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Gipsman AI, Feld L, Johnson B, Needleman JP, Boas H, Lin N, DePasquale B, Pogoriler J, McDowell KM, Piccione JC. Eosinophilic plastic bronchitis: Case series and review of the literature. Pediatr Pulmonol 2023; 58:3023-3031. [PMID: 37606213 PMCID: PMC10928548 DOI: 10.1002/ppul.26650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 08/23/2023]
Abstract
Plastic bronchitis is a term used to describe group of life-threatening disorders characterized by the presence of large obstructing casts in the airways. Eosinophilic plastic bronchitis is a subtype of plastic bronchitis that occurs mainly in children and has not been well-described in the literature. Patients may have a history of asthma or atopy, but many do not. They often present with cough and wheezing, and frequently have complete collapse of one lung seen on imaging. The severity of presentation varies depending on the location of the casts, ranging from mild symptoms to severe airway obstruction and death. Bronchoscopy is often required to both diagnose and treat this condition. A variety of medical therapies have been used, although no formal studies have evaluated their efficacy. Symptoms may resolve after initial cast removal, but in some patients, cast formation recurs. Here, we report a case series of nine patients with eosinophilic plastic bronchitis and review the existing literature of this condition.
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Affiliation(s)
- Alexander I. Gipsman
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lance Feld
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brandy Johnson
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joshua P. Needleman
- Pediatric Pulmonary Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Heather Boas
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nancy Lin
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Jennifer Pogoriler
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Karen M. McDowell
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Joseph C. Piccione
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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O'Leary C, Itkin M, Roshkovan L, Katz S, Cao Q, Hershman M, Galperin-Aizenberg M. CT Features of Lymphatic Plastic Bronchitis in Adults: Correlation with Multimodality Lymphatic Imaging. Radiol Cardiothorac Imaging 2022; 4:e210048. [PMID: 35506131 DOI: 10.1148/ryct.210048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 12/05/2021] [Accepted: 03/24/2022] [Indexed: 11/11/2022]
Abstract
Purpose To distinguish CT patterns of lymphatic and nonlymphatic causes of plastic bronchitis (PB) through comparison with lymphatic imaging. Materials and Methods In this retrospective study, chest CT images acquired prior to lymphatic workup were assessed in 44 patients with PB from January 2014 to August 2020. The location and extent of ground-glass opacity (GGO) was compared with symptoms and lymphatic imaging. Statistical analysis was performed using descriptive statistics, logistic regression, Pearson correlation coefficient, and unweighted κ coefficient for interobserver agreement. Sensitivity and specificity of GGO for lymphatic PB were calculated. Results Lymphatic imaging was performed in 44 patients (median age, 52 years ± 21 [IQR]; 23 women): 35 with lymphatic PB and nine with nonlymphatic PB. GGO was more frequently observed in patients with lymphatic PB than in those with nonlymphatic PB (91% [32 of 35] vs 33% [three of nine]; P < .001). Univariate logistic regression confirmed this result by showing that GGO was a significant predictor of lymphatic PB (odds ratio, 21 (95% CI: 3.8, 159.7). The model areas under the receiver operating characteristic curve (AUCs) of GGO unadjusted and adjusted for demographics were 0.79 and 0.86, respectively. The location of GGO correlated with lymphatic imaging and bronchoscopic findings. Overall sensitivity and specificity of GGO for lymphatic PB were 91% (32 of 35; 95% CI: 76, 98) and 67% (six of nine; 95% CI: 30, 93), respectively. Conclusion Patients with lymphatic PB predominantly had multifocal GGO with or without a "crazy paving" pattern; identification of GGO should prompt lymphatic workup in this frequently misdiagnosed condition.Keywords: Lymphography, Lymphatic, CT, Tracheobronchial Tree, Thorax© RSNA, 2022See also commentary by Kligerman and White in this issue.
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Affiliation(s)
- Cathal O'Leary
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104-6243 (C.O., L.R.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (M.I., S.K., M.H., M.G.A.); and Department of Biostatistics, University of Pennsylvania, Philadelphia, Pa (Q.C.)
| | - Maxim Itkin
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104-6243 (C.O., L.R.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (M.I., S.K., M.H., M.G.A.); and Department of Biostatistics, University of Pennsylvania, Philadelphia, Pa (Q.C.)
| | - Leonid Roshkovan
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104-6243 (C.O., L.R.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (M.I., S.K., M.H., M.G.A.); and Department of Biostatistics, University of Pennsylvania, Philadelphia, Pa (Q.C.)
| | - Sharyn Katz
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104-6243 (C.O., L.R.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (M.I., S.K., M.H., M.G.A.); and Department of Biostatistics, University of Pennsylvania, Philadelphia, Pa (Q.C.)
| | - Quy Cao
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104-6243 (C.O., L.R.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (M.I., S.K., M.H., M.G.A.); and Department of Biostatistics, University of Pennsylvania, Philadelphia, Pa (Q.C.)
| | - Michelle Hershman
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104-6243 (C.O., L.R.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (M.I., S.K., M.H., M.G.A.); and Department of Biostatistics, University of Pennsylvania, Philadelphia, Pa (Q.C.)
| | - Maya Galperin-Aizenberg
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104-6243 (C.O., L.R.); Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (M.I., S.K., M.H., M.G.A.); and Department of Biostatistics, University of Pennsylvania, Philadelphia, Pa (Q.C.)
