A resected case of broncholithiasis suspected of having pulmonary nocardiosis

A 48-year-old woman complained of a cough, sputum, and fever which had persisted for a year and had not improved with conservative therapy. Her parents had died of pulmonary tuberculosis. She was also suspected of having old pulmonary tuberculosis. A chest X-ray showed atelectasis of the left lower lobe of the lung. A chest CT and a chest tomogram revealed the presence of some calcified masses, one of which was in the orifice of the left lower lobe bronchus of the lung. Bronchoscopic examination revealed a broncholith, but we failed to remove it. Therefore, a lobectomy, with removal of the broncholith, and calcified lymph node dissection were performed. Examination of the operative specimen showed atelectasis, fibrosis, and microabscesses containing branching filamentous structures positively stained with Gram's and silver methenamine stains. Culture studies were not helpful. These findings suggested that the lung was affected by nocardiosis. The broncholith consisted of calcium phosphate and calcium carbonate.