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Chen X, Wu S, Huang Z, Lin Y, Xu J, Xu Q, Chen D. Plastic Bronchitis in Children: A Review of 55 Cases over a 10-Year Period. Int J Pediatr 2024; 2024:9271324. [PMID: 38957711 PMCID: PMC11219203 DOI: 10.1155/2024/9271324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 05/21/2024] [Accepted: 06/08/2024] [Indexed: 07/04/2024] Open
Abstract
Objective To summarize the clinical characteristics and treatment experiences of patients with plastic bronchitis (PB). Methods All patients who were diagnosed with PB by bronchoscopic removal of tree-like casts at a single institution from January 2012 to May 2022 were retrospectively reviewed. Demographic and clinical data were retrieved from electronic patient records. Results A total of 55 patients, with a median age of 5.3 years, were eligible for the study. Nineteen cases had underlying diseases, among which asthma was the most common. The median course of the disease before admission was 11 days. Clinical symptoms were characterized by cough and fever, while moist rales (78.2%) and dyspnea (61.8%) were the most common signs. The most common laboratory finding was elevated C-reactive protein (58.2%). Patchy opacity was the most frequent radiographic finding (81.2%), followed by consolidation (60.0%) and pleural effusion (43.6%). Respiratory pathogens were detected in 41 cases, and M. pneumoniae was the most common one (41.8%), followed by adenovirus (20.0%) and influenza B virus (10.9%). The casts were removed by alveolar lavage, combined with ambroxol immersion (63.6%) and forceps (30.9%). Patients received an average of 2.3 bronchoscopies, and the median time for the first procedure was 3 days after admission. Antibiotics were given to all patients, methylprednisolone to 33 (60.0%), and gamma globulin to 25 (45.5%). A total of 53 cases were improved with an overall mortality rate of 3.6%. Conclusions PB in children is characterized by airway obstruction, mostly caused by respiratory infections, and timely removal of the cast by bronchoscopy is the most effective treatment.
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Affiliation(s)
- Xiaowen Chen
- Department of PediatricsThe First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shangzhi Wu
- Department of PediatricsThe First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhanhang Huang
- Department of PediatricsThe First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuneng Lin
- Department of PediatricsThe First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiaxing Xu
- Department of PediatricsThe First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qingyun Xu
- Department of PediatricsThe First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Dehui Chen
- Department of PediatricsThe First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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Fei-Zhou Z, Mei-Xia H, Xiaofen T, Lei W, Xuan J, Lan-Fang T. Plastic bronchitis associated with human bocavirus 1 infection in children. Pediatr Pulmonol 2024. [PMID: 38869182 DOI: 10.1002/ppul.27113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/01/2024] [Accepted: 05/28/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Plastic bronchitis (PB) is a clinical-pathological syndrome characterized by the abnormal accumulation of endogenous substances in the bronchial airways, causing partial or complete obstruction and resulting in impaired lung ventilation. METHODS In this retrospective analysis, we aim to summarize the clinical manifestations, imaging characteristics, diagnostic methods, and treatment approaches to enhance clinicians' ability to detect children who are infected with human bocavirus 1 (hBoV 1) and develop PB. RESULTS In the period from January 2021 to January 2024, a total of six hBoV 1 infection children were diagnosed with PB through bronchoscopy. The onset of the condition was mainly concentrated between June and December. The detection methods used included metagenomic next-generation sequencing for pathogen identification (three cases) and respiratory pathogen nucleic acid 13-plex detection (oropharyngeal swab) (three cases), both of which confirmed the presence of hBoV 1. Out of the six children with PB, two were girls and four were boys. Their ages ranged from 10 months to 4 years old. Common symptoms reported by all patients included fever, cough, and wheezing. Chest high-resolution computed tomography scans revealed atelectasis in six cases, in addition to pneumonia. After the removal of the plastic bronchi via bronchoscopy, the airway obstruction symptoms in the children were relieved, and no recurrence was observed during the follow-up period. Pathological findings indicated cellulose exudation and inflammatory cell infiltration, consistent with nonlymphatic PB. CONCLUSION When children infected with hBoV 1 exhibit persistent or worsening symptoms such as cough, fever, and wheezing despite treatment, clinicians should remain highly vigilant for the potential occurrence of PB. Bronchoscopy plays a crucial role not only in diagnosing the presence of a plastic bronchus but also in effectively treating PB.