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3
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Maehara K, Kurokawa M, Tezuka J, Lee S, Kaku Y. Plastic bronchitis in a child with nephrotic syndrome. Pediatr Int 2022; 64:e15015. [PMID: 35278244 DOI: 10.1111/ped.15015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/03/2021] [Accepted: 09/30/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Kenji Maehara
- Department of Nephrology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Mari Kurokawa
- Department of Nephrology, Fukuoka Children's Hospital, Fukuoka, Japan.,Division of Pediatrics, National Hospital Organization Fukuokahigashi Medical Center, Koga, Japan
| | - Junichiro Tezuka
- Department of Allergy and Pulmonology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Sooyoung Lee
- Division of Pediatrics, National Hospital Organization Fukuokahigashi Medical Center, Koga, Japan.,Department of Intensive Care, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yoshitsugu Kaku
- Department of Nephrology, Fukuoka Children's Hospital, Fukuoka, Japan
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Shirota J, Sato M, Saito Y, Asano Y, Tomita Y, Watanabe M, Suyama K, Kawasaki Y, Hosoya M. Plastic bronchitis associated with influenza B virus infection: A case report. Fukushima J Med Sci 2022; 68:43-48. [PMID: 35314523 PMCID: PMC9071359 DOI: 10.5387/fms.2021-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Plastic bronchitis (PB) is a severe acute respiratory disease that develops as a result of the formation of branching mucus plugs in the bronchial tree. PB is known as a complication of influenza A virus infection, but some cases have been associated with influenza B virus infections. This patient was a 3-year-old boy with no history of allergic disease who developed PB requiring ventilator management after influenza B virus infection. He was hospitalized and managed with ventilator support because of acute respiratory failure. Influenza B virus infection was diagnosed via rapid antigen test and real-time reverse-transcription polymerase chain reaction (RT-PCR). A bronchoscopy performed after a chest X-ray and computed tomography confirmed the presence of extensive atelectasis in the right lung field and mucus plugs in the right bronchus. The patient’s respiratory condition improved rapidly after removal of the plugs. Quantitative real-time RT-PCR performed with nasal and aspirated sputum samples obtained at hospitalization revealed a higher viral RNA load in the upper rather than in the lower respiratory tract. Viral replication in the lower respiratory was not found to be a major contributor toward mucus plug formation. The finding of increased serum IgE in the absence of a history of allergic disease suggests that an allergic reaction contributed to the formation of mucus plugs.
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Affiliation(s)
- Jun Shirota
- Department of Pediatrics, Fukushima Medical University
| | - Masatoki Sato
- Department of Pediatrics, Fukushima Medical University
| | - Yasushi Saito
- Department of Pediatrics, Fukushima Medical University
| | | | - Yoichi Tomita
- Department of Pediatrics, Fukushima Medical University
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Irungu A, Achola C, Ongulo B, Awori M, Waris A. Paediatric plastic bronchitis in an atopic child; A case report from East Africa. Respir Med Case Rep 2021; 34:101542. [PMID: 34765436 PMCID: PMC8569588 DOI: 10.1016/j.rmcr.2021.101542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/08/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022] Open
Abstract
Paediatric plastic bronchitis (PB) is a rare disease characterized by the presence or expectoration of branching airway casts usually in children with cardiac conditions and allergy. It is thought to be due to obstruction or altered drainage of the lymphatics in those with cardiac conditions. Obstruction can be diffuse and thus fatal if untreated. Less than 600 cases have been described in literature and just one in our region in a patient with sickle cell disease. We present a case of a 7-year-old female with acute symptoms suggestive of a lower respiratory tract infection and left hemithorax opacification and bronchial casts on bronchoscopy.
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Affiliation(s)
- Anne Irungu
- Paediatric Pulmonology Unit, Gertrude's Children's Hospital Nairobi, Kenya
| | - Cynthia Achola
- Paediatric Critical Care Unit, Gertrude's Children's Hospital Nairobi, Kenya
| | - Barrack Ongulo
- Ear Nose and Throat Surgery Unit, Gertrude's Children's Hospital Nairobi, Kenya
| | - Mark Awori
- Cardiothoracic Unit, Gertrude's Children's Hospital Nairobi, Kenya
| | - Adil Waris
- Paediatric Pulmonology Unit, Aga Khan University Hospital Nairobi, Kenya
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6
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Chhawchharia R, Gupta N, Gupta D, Agarwal P. Plastic Bronchitis: A Manifestation of Dander Hypersensitivity. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1930-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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7
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Yuan L, Huang JJ, Zhu QG, Li MZ, Zhuo ZQ. Plastic bronchitis associated with adenovirus serotype 7 in children. BMC Pediatr 2020; 20:268. [PMID: 32493254 PMCID: PMC7268262 DOI: 10.1186/s12887-020-02119-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 05/04/2020] [Indexed: 11/20/2022] Open
Abstract
Background Plastic bronchitis is an uncommon but severe respiratory disease characterized by formation of casts in tracheobronchial tree. It can lead to airway obstruction and even respiratory failure. Case presentation Plastic bronchitis is mostly seen in both post-cardiac surgery patients, especially Fontan procedure, and infections including those caused by influenza viruses, Mycoplasma pneumoniae or tuberculosis. But it has rarely been reported to be associated with adenovirus infection. We report 2 cases of plastic bronchitis arising from adenovirus serotype 7 infection, manifested in repeated high fever, cough, and progressive dyspnea, and were diagnosed and eventually cured by bronchoscopy. Conclusions Plastic bronchitis is a rare, variable and potentially fatal disease. In the cases we described, the cause was associated with adenovirus serotype 7 and its treatment required intervention with bronchoscopy and adequate control of the underlying disease.
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Affiliation(s)
- Lin Yuan
- Department of Infectious Diseases, Xiamen Children's Hospital (Children's Hospital of Fudan University Xiamen Branch), 92 Yibin Road, Huli District, Xiamen City, 361006, Fujian Province, China
| | - Jing-Jing Huang
- Department of Infectious Diseases, Xiamen Children's Hospital (Children's Hospital of Fudan University Xiamen Branch), 92 Yibin Road, Huli District, Xiamen City, 361006, Fujian Province, China
| | - Qi-Guo Zhu
- Department of Infectious Diseases, Xiamen Children's Hospital (Children's Hospital of Fudan University Xiamen Branch), 92 Yibin Road, Huli District, Xiamen City, 361006, Fujian Province, China
| | - Ming-Zhen Li
- Department of Infectious Diseases, Xiamen Children's Hospital (Children's Hospital of Fudan University Xiamen Branch), 92 Yibin Road, Huli District, Xiamen City, 361006, Fujian Province, China
| | - Zhi-Qiang Zhuo
- Department of Infectious Diseases, Xiamen Children's Hospital (Children's Hospital of Fudan University Xiamen Branch), 92 Yibin Road, Huli District, Xiamen City, 361006, Fujian Province, China.
