Bronchoesophageal fistula secondary to broncholithiasis

An emaciated 75-year-old woman with a 2-month history of persistent right lower lobe pneumonia described streaky hemoptysis and complained of a persistent cough productive of “gravel” (Fig. 1). Her oral intake was markedly limited as she regurgitated solid foods and had violent coughing spells with consumption of liquids. Fifteen years earlier, bronchoscopy had demonstrated no conclusive etiology for an episode of gross hemoptysis. Another...