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Affiliation(s)
- Zhang Fei-Zhou
- Department of Pulmonology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huang Mei-Xia
- Department of Pulmonology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Xiaofen
- Department of Pulmonology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wu Lei
- Department of Pulmonology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jia Xuan
- Department of Radiology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tang Lan-Fang
- Department of Pulmonology, National Clinical Research Center for Child Health, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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3
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Briski K, Labib B, Hussain S, Ramagopal M, Uppaluri L. Novel therapies for eosinophilic pediatric plastic bronchitis. Pediatr Pulmonol 2024; 59:1792-1794. [PMID: 38488768 DOI: 10.1002/ppul.26974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/12/2024] [Accepted: 03/08/2024] [Indexed: 05/28/2024]
Affiliation(s)
| | | | - Sabiha Hussain
- Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
| | - Maya Ramagopal
- Rutgers Robert Wood Johnson Medical School, New Brunswick, USA
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Li XP, Zhang Y, Sun XL, Hao K, Liu MK, Hao Q, Wang RG. Lymphatic plastic bronchitis and primary chylothorax: A study based on computed tomography lymphangiography. World J Clin Cases 2024; 12:2350-2358. [PMID: 38765753 PMCID: PMC11099413 DOI: 10.12998/wjcc.v12.i14.2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/09/2024] [Accepted: 04/07/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND This study presents an evaluation of the computed tomography lymphangiography (CTL) features of lymphatic plastic bronchitis (PB) and primary chylothorax to improve the diagnostic accuracy for these two diseases. AIM To improve the diagnosis of lymphatic PB or primary chylothorax, a retrospective analysis of the clinical features and CTL characteristics of 71 patients diagnosed with lymphatic PB or primary chylothorax was performed. METHODS The clinical and CTL data of 71 patients (20 with lymphatic PB, 41 with primary chylothorax, and 10 with lymphatic PB with primary chylothorax) were collected retrospectively. CTL was performed in all patients. The clinical manifestations, CTL findings, and conventional chest CT findings of the three groups of patients were compared. The chi-square test or Fisher's exact test was used to compare the differences among the three groups. A difference was considered to be statistically significant when P < 0.05. RESULTS (1) The percentages of abnormal contrast medium deposits on CTL in the three groups were as follows: Thoracic duct outlet in 14 (70.0%), 33 (80.5%) and 8 (80.0%) patients; peritracheal region in 18 (90.0%), 15 (36.6%) and 8 (80.0%) patients; pleura in 6 (30.0%), 33 (80.5%) and 9 (90.0%) patients; pericardium in 6 (30.0%), 6 (14.6%) and 4 (40.0%) patients; and hilum in 16 (80.0%), 11 (26.8%) and 7 (70.0%) patients; and (2) the abnormalities on conventional chest CT in the three groups were as follows: Ground-glass opacity in 19 (95.0%), 18 (43.9%) and 8 (80.0%) patients; atelectasis in 4 (20.0%), 26 (63.4%) and 7 (70.0%) patients; interlobular septal thickening in 12 (60.0%), 11 (26.8%) and 3 (30.0%) patients; bronchovascular bundle thickening in 14 (70.0%), 6 (14.6%) and 4 (40.0%) patients; localized mediastinal changes in 14 (70.0%), 14 (34.1%), and 7 (70.0%) patients; diffuse mediastinal changes in 6 (30.0%), 5 (12.2%), and 3 (30.0%) patients; cystic lesions in the axilla in 2 (10.0%), 6 (14.6%), and 2 (20.0%) patients; and cystic lesions in the chest wall in 0 (0%), 2 (4.9%), and 2 (4.9%) patients. CONCLUSION CTL is well suited to clarify the characteristics of lymphatic PB and primary chylothorax. This method is an excellent tool for diagnosing these two diseases.
