Bronchoesophageal fistula due to broncholithiasis: a case series

OBJECTIVE: To describe the clinical presentation, diagnostic evaluation, and treatment of bronchoesophageal (BE) fistula due to broncholithiasis, a rare cause of chronic cough with specific therapeutic implications. METHODS: Retrospective chart review of 9 patients diagnosed with BE fistulae at our tertiary-care institution between 1964 and 2002. RESULTS: The median age of patients (3 men, 6 women) was 56 years (range, 34-72 years). Six patients had never smoked. Eight presented with intractable cough typically worse after drinking that was relieved by lying on either side; 1 patient presented with dysphagia. Six patients reported lithoptysis, and most had a history of recurrent pneumonia. Chest findings were nonspecific. Diagnosis was established by radiocontrast studies of the esophagus (5 patients), surgical procedures (3), or bronchoscopy (1). Fistulae were right-sided in 7 patients and left-sided in 2. All patients had surgical repair of the fistulae; 6 patients experienced symptom resolution. CONCLUSION: BE fistula caused by broncholithiasis most commonly affects the right bronchial tree and should be considered in patients with chronic cough associated with drinking, lithoptysis, or recurrent pneumonia. The diagnosis is usually established by radiocontrast studies of the esophagus or incidentally during operations. Surgical repair is required.