surgical intervention , bronchoscopic management appears favorable for patients with loose or partly eroded broncholiths6 ) .
loose , movable broncholiths are especially suitable for removal by bronchoscopic extraction in the clinical setting having capabilities for rigid and flexible bronchoscopy and immediate thoracic surgical support , and after the relation of the broncholith to adjacent vascular structures has been studied by computerized tomography3 ) .
 most broncholiths are related to infection with fungus or tuberculosis and they involve the lymph nodes ; those cases that are caused by silicosis are rarely seen . 
 broncholith might lead complication such as bronchial rupture into the mediastinum , which can result in hemoptysis , cough , repeated pneumonia and so on . 
 flexible bronchoscopy plays an important part in the diagnosis of broncholithiasis , but its therapeutic application in the clinical setting is controversial . 
 we report here on two cases of broncholith removal without complication with the use of a balloon catheter and tripod forceps using flexible bronchoscopy . 
INTRODUCTION
CASE REPORT
Case 1
Case 2
DISCUSSION