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8
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[A case report of an adult with bronchial mould infection complicated by purulent pleurisy]. Rev Mal Respir 2018; 36:63-68. [PMID: 30429094 DOI: 10.1016/j.rmr.2018.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 02/07/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Bronchial mould infection or plastic bronchitis is a rare condition, encountered at any age, but with a predilection for childhood. The clinical diagnosis is made easy by the demonstration of solid, branched expectorations. However, the aetiology is not easy to determine and investigation does not often lead to a pathological diagnosis. CASE REPORT We report the case of a 24 year-old patient, with a history of pulmonary tuberculosis in January 2016, who had had chronic, persistent, solid and branched expectorations since January 2015. Fibreoptic bronchoscopy revealed thick white secretions plugging the bronchi. Pathological examination of the bronchial plugs showed fibrous tissue infiltrated with predominantly lymphoplasmocytic and histiocytic inflammatory cells. Investigations carried out on the pleura did not establish the aetiological diagnosis. The diagnosis of bronchial mould disease of tuberculous origin complicated by pleurisy was established. Corticosteroid therapy led to a complete regression of the moulds within six weeks. CONCLUSION The presence of solid and branched sputum should suggest fungal bronchitis and is an indication for bronchoscopy for diagnostic and therapeutic purposes. Early management is important to avoid complications.
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9
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Chasing the Lymph: New Clues for the Management of Idiopathic Plastic Bronchitis. Ann Am Thorac Soc 2018; 13:1671-1673. [PMID: 27726438 DOI: 10.1513/annalsats.201607-570ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Patil MH, Siddiqi A, Jeffrey Mador M. Successful bronchoscopy in a pregnant patient with plastic bronchitis. Respir Med Case Rep 2016; 18:8-9. [PMID: 27054088 PMCID: PMC4802819 DOI: 10.1016/j.rmcr.2016.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 03/04/2016] [Accepted: 03/06/2016] [Indexed: 11/26/2022] Open
Abstract
Plastic bronchitis is a rare disorder, characterized by formation of thick fibrinous bronchial casts which can obstruct the airway and present as a life threatening emergency (1). It is more common in the pediatric population after corrective or palliative surgery for congenital heart disease like fontan procedure but has rarely been reported in adults as well (1). Pregnancy is a relative contraindication for bronchoscopy. Bronchoscopy in the pregnant patient poses significant risks as manipulation of the airway can lead to impaired oxygenation and ventilation. In addition, the drugs used during this procedure to provide sedation can have a direct impact on the developing fetus (2). In spite of these risks bronchoscopy should not be withheld in an emergent situation as it can be a lifesaving measure. We report a case of successful bronchoscopy using Propofol as the sedating agent in a pregnant female with plastic bronchitis who presented with respiratory distress.
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Affiliation(s)
- Monali H Patil
- University at Buffalo, Department of Pulmonary Critical Care Medicine, Buffalo, NY, USA
| | - Attiya Siddiqi
- University at Buffalo, Department of Pulmonary Critical Care Medicine, Buffalo, NY, USA; Buffalo General Medical Center, Department of Critical Care Medicine, Buffalo, NY, USA
| | - M Jeffrey Mador
- University at Buffalo, Department of Pulmonary Critical Care Medicine, Buffalo, NY, USA; Veteran Affairs Western New York Health Care System-Buffalo Division, Department of Pulmonary and Critical Care Medicine, Buffalo, NY, USA
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El Mouhadi S, Taillé C, Cazes A, Arrivé L. Plastic Bronchitis Related to Idiopathic Thoracic Lymphangiectasia. Noncontrast Magnetic Resonance Lymphography. Am J Respir Crit Care Med 2015; 192:632-3. [PMID: 26561678 DOI: 10.1164/rccm.201503-0631im] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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Abstract
Plastic bronchitis is a rare pulmonary disorder associated with various conditions like cystic fibrosis, asthma, pulmonary infection and characterized by formation and expectoration of cast which assumes the shape of the bronchial tree. We report a case of a 33-year-old woman with beta thalassemia minor who developed plastic bronchitis.
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Affiliation(s)
- Makaresh Yadav
- Department of Pulmonary Medicine, T. N. Medical College, B. Y. L. Nair Hospital, Mumbai, India
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14
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Kim S, Cho HJ, Han DK, Choi YD, Yang ES, Cho YK, Ma JS. Recurrent plastic bronchitis in a child with 2009 influenza A (H1N1) and influenza B virus infection. J Korean Med Sci 2012; 27:1114-9. [PMID: 22969262 PMCID: PMC3429833 DOI: 10.3346/jkms.2012.27.9.1114] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 05/28/2012] [Indexed: 11/20/2022] Open
Abstract
Plastic bronchitis is an uncommon disorder characterized by the formation of bronchial casts. It is associated with congenital heart disease or pulmonary disease. In children with underlying conditions such as allergy or asthma, influenza can cause severe plastic bronchitis resulting in respiratory failure. A review of the literature showed nine cases of plastic bronchitis with H1N1 including this case. We report a case of a child with recurrent plastic bronchitis with eosinophilic cast associated with influenza B infection, who had recovered from plastic bronchitis associated with an influenza A (H1N1) virus infection 5 months previously. To the best of our knowledge, this is the first case of recurrent plastic bronchitis related to influenza viral infection. If patients with influenza virus infection manifest acute respiratory distress with total lung atelectasis, clinicians should consider plastic bronchitis and early bronchoscopy should be intervened. In addition, management for underlying disease may prevent from recurrence of plastic bronchitis.
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Affiliation(s)
- Sun Kim
- Department of Family Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Hwa Jin Cho
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Dong Kyun Han
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Eun Seok Yang
- Department of Pediatrics, Chosun University College of Medicine, Gwangju, Korea
| | - Young Kuk Cho
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Sook Ma
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
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15
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Kim EJ, Park JE, Kim DH, Lee J. Plastic bronchitis in an adult with asthma. Tuberc Respir Dis (Seoul) 2012; 73:122-6. [PMID: 23166545 PMCID: PMC3492376 DOI: 10.4046/trd.2012.73.2.122] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 04/02/2012] [Accepted: 04/25/2012] [Indexed: 11/24/2022] Open
Abstract
Plastic bronchitis is a rare disease characterized by marked airway obstruction, via the formation of large gelatinous or rigid airway cast. In Korea, there were a few case reports with plastic bronchitis not in adults, but in children. So we report a case of an adult who was diagnosed as plastic bronchitis with eosinophilic casts, with no history of atopic and cardiac disease.