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Affiliation(s)
- Xing-Peng Li
- Department of Radiology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Yan Zhang
- Department of Radiology, Qilu Hospital, Shandong University, Jinan 250063, Shandong Province, China
| | - Xiao-Li Sun
- Department of Radiology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Kun Hao
- Department of Lymph Surgery, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Meng-Ke Liu
- Department of Radiology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
| | - Qi Hao
- Department of Radiology, People's Hospital of Peking University, The Second School of Clinical Medicine of Peking University, Beijing 100034, China
| | - Ren-Gui Wang
- Department of Radiology, Beijing Shijitan Hospital Affiliated to Capital Medical University, Beijing 100038, China
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5
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Yang S, Chi S. Bronchial tree-shaped mucus plugs caused by COVID-19. J Paediatr Child Health 2024; 60:154. [PMID: 38760913 DOI: 10.1111/jpc.1_16441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2024]
Affiliation(s)
- Su Yang
- Department of Pediatrics, Longchang Maternal and Child Health and Family Planning Service Center, Longchang, China
| | - Shenglin Chi
- Tuberculosis Department, First People's Hospital of Zigong City, Zigong, China
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6
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Xu XH, Cai JR, Fan HF, Shi TT, Yang DY, Huang L, Zhang DW, Lu G. Analysis of the Risk Factors for Plastic Bronchitis in Children with Severe Adenovirus Pneumonia: A Retrospective Study. Infect Drug Resist 2024; 17:1011-1019. [PMID: 38505250 PMCID: PMC10948331 DOI: 10.2147/idr.s452347] [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: 12/15/2023] [Accepted: 02/29/2024] [Indexed: 03/21/2024] Open
Abstract
Purpose Plastic bronchitis (PB), a rare complication of respiratory infection characterized by the formation of casts in the tracheobronchial tree, can lead to airway obstruction and severe condition. Adenovirus is one of the common pathogens of PB caused by infection. This study aimed to evaluate the clinical features and risk factors for PB in children with severe adenovirus pneumonia. Methods A retrospective study of children with severe adenovirus pneumonia with bronchoscopy results at Guangzhou Women and Children's Hospital between January 2018 and January 2020 was performed. Based on bronchoscopy, we divided children with severe adenovirus pneumonia into two groups: PB and non-PB. Binary logistic regression analysis was used to identify independent risk factors for PB in patients with severe adenovirus pneumonia after univariate analysis. Results Our study examined 156 patients with severe adenovirus pneumonia with bronchoscopy results in hospital. Among them, 18 developed PB and 138 did not. On multivariate analysis, the independent risk factors of PB in children with severe adenovirus pneumonia were history of allergies (OR 10.147, 95% CI 1.727-59.612; P=0.010), diminished breath sounds (OR 12.856, 95% CI 3.259-50.713; P=0.001), and increased proportion of neutrophils (>70%; OR 8.074, 95% CI 1.991-32.735; P=0.003). Conclusion Children with severe adenovirus pneumonia with a history of allergies, diminished breath sounds, and increased the proportion of neutrophils >70% may show higher risk of PB.
