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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 31  |  Issue : 3  |  Page : 202-203

Tracheolith: a case report of a new disease entity


Qatif Central Hospital, Eastern Province, Qatif, Saudi Arabia

Date of Submission04-Jul-2014
Date of Acceptance26-Aug-2014
Date of Web Publication28-Jul-2015

Correspondence Address:
Hussain Albaharna
Qatif Central Hospital, Eastern Province, 32631-7074 Mahmod Wararq Street - 4568, Qatif
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1012-5574.161622

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  Abstract 

This case reports a stone in the trachea of a patient with tracheostomy. The presence of stone in the airway is uncommon condition. Broncholithiasis is characterized by formation of the stone due to erosion of calcified lymph node in the bronchus. There is no reported case of a stone in the trachea in the literature. The pathophysiology of this condition is still unknown, but we think that it is related to prolong tracheostomy. We recommend performing chest radiography in all cases of tracheostomy obstruction.
More investigation and data collection of same cases are needed to have a more clear picture regarding the pathophysiology and the underlying cause.

Keywords: airway, broncholith, stone, tracheolith


How to cite this article:
Albaharna H, Ahmad A. Tracheolith: a case report of a new disease entity. Egypt J Otolaryngol 2015;31:202-3

How to cite this URL:
Albaharna H, Ahmad A. Tracheolith: a case report of a new disease entity. Egypt J Otolaryngol [serial online] 2015 [cited 2019 Nov 21];31:202-3. Available from: http://www.ejo.eg.net/text.asp?2015/31/3/202/161622


  Introduction Top


The presence of stone in the airway is uncommon condition. Broncholithiasis is characterized by formation of the stone due to erosion of calcified lymph node in the bronchus. There is no reported case of a stone in the trachea in the literature. This case reports a stone in the trachea of a patient with tracheostomy. We would like to propose the term tracheolith to describe this condition.


  Case report Top


A 13-year-old girl was diagnosed as a case of oculocerebral syndrome (Lowe's syndrome). She was admitted to the ICU because of respiratory problem. During her stay of more than 1 month, tracheostomy was performed using silicon (portex) tracheostomy tube with cuff. Later, gastrostomy was performed for feeding purposes. Tracheostomy care was given either at hospital or by qualified nurse at home after discharge. About 2 years and 9 months later (post-tracheostomy), she was brought to emergency department with difficulty in breathing, despite adequate cleaning of tracheostomy tube and suctioning of secretions as per standard guidelines. Patient was taken to operation room and tracheostomy tube was replaced, but surprisingly dyspnea aggravated. Plain radiograph of the neck and chest revealed an opaque shadow in trachea between carina and tip of tracheostomy tube. A bronchoscopy showed a gritty mass, which was removed in piecemeal with difficulty. Slight oozing was noted at the site and was controlled. Postoperatively, airway obstruction was completely alleviated. The removed specimen was sent for analysis, which concluded to be a stone. Since then, she is under periodic observation and no similar complaint has been reported.


  Discussion Top


It is uncommon to have stone formation in the airway. Broncholith is a term used to describe presence of stone in the bronchus due to erosion of calcified lymph node to the airway [1] . The most common underlying causes are tuberculosis and histoplasmosis [1],[2] . Hemoptysis is the most common symptom and lithoptysis is almost peculiar for the disease [2],[3] . Computed tomographic scan can help in the diagnosis and knowing the site to plan for removal [3],[4] . Lobectomy is the traditional method of treatment but there are many reported cases managed using bronchoscopy or moreover laser and cryotherapy [2],[5],[6],[7] . We want here to introduce a new term, tracheolith. In this case, we reported a presence of stone in the trachea of a patient with tracheostomy for 2 years. It is unusual cause of tracheostomy tube obstruction. Chest radiography showed the finding of radio-opaque mass and bronchoscope was used to remove the mass [Figure 1] and [Figure 2]. The analysis of the mass confirmed the diagnosis of stone [Table 1]. The patient was followed for 1 year after that without recurrence.
Figure 1: Gross picture of the stone after removal.

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Figure 2: Chest radiograph of the patient showing radio-opaque mass at the end of the tracheostomy tube.

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Table 1: Chemical analysis of the stone

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It is unclear what the underlying cause is, because the patient does not have history of tuberculosis or histoplasmosis. We suggest two theories to explain this phenomenon: to have calcified granuloma after prolong tracheostomy or formation of stone from stagnant secretion. It is unlikely to have lymph node eroding to trachea because it will be obvious on the bronchoscopy. As the stone is formed in the trachea, it can be directly removed by the rigid bronchoscope.


  Conclusion Top


Tracheolith is a stone formation in the trachea. As it leads to airway obstruction, it must be removed. The most effective and easy way is to perform rigid bronchoscopy. The pathophysiology of this condition is still unknown, but we think that it is related to prolong tracheostomy. We recommend performing chest radiography in all cases of tracheostomy obstruction.

More investigation and data collection of same cases are needed to have a more clear picture regarding the pathophysiology and the underlying cause.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Nollet AS, Vansteenkiste JF, Demedts MG. Broncholithiasis: rare but still present. Respir Med 1998; 92:963-965.  Back to cited text no. 1
    
2.
Reddy AJ, Govert JA, Sporn TA, Wahidi MM. Broncholith removal using cryotherapy during flexible bronchoscopy: a case report. Chest 2007; 132:1661-1663.  Back to cited text no. 2
    
3.
Shin MS, Ho KJ. Broncholithiasis: its detection by computed tomography in patients with recurrent hemoptysis of unknown etiology. J Comput Tomogr 1983; 7:189-193.  Back to cited text no. 3
[PUBMED]    
4.
Conces DJ, Tarver RD, Vix VA. Broncholithiasis: CT features in 15 patients. Am J Roentgenol 1991; 157:249-253.  Back to cited text no. 4
    
5.
Olson EJ, Utz JP, Prakash UB. Therapeutic bronchoscopy in broncholithiasis. Am J Respir Crit Care Med 1999; 160:766-770.  Back to cited text no. 5
    
6.
Menivale F, Deslee G, Vallerand H, Toubas O, Delepine G, Guillou PJ, et al. Therapeutic management of broncholithiasis. Ann Thorac Surg 2005; 79:1774-1776.  Back to cited text no. 6
    
7.
Miks VM, Kvale PA, Riddle JM, Lewis JW. Broncholith removal using the YAG laser. Chest 1986; 90:295-297.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]



 

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Abstract
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Case report
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