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Affiliation(s)
- Eun Jin Kim
- Department of Internal Medicine, CHA Gumi Medical Center, CHA University School of Medicine, Gumi, Korea
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16
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Do P, Randhawa I, Chin T, Parsapour K, Nussbaum E. Successful management of plastic bronchitis in a child post Fontan: case report and literature review. Lung 2012; 190:463-8. [PMID: 22430124 DOI: 10.1007/s00408-012-9384-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 03/02/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE Plastic bronchitis is the occlusion of the major bronchial airways by a firm, gelatinous mucoid cast. It is a rare condition, which while classically described in asthma and sickle cell disease has greater mortality in patients with congenital heart disease. The management of this disease is obscure given the lack of clinical data regarding treatment therapies. METHODS We describe a case of an 11-year-old female status after Fontan surgery who presented with respiratory distress secondary to atelectasis of the right lung. RESULTS A bronchoscopy was performed demonstrating an obstructing bronchial cast with successful extraction. The plastic bronchitis continued to recur and she was placed on multiple inhaled mucolytics as well as inhaled tissue plasminogen activator with temporary resolution. Further evaluation of the etiology of her casts revealed that she had elevated pulmonary arterial pressures. Repeated bronchoscopic removal of the casts was utilized as well as continuation of the aggressive airway clearance. Ultimately fenestration of her Fontan was performed along with treatment of pulmonary vasodilators sildenafil and bosentan. Although there was improvement of the cast formation, her airway clearance could only be weaned to four times a day therapy with which she was discharged home after a 3-month hospitalization. She continues to remain on this therapy and has not required hospitalization since the initial incident over 1 year ago. CONCLUSIONS Plastic bronchitis in a patient with Fontan physiology presents a treatment dilemma that may require comprehensive therapy in severe cases such as described.
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Affiliation(s)
- Paul Do
- Miller Children's Hospital, 2801 Atlantic Ave. Ground Floor, Long Beach, CA, USA.
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17
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Laubisch JE, Green DM, Mogayzel PJ, Reid Thompson W. Treatment of plastic bronchitis by orthotopic heart transplantation. Pediatr Cardiol 2011; 32:1193-5. [PMID: 21479821 DOI: 10.1007/s00246-011-9989-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 03/25/2011] [Indexed: 01/22/2023]
Abstract
This case illustrates the successful use of orthotopic heart transplantation for the treatment of plastic bronchitis in a 6-year-old boy with hypoplastic left heart syndrome, which developed 2 years after Fontan procedure. Transplantation was undertaken after he failed medical management of airway obstruction. He is currently 1-year post-cardiac transplantation and has no evidence of plastic bronchitis despite weaning of an aggressive airway clearance regimen.
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Affiliation(s)
- Jamie E Laubisch
- The Johns Hopkins Hospital, 600N Wolfe Street, Baltimore, MD 21287, USA.
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Aryal S, Ihle R, Hayes D, Buch KP. A 47-year-old woman with progressive dyspnea and hypoxemia after lung transplantation. Chest 2011; 139:1532-1535. [PMID: 21652565 DOI: 10.1378/chest.10-2856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Shambhu Aryal
- Division of Pulmonary and Critical Care Medicine, University of Kentucky, Lexington, KY.
| | - Rayan Ihle
- Division of Pulmonary and Critical Care Medicine, University of Kentucky, Lexington, KY
| | - Don Hayes
- Division of Pulmonary and Critical Care Medicine, University of Kentucky, Lexington, KY
| | - Ketan P Buch
- Division of Pulmonary and Critical Care Medicine, University of Kentucky, Lexington, KY
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19
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ElMallah MK, Prabhakaran S, Chesrown SE. Plastic bronchitis: resolution after heart transplantation. Pediatr Pulmonol 2011; 46:824-5. [PMID: 21465672 DOI: 10.1002/ppul.21432] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 12/20/2010] [Accepted: 12/23/2010] [Indexed: 11/07/2022]
Abstract
Plastic bronchitis (PB) is a rare cause of obstructive airway disease in patients who have undergone partially corrective surgery for congenital heart disease (CHD). The etiology of plastic bronchitis in such patients is ill-defined, and treatment is ineffective. We report resolution of PB and severe obstructive airway disease after heart transplantation in a patient with CHD.
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Affiliation(s)
- Mai K ElMallah
- Pediatric Pulmonary Division, Department of Pediatrics, University of Florida, Gainesville, Florida, USA
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20
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Abstract
Fatal bronchial asthma is classically characterized in pathology textbooks and journal articles as associated with lung hyperinflation at autopsy. The following is a report of a case of fatal bronchial asthma associated instead with bilateral lung collapse. This manifestation of asthma at autopsy has not been previously reported, to my knowledge. A 31-year-old man with a history of recurrent asthma was found in an unresponsive state in his automobile after a low-speed collision. Medical personnel during the resuscitation noted a decrease in breath sounds bilaterally and some wheezing. There was no escaping air with needle thoracostomies at the outset. Cardiac monitoring demonstrated pulseless electrical activity during most of the 30-minute resuscitation attempt. An autopsy disclosed collapsed lungs bilaterally. Microscopic examination of the lungs disclosed the characteristic histopathologic features of bronchial asthma.
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Terano C, Miura M, Fukuzawa R, Saito Y, Arai H, Sasaki M, Ariyasu D, Hasegawa Y. Three children with plastic bronchitis associated with 2009 H1N1 influenza virus infection. Pediatr Infect Dis J 2011; 30:80-2. [PMID: 20686435 DOI: 10.1097/inf.0b013e3181f10fff] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report the cases of 3 children with plastic bronchitis associated with 2009 H1N1 influenza virus infection. These 3 children shared common clinical and radiologic features: rapid and progressive respiratory distress with whole lung atelectasis on chest radiograph. In children with severe respiratory symptoms accompanied by H1N1 influenza, plastic bronchitis should be considered.