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Affiliation(s)
- Xue-hua Xu
- Department of Respiratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Jie-rong Cai
- Department of Pediatrics, Guangzhou Panyu District Central Hospital, Guangdong, Guangdong, People’s Republic of China
| | - Hui-feng Fan
- Department of Respiratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Ting-ting Shi
- Department of Respiratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Di-yuan Yang
- Department of Respiratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Li Huang
- Pediatric Intensive Care Unit, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Dong-wei Zhang
- Department of Respiratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Gen Lu
- Department of Respiratory, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
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7
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Bustamante-Guevara GV, Iglesias-Serrano I, Camacho Soriano J. Refractory Inflammatory Plastic Bronchitis in Children and the Use of Mepolizumab as a Treatment. Arch Bronconeumol 2023; 59:829-830. [PMID: 37730522 DOI: 10.1016/j.arbres.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Gina V Bustamante-Guevara
- Unidad de Neumología Pediátrica y Fibrosis Quística, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Ignacio Iglesias-Serrano
- Unidad de Neumología Pediátrica y Fibrosis Quística, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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8
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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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9
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Rubin BK. Plastic bronchitis: Casting a wider net. Pediatr Pulmonol 2023; 58:3001-3002. [PMID: 37750595 DOI: 10.1002/ppul.26707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/10/2023] [Accepted: 09/19/2023] [Indexed: 09/27/2023]
Affiliation(s)
- Bruce K Rubin
- Pediatrics and Biomedical Engineering, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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10
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Nayır Büyükşahin H, Emiralioglu N, Sekerel BE, Soyer T, Oguz B, Güzelkaş I, Sunman B, Alboğa D, Akgül Erdal M, Yalcın E, Doğru D, Ozcelik U, Kiper N. Plastic bronchitis during childhood: Diversity of presentation, etiology, treatment, and outcomes. Pediatr Pulmonol 2023; 58:2559-2567. [PMID: 37278540 DOI: 10.1002/ppul.26548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/11/2023] [Accepted: 05/27/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Plastic bronchitis (PB) is a rare disease in children, and reliable data are scarce. Here, we aimed to analyze the clinical features, management, and outcomes in children with PB. METHODS The medical data of patients who were followed up with a diagnosis of PB between January 2010 and March 2022 were retrospectively analyzed. RESULTS The median age of 15 patients was 9 (interquartile range: 4-10) years with a male/female ratio of 12/3. Initial symptoms included recurrent pneumonia (33.3%), persistent atelectasis (33.3%), cast expectoration (26.6%), and intense, persistent cough (6.6%). The most common underlying diagnosis was asthma (n = 12, 80%), and six of the patients were newly diagnosed. The most common radiological findings were atelectasis as a consequence of major airway obstruction on chest X-ray or computed tomography. Five patients, all diagnosed as having asthma, had recurrent PB and required multiple airway procedures for treatment and diagnosis. During a median 7-year follow-up of five patients, occasionally cast expectoration was observed in one patient with asthma who had poor compliance with inhaled corticosteroids. CONCLUSION PB is a common reflection of the different underlying etiologies in the pediatric age group, and treatment and outcomes are closely related to these. It should be kept in mind that asthma can be a predisposing factor for the development of PB.
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Affiliation(s)
- Halime Nayır Büyükşahin
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bulent E Sekerel
- Division of Allergy and Asthma, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Tutku Soyer
- Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Berna Oguz
- Division of Pediatric Radiology, Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ismail Güzelkaş
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Birce Sunman
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Didem Alboğa
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Akgül Erdal
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalcın
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Doğru
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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11
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Pieper CC. Back to the Future II-A Comprehensive Update on the Rapidly Evolving Field of Lymphatic Imaging and Interventions. Invest Radiol 2023; 58:610-640. [PMID: 37058335 DOI: 10.1097/rli.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
ABSTRACT Lymphatic imaging and interventional therapies of disorders affecting the lymphatic vascular system have evolved rapidly in recent years. Although x-ray lymphangiography had been all but replaced by the advent of cross-sectional imaging and the scientific focus shifted to lymph node imaging (eg, for detection of metastatic disease), interest in lymph vessel imaging was rekindled by the introduction of lymphatic interventional treatments in the late 1990s. Although x-ray lymphangiography is still the mainstay imaging technique to guide interventional procedures, several other, often less invasive, techniques have been developed more recently to evaluate the lymphatic vascular system and associated pathologies. Especially the introduction of magnetic resonance, and even more recently computed tomography, lymphangiography with water-soluble iodinated contrast agent has furthered our understanding of complex pathophysiological backgrounds of lymphatic diseases. This has led to an improvement of treatment approaches, especially of nontraumatic disorders caused by lymphatic flow abnormalities including plastic bronchitis, protein-losing enteropathy, and nontraumatic chylolymphatic leakages. The therapeutic armamentarium has also constantly grown and diversified in recent years with the introduction of more complex catheter-based and interstitial embolization techniques, lymph vessel stenting, lymphovenous anastomoses, as well as (targeted) medical treatment options. The aim of this article is to review the relevant spectrum of lymphatic disorders with currently available radiological imaging and interventional techniques, as well as the application of these methods in specific, individual clinical situations.
