Active Bronchopulmonary Lithiasis

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Abstract
LUNG STONES attracted the curiosity of physicians of ancient Greece and Rome, and according to Morgagni (quoted by Atlee, 2), pneumoliths were known to Areteus, Galen, and Aristotle. As autopsies became part of medical investigation, more knowledge was gathered about this condition. The earliest comprehensive clinical report was that of Schenck (39) in 1600 (Barrett, 5). In 1744 Boerhaave described the case of the famous botanist Sebastian Veillantius, who expectorated 400 stones (Stivelman, 42). Leroy (24) in 1868 and Poulalion (32) in 1891 published the first accurate and modern discussions on the subject, and changed the name phthysis calculosa to pseudophthysis calculosa, appreciating the fact that pulmonary tuberculosis did not play an active part in the clinical syndrome of bronchopulmonary lithiasis. Other terms employed for the condition in modern medical literature are pulmoliths, pneumoliths, lung stones, and bronchial calculi. Lyter (26) designated as active bronchopulmonary lithiasis those cases in which calcifications cause clinical symptoms, and we believe this to be the most descriptive of all terms. A complete review of the English and American literature since 1900 reveals a total of 96 recorded cases. The largest individual group was reported by Tinney and Moersch (43), who in 1944 collected 28 cases from the files of the Mayo Clinic. Graham, Singer and BaIlon (18) observed 13 cases, Fox and Clerf (15) 10 cases, Myers (29) 7 cases, Vinson and Bumpus (45) 7 cases. The remaining 31 were mostly single case reports (1, 2, 5, 7, 8, 9, 12, 13, 14, 22, 23, 25, 26, 27, 28, 29, 31, 33, 35, 36, 41, 42, 44, 49). In spite of the relatively meager literature on the subject, bronchopulmonary lithiasis is apparently more frequent than the available publications would indicate. In the X-Ray Department of a relatively small hospital of 310 beds, we have had the opportunity during the past year to study 7 proved cases. Pathology According to Poulalion (32) broncholiths may originate from the pleura,' the lung parenchyma, the tracheobronchial lymph nodes, and from within the bronchi. The deposits usually develop in areas of previous inflammation or necrosis. Suppuration, hemorrhages, infarcts, fungous infections and pneumoconioses are known to leave calcific scars within the lungs, but pulmonary tuberculosis is by far their most frequent source. Conditions producing hypercalcemia, such as hyperparathyroidism or extensive bone destruction due to various etiological factors, may lead to metastatic calcium deposits within the lungs (4, 10). Gander (16) and Harbitz (19) described cases of extensive alveolar wall calcification and ossification in the lungs, without finding any primary causative condition. Miliary calcium and bone deposits have been found in the lungs of patients suffering from mitral stenosis, probably originating in areas of hemorrhage (37, 38).

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