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Affiliation(s)
- Chikako Terano
- Department of General Medicine, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
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22
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Abstract
OBJECTIVE We report two cases of plastic bronchitis presenting with acute respiratory failure and mimicking foreign body inhalation. METHOD The clinical findings, differential diagnoses and radiological investigation are discussed. RESULTS Plastic bronchitis is an uncommon condition, particularly in children. The condition may present to otolaryngologists with symptoms mimicking foreign body inhalation. It is important to consider plastic bronchitis as a differential diagnosis, based on its clinical and radiological signs. Early intervention, in the form of bronchoscopy, can be both diagnostic and therapeutic. CONCLUSION Plastic bronchitis is uncommon and its clinical and radiological features are non-specific. The recommended management is early bronchoscopy to establish the diagnosis and enable therapeutic intervention.
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Perioperative management of plastic bronchitis in children. Int J Pediatr Otorhinolaryngol 2010; 74:15-21. [PMID: 19880198 DOI: 10.1016/j.ijporl.2009.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 09/15/2009] [Accepted: 09/15/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE The aim of this study was to summarize clinical features and perioperative management of plastic bronchitis in 21 children. METHODS We reviewed the clinical data of 21 children diagnosed with plastic bronchitis in our hospital from April 2001 to February 2009 in this retrospective study. RESULTS Bronchoscopy was performed in 19 of the 21 cases. Of these, 13 patients were cured with the first procedure, during which branching bronchial casts were taken out. Six cases required a second procedure; of these, five patients were cured by removing branching bronchial casts; one patient died from massive pulmonary hemorrhage during anesthesia induction. Two patients were critically ill at initial diagnosis and worsened despite airway intubation, these patients died of multiple organ failure. The branching bronchial casts which were composed primarily of gelatinous fibers were sent for pathologic examination. Pathologically, 12 foreign bodies were classified as type I casts (containing inflammatory cells), 9 cases were type II (no inflammatory cells detected). CONCLUSIONS Plastic bronchitis in children is a life-threatening disease, the only effective therapeutic modality is bronchoscopic extraction. The early diagnosis of plastic bronchitis is difficult, anesthesia and extraction procedures are demanding, and the postoperative monitoring is challenging. The clinician should try to make an early diagnosis, use enhanced perioperative monitoring, and improve operational technique to provide timely treatment for the children with plastic bronchitis, thereby reducing the associated mortality rate.
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24
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Bongaerts D, Wojciechowski M, Suys B, Luijks M, Van Marck E, Jorens PG. Plastic bronchitis in a 5-year-old boy causing asystoly and fatal outcome. J Asthma 2009; 46:586-90. [PMID: 19657899 DOI: 10.1080/02770900902915854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Here we present the case of a 5-year-old boy who experienced a prehospital cardiac arrest after a period of wheezing, upper respiratory tract infection, and diarrhea. After successful resuscitation, ventilation was initially extremely difficult for no obvious reason. Various bronchodilatatory therapies were started with only limited result. Diagnosis of plastic bronchitis was made after bronchoscopy and at autopsy when therapy was withdrawn in view of the absence of cerebral circulation. A thickened basal membrane, a specific hallmark of asthma, was also present. Cardiac arrest in plastic bronchitis due to inflammatory and allergic disease is very rare. Pathological examination of the cast showed a mucinous cast with neutrophilic granulocytes, which is also seldom seen. This case illustrates that the diagnosis of plastic bronchitis can be extremely difficult if only minor respiratory symptoms occur. This resulted in a delayed diagnosis and fatal outcome.
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Affiliation(s)
- Dries Bongaerts
- Departments of Anesthesiology, Antwerp University Hospital, University of Antwerp, Belgium
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25
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Cho YK, Oh SM, Choi WY, Song ES, Han DK, Kim YO, Ma JS. Fatal plastic bronchitis with eosinophilic casts in a previously healthy child. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.9.1048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Young Kuk Cho
- Department of Pediatrics, Chonnam National University, Medical School Chonnam National University Hospital, Gwangju, Korea
| | - Soo Min Oh
- Department of Pediatrics, Chonnam National University, Medical School Chonnam National University Hospital, Gwangju, Korea
| | - Woo-Yeon Choi
- Department of Pediatrics, Chonnam National University, Medical School Chonnam National University Hospital, Gwangju, Korea
| | - Eun Song Song
- Department of Pediatrics, Chonnam National University, Medical School Chonnam National University Hospital, Gwangju, Korea
| | - Dong-Kyun Han
- Department of Pediatrics, Chonnam National University, Medical School Chonnam National University Hospital, Gwangju, Korea
| | - Young-Ok Kim
- Department of Pediatrics, Chonnam National University, Medical School Chonnam National University Hospital, Gwangju, Korea
| | - Jae Sook Ma
- Department of Pediatrics, Chonnam National University, Medical School Chonnam National University Hospital, Gwangju, Korea
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26
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Khemiri M, Hammami O, Zouari S, Khaldi F, Barsaoui S. [Plastic bronchitis: report of a pediatric case]. REVUE DE PNEUMOLOGIE CLINIQUE 2008; 64:234-237. [PMID: 18995152 DOI: 10.1016/j.pneumo.2008.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Revised: 05/28/2008] [Accepted: 05/31/2008] [Indexed: 05/27/2023]
Abstract
Plastic bronchitis (PB) is a rare disease, characterized by the formation of obstructive branching airways tracheobronchial casts. Commonly, PB often complicates the course of cardiac or respiratory disorders. The occurrence of PB before manifestation of the underlying respiratory disease is unusual. We report on the case of a boy, aged three years and eight months, free from underlying pulmonary disease, who presented with extensive atelectasis of the left lung during an acute respiratory tract infection. Bronchoscopy revealed the obstruction of the left tracheobronchial tree with large purulent casts. After bronchoscopic removal of the casts, the boy became asymptomatic. Initial aetiological investigations were negative. Two years later, the patient developed an asthma.
