Bronchial anthracofibrosis is defined as bronchial pigmentation with stenosis/obstruction observed on bronchoscopy, but its pathology remains unclear. An 86-year-old retired stonemason presented with recent onset of breathlessness. Computed tomography (CT) scan showed bilateral hilar and mediastinal lymphadenopathy and bronchial obstruction of right B³, but typical signs of silicosis were absent. Bronchoscopy revealed anthracosis on several parts of the bronchial epithelium including that on the obstructed right B³. In spite of the extensive uptake of ¹⁸F-FDG to the enlarged lymph nodes, repeated bronchoscopy could not demonstrate any sign of tuberculosis or malignancy, and a diagnosis of bronchial anthracofibrosis was made. After he died of recurrent idiopathic thrombocytopenic purpura, his right lung was examined. In the hilar lymph nodes, numerous dust-laden macrophages and other inflammatory cells were aggregated and these cells were distributed continuously to the swollen bronchial epithelium. Electron microscopical analysis demonstrated silica as a main mineral component in that lesion, which was suspected as a cause of the patient’s anthracofibrosis.