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Affiliation(s)
- M Khemiri
- Service de médecine infantile A, hôpital d'enfants, Bab-Saadoun-Jabbary, 1007 Tunis, Tunisie.
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27
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Goo HW, Jhang WK, Kim YH, Ko JK, Park IS, Park JJ, Yun TJ, Seo DM. CT findings of plastic bronchitis in children after a Fontan operation. Pediatr Radiol 2008; 38:989-93. [PMID: 18629486 DOI: 10.1007/s00247-008-0937-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 05/14/2008] [Accepted: 05/14/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Plastic bronchitis is a rare cause of acute obstructive respiratory failure in children. Life-threatening events are much more frequent in patients with repaired cyanotic congenital heart disease, and most frequent following a Fontan operation. Commonly, the diagnosis is not made until bronchial casts are expectorated. Detailed CT findings in plastic bronchitis have not been described. OBJECTIVE To describe the CT findings in plastic bronchitis in children after a Fontan operation. MATERIALS AND METHODS Three children with plastic bronchitis after a Fontan operation were evaluated by chest CT. Bronchial casts were spontaneously expectorated and/or extracted by bronchoscopy. Airway and lung abnormalities seen on CT were analyzed in the three children. RESULTS CT demonstrated bronchial casts in the central airways with associated atelectasis and consolidation in all children. The affected airways were completely or partially obstructed by the bronchial casts without associated bronchiectasis. The airway and lung abnormalities rapidly improved after removal of the bronchial casts. CONCLUSION CT can identify airway and lung abnormalities in children with plastic bronchitis after a Fontan operation. In addition, CT can be used to guide bronchoscopy and to monitor treatment responses, and thereby may improve clinical outcomes.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-2 dong, Songpa-gu, Seoul, South Korea.
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28
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29
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Wang G, Wang YJ, Luo FM, Wang L, Jiang LL, Wang L, Mao B. Effective use of corticosteroids in treatment of plastic bronchitis with hemoptysis in Chinese adults. Acta Pharmacol Sin 2006; 27:1206-12. [PMID: 16923342 DOI: 10.1111/j.1745-7254.2006.00418.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate whether corticosteroids are effective in the treatment of plastic bronchitis with hemoptysis. METHODS A retrospective, clinical study was undertaken. Thirty two patients with only first episodes of plastic bronchitis with hemoptysis were divided into a steroid group (n=18) treated with glucocorticoids, and a non-steroid group (n=14). The supportive therapy was uniformly applied to both groups, except for glucocorticoids. Variables such as temperature and white blood cell counts were determined. Furthermore, the volume of hemoptysis and bronchial casts were evaluated in detail daily. RESULTS There was no difference in the demographic data and variables at baseline between both groups (all P>0.05). On days 5, 6, 7 and 8, the volume of hemoptysis was significantly decreased in the steroid group compared with the non-steroid group (43+/-15 mL vs 117+/-33 mL on d 5, 29+/-12 mL vs 97+/-23 mL on d 6, 18+/-10 mL vs 80+/-20 mL on d 7, and 13+/-8 mL vs 66+/-14 mL on d 8; all P<0.05), and on d 10 after fibreoptic bronchoscopy, the cases with bronchial casts was reduced evidently in the steroid group in comparison with the non-steroid group (OR=5.69, 95% CI=1.76-43.6; P=0.005). There was no significance in mechanical ventilation and mortality between both groups. CONCLUSION Despite some limitations of this study, it has been demonstrated that, on the basis of common supportive therapy, corticosteroids would be effective and safe for the treatment of plastic bronchitis with hemoptysis.
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Affiliation(s)
- Gang Wang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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30
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Shah SSA, Drinkwater DC, Christian KG. Plastic Bronchitis: Is Thoracic Duct Ligation a Real Surgical Option? Ann Thorac Surg 2006; 81:2281-3. [PMID: 16731170 DOI: 10.1016/j.athoracsur.2005.07.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2005] [Revised: 06/29/2005] [Accepted: 07/05/2005] [Indexed: 11/15/2022]
Abstract
Plastic bronchitis is an unusual clinical scenario of unknown cause and occurs in multiple clinical settings. The disease is characterized by the development of arborizing, thick, tenacious casts of the tracheobronchial tree that results in airway obstruction. Patients with congenital heart disease who have undergone a Fontan operation are at high risk for having this problem develop. Management of this distressing situation is difficult with only palliative options being available, such as repeated bronchoscopies, inhaled heparin, tissue plasminogen activator, inhaled bronchodilators, or azithromycin. The patients with Fontan circuits have a myriad of unique complications develop, such as atrial arrhythmias, recurrent pleural effusions, chylothoraces, protein-losing enteropathy, and plastic bronchitis. High intrathoracic lymphatic pressures with nondemonstrable lympho-bronchial fistulas were believed to be the cause for the development of these recurrent bronchial casts in plastic bronchitis. Faced with recurrent plastic bronchitis resistant to medical management in 2 Fontan patients with normal Fontan pressures on cardiac catheterization, we decided to explore a surgical solution by performing a thoracic duct ligation. This resulted in complete resolution of the formation of casts in both patients, who were discharged home and remain asymptomatic on continued follow-up. Thoracic duct ligation provides a surgical cure for plastic bronchitis by decreasing intrathoracic lymphatic pressure and flow.
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Affiliation(s)
- S Salman A Shah
- Department of Cardiac Surgery, Vanderbilt University, Nashville, Tennessee, USA.
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31
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Mendoza Soto A, Galletti L, Gómez de Quero P, Ramos Casado MV, Velasco Bayón JM. [Plastic bronchitis. A case report and review of the literature]. An Pediatr (Barc) 2005; 62:72-5. [PMID: 15642245 DOI: 10.1157/13070185] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Plastic bronchitis is a rare complication in which bronchial casts of lymphatic origin develop in the tracheobronchial tree and cause airway obstruction. The main feature is expectoration of bronchial casts. This condition usually occurs in the postoperative period after the Fontan operation for congenital heart disease. Treatment modalities include mucolytics and chest physiotherapy, and in the most severe cases bronchoscopy to remove the casts and aerosolized urokinase or r-TPA. We describe a 12-year-old boy with pulmonary atresia with intact ventricular septum and severely hypoplastic right ventricle who underwent a modified Fontan operation at the age of 7 years. At the age of 12 years the patient started to present frequent episodes of coughing, dyspnea, and desaturation followed by difficult emission of white bronchial casts. An extracardiac Fontan conversion was performed to improve hemodynamics and symptoms. During the postoperative period frequent episodes of airway obstruction required bronchoscopy and finally improved with administration of aerosolized urokinase.
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Affiliation(s)
- A Mendoza Soto
- Instituto Pediátrico del Corazón, Hospital Universitario 12 de Octubre, Madrid, Spain.
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32
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33
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Abstract
Airway mucus hypersecretion is a clinical feature of a number of childhood diseases, including asthma and bronchitis-associated conditions. However, compared with adults, there is relatively scarce information concerning mucus pathophysiology in respiratory diseases in children. The available evidence indicates many similarities between adult and childhood respiratory hypersecretory conditions, including goblet-cell hyperplasia and submucosal gland hypertrophy, and airway mucus plugging in asthma. Consequently, it is likely that treatments that are effective in adults would be effective in children. Numerous therapeutic targets are linked to the pathophysiology of airway mucus hypersecretion in experimental models and adults with respiratory disease. Whether or not these same targets are relevant in children is for the most part unclear. These targets include the inflammatory cells mediating the inflammatory response that generates the hypersecretory phenotype, and highly specific cellular elements such as epidermal growth factor receptor tyrosine kinase and calcium-activated chloride (CACL) channels. Identification of these factors is linked with the development of different classes of pharmacotherapeutic molecules directed at these targets. Compounds with a broader spectrum of anti-inflammatory activity are likely to be more effective than compounds with restricted activity. However, certain highly specific targets, such as human CACL1 channels, appear to be strongly associated with the development of an airway hypersecretory phenotype. Data from current clinical trials in adults with blockers of these specific targets are awaited with great interest. The hope is that, if effective, pediatric trials with these compounds could be initiated with a view to alleviation of the clinical impact of airway mucus hypersecretion in children. A significant challenge to the therapeutic progression of these new compounds is effective delivery to the airways in children, with the research effort into development of new compounds matched by advances in inhaler design.
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Affiliation(s)
- Duncan F Rogers
- Thoracic Medicine, National Heart and Lung Institute, Imperial College London, London, UK.
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34
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Abstract
Cast or plastic bronchitis is an unusual disorder that is rarely encountered in the pediatric population. It is characterized by the expectoration of large, branching plugs of airway debris. These "casts" conform to the shape of portions of the tracheobronchial tree, and give the disorder its name. Cast bronchitis is typically seen in association with several primary pulmonary disorders and cyanotic congenital heart disease. It can be classified as inflammatory or acellular, based on the histologic characteristics of the casts. The presence of large, obstructive plugs filling the airways of lobes or entire lungs can result in a variety of clinical signs and symptoms, and may ultimately lead to respiratory failure and death. Conventional treatment of cast bronchitis has focused on the clearance of obstructing material from the airways combined with therapy for any underlying cardiopulmonary disease. Unfortunately, this approach has not proven very effective, and patient mortality remains high. We report on a case in which a patient with cast bronchitis was treated with long-term, low-dose oral azithromycin. This therapy resulted in clinical, spirometric, and radiographic improvement of the patient.
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Affiliation(s)
- Karen D Schultz
- Pulmonology Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
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35
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Noizet O, Leclerc F, Leteurtre S, Brichet A, Pouessel G, Dorkenoo A, Fourier C, Cremer R. Plastic bronchitis mimicking foreign body aspiration that needs a specific diagnostic procedure. Intensive Care Med 2003; 29:329-31. [PMID: 12594596 DOI: 10.1007/s00134-002-1610-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2002] [Accepted: 11/13/2002] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To report two children admitted to our emergency department with respiratory failure, one for status asthmaticus with pneumomediastinum and requiring mechanical ventilation and the other for high suspicion of foreign body aspiration. INTERVENTIONS Bronchoscopy revealed obstructive plugs and permitted their extraction and their identification as bronchial casts after the immersion in normal saline. Allergy was suspected in the first one, and Hemophilus influenzae infection was present in the second. The outcome was favorable. CONCLUSIONS Plastic bronchitis is an infrequent cause of acute life-threatening respiratory failure that can mimic foreign body aspiration or status asthmaticus. Bronchoscopic extraction must be performed urgently in the case of severe obstruction. This entity is probably underestimated as the casts with their specific ramifications are difficult to recognize. We recommend the immersion in normal saline of all plugs discovered in children with predisposing diseases mainly represented by infections, allergy, acute chest syndrome, and congenital cardiopathies.
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Affiliation(s)
- O Noizet
- Pediatric Intensive Care Unit, University Hospital of Lille, 59037 Lille, France
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36
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Costello JM, Steinhorn D, McColley S, Gerber ME, Kumar SP. Treatment of plastic bronchitis in a Fontan patient with tissue plasminogen activator: a case report and review of the literature. Pediatrics 2002; 109:e67. [PMID: 11927740 DOI: 10.1542/peds.109.4.e67] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Plastic bronchitis is a condition in which large, bronchial casts with rubber-like consistency develop in the tracheobronchial tree and cause airway obstruction. We describe a 4-year-old girl who had Fontan physiology and who developed plastic bronchitis and report for the first time the use of aerosolized tissue plasminogen activator for treatment of this condition. The literature is reviewed with emphasis placed on the occurrence of this disorder in patients with single ventricle physiology.
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Affiliation(s)
- John M Costello
- Division of Cardiology, Children's Memorial Hospital, Northwestern University Medical School, Chicago, Illinois 60614, USA
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37
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Stiller B, Riedel F, Paul K, van Landeghem FKH. Plastic bronchitis in children with Fontan palliation: analogue to protein losing enteropathy? Pediatr Cardiol 2002; 23:90-4. [PMID: 11924535 DOI: 10.1007/s00246-001-0024-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We studied a 6-year-old boy and a 2-year-old girl with bronchitis fibroplastica following Fontan operation. Large endobronchial casts of rubber-like consistency resulted in life-threatening pulmonary failure. In one patient symptoms improved after optimizing heart function with diuretics, and in the other a dramatic improvement with the resolution of the clinical symptoms and normalized serum albumin followed subcutaneous high-molecular-weight heparin treatment. The severe relapse after discontinuation of the heparin medication and the once more successful treatment with heparin suggest that in addition to optimizing heart function, high-molecular-weight heparin might be a therapeutic option for this poorly understood condition.
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Affiliation(s)
- B Stiller
- Department of Pediatric Cardiology, Deutsches Herzzentrum Berlin, Germany.
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Abstract
About 10% of American children have asthma, and its prevalence, morbidity, and mortality have been increasing. Asthma is an inflammatory disease with edema, bronchial constriction, and mucous plugging. Status asthmaticus in children requires aggressive treatment with beta-agonists, anticholinergics, and corticosteroids. Intubation and mechanical ventilation should be avoided if at all possible, as the underlying dynamic hyperinflation will worsen with positive-pressure ventilation. If mechanical ventilation becomes necessary, controlled hypoventilation with low tidal volume and long expiratory time may lessen the risk of barotrauma and hypotension. Unusual and nonestablished therapies for severe asthma are discussed.
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Affiliation(s)
- H A Werner
- Division of Critical Care, University of Kentucky Children's Hospital, Lexington, KY 40536, USA.
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39
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Affiliation(s)
- N Setzer
- Department of Anesthesiology, Miami Children's Hospital, Miami, FL 33155, USA
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40
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Quasney MW, Orman K, Thompson J, Ring JC, Salim M, Schoumacher RA, Watson D, Novick W, Deitcher SR, Joyner R. Plastic bronchitis occurring late after the Fontan procedure: treatment with aerosolized urokinase. Crit Care Med 2000; 28:2107-11. [PMID: 10890673 DOI: 10.1097/00003246-200006000-00074] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the use of aerosolized urokinase in a patient with plastic bronchitis after a Fontan procedure. DESIGN Case report. SETTING Pediatric intensive care unit in a university-affiliated children's hospital. PATIENTS Report of one patient with acute respiratory failure secondary to plastic bronchitis. INTERVENTIONS Aerosolized urokinase, multiple bronchoscopies, corticosteroids, mucolytics, bronchodilators, and atrial pacing. MEASUREMENTS AND MAIN RESULTS Airway obstruction secondary to recurring casts improved with the treatments. Histologic analysis of the casts demonstrated less fibrin after treatments with aerosolized urokinase. No adverse events were noted. CONCLUSIONS The addition of aerosolized urokinase to this patient's treatment regimen helped to resolve life-threatening airway obstruction secondary to fibrin casts.
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Affiliation(s)
- M W Quasney
- Department of Pediatrics, Crippled Children's Foundation Research Center, Memphis, TN 38103, USA.
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Languepin J, Scheinmann P, Mahut B, Le Bourgeois M, Jaubert F, Brunelle F, Sidi D, de Blic J. Bronchial casts in children with cardiopathies: the role of pulmonary lymphatic abnormalities. Pediatr Pulmonol 1999; 28:329-36. [PMID: 10536063 DOI: 10.1002/(sici)1099-0496(199911)28:5<329::aid-ppul4>3.0.co;2-k] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Expectoration of bronchial casts, a condition also called plastic bronchitis, is very rare in children. Bronchial casts may be associated with bronchopulmonary diseases associated with mucus hypersecretion, bronchopulmonary bacterial infections, congenital and acquired cardiopathies, or pulmonary lymphatic abnormalities. A classification based on anatomy and pathology has been proposed which identifies an "acellular" group associated with congenital cardiopathies and palliative surgery. We report on 3 cases with bronchial casts associated with cardiopathy. Observations suggest that the formation of bronchial casts may result from lymphatic leakage into the bronchi. The 3 cases on which we report were immunodeficient and had pulmonary lymphatic abnormalities. The bronchial casts contained lymphocytes and lipids, as determined by histologic examination. In the absence of congenital pulmonary or diffuse lymphatic dysplasia associated with cardiopathy, the principal factors resulting in the formation of bronchial casts appear to be surgical trauma to the lymphatic channels surrounding the bronchi, pleural adhesions, and high systemic venous blood pressure. The prognosis for these patients is poor, and possibilities for treatment are limited.
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Affiliation(s)
- J Languepin
- Department of Pediatric Pulmonology, Hôpital Necker Enfants Malades, Paris, France
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42
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Abstract
We report a case of bronchial cast in a boy 1 year and 5 months old. Bronchial casts often obstruct the main bronchi, causing dyspnea and hypoxia. The bronchial cast was studied pathologically, with findings of eosinophilia and neutrophilic infiltration; the cast seemed to involve an allergic reaction. Such casts can be removed during bronchoscopy, but we used aspiration.
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Affiliation(s)
- R Murata
- Department of Pediatrics, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534, Japan
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43
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Affiliation(s)
- B R Borbely
- Department of Medicine, Medical Center of Delaware, Newark
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44
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45
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Abstract
Expectoration of bronchial casts (plastic bronchitis) is an uncommon but ancient problem. Herein we describe a 40-year-old man, with no prior lung disease, who had dyspnea, cough, and expectoration of long branching bronchial casts. No specific cause was delineated, although special stains for eosinophilic granule major basic protein demonstrated occasional foci of eosinophils and small amounts of extracellular major basic protein in the bronchial casts. Various diseases, such as allergic bronchopulmonary aspergillosis, bronchiectasis, and cystic fibrosis, have been associated with the formation of bronchial casts and should be considered in the differential diagnosis. Although most previously reported cases have been associated with some type of pulmonary disease, our patient had no evidence of an underlying pulmonary disorder.
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Affiliation(s)
- J R Jett
- Division of Thoracic Diseases and Internal Medicine, Division of Pulmonary Medicine, Bishop Clarkson Memorial Hospital, Omaha, Nebraska
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