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Affiliation(s)
- Claus C Pieper
- From the Division for Minimally Invasive Lymphatic Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn; and Center for Rare Congenital Lymphatic Diseases, Center of Rare Diseases Bonn, Bonn, Germany
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12
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Tomasulo CE, Dori Y, Smith CL. Understanding the next circulation: lymphatics and what the future holds. Curr Opin Cardiol 2023; 38:369-374. [PMID: 37195304 DOI: 10.1097/hco.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
PURPOSE OF REVIEW The lymphatic system was previously considered the forgotten circulation because of an absence of adequate options for imaging and intervention. However, recent advances over the last decade have improved management strategies for patients with lymphatic disease, including chylothorax, plastic bronchitis, ascites, and protein-losing enteropathy. RECENT FINDINGS New imaging modalities have enabled detailed visualization of lymphatic vessels to allow for a better understanding of the cause of lymphatic dysfunction in a variety of patient subsets. This sparked the development of multiple transcatheter and surgery-based techniques tailored to each patient based on imaging findings. In addition, the new field of precision lymphology has added medical management options for patients with genetic syndromes, who have global lymphatic dysfunction and typically do not respond as well to the more standard lymphatic interventions. SUMMARY Recent developments in lymphatic imaging have given insight into disease processes and changed the way patients are managed. Medical management has been enhanced and new procedures have given patients more options, leading to better long-term results.
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Affiliation(s)
| | - Yoav Dori
- Division of Cardiology, Jill and Mark Fishman Center for Lymphatic Disorders, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christopher L Smith
- Division of Cardiology, Jill and Mark Fishman Center for Lymphatic Disorders, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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13
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Hu Q, Wu J, Wang C, Liang W, Wang Y, Zheng Y, Wen F, Wang W, Yu U. Outcomes and Risk Factor Analysis of Plastic Bronchitis Among 321 Children with Influenza Pneumonia After Bronchoscopy Examination. Infect Drug Resist 2023; 16:4001-4011. [PMID: 37366500 PMCID: PMC10290863 DOI: 10.2147/idr.s405444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
Background Plastic bronchitis (PB) is a rare and severe lung disease. It can be triggered by influenza virus infection, which is a common respiratory infection in children. Bronchoscopy can aid in the early detection and treatment of PB. However, the outcomes and risk for PB development in pediatric patients with influenza virus infection are not fully understood. Methods Data from 321 children diagnosed with influenza virus pneumonia who underwent bronchoscopy examinations between 1st January, 2009 and 31st December, 2020 were retrospectively analyzed to assess the outcomes and risk factors associated with PB development. Results This study included 97 girls and 224 boys with influenza virus pneumonia with a median age of 42 months. Among them, 36 patients (11.2%) were categorized as having PB based on bronchoscopy findings. PB patients had significantly longer fever durations (p=0.010) and higher risks of developing severe conditions including respiratory failure (p<0.001), acute respiratory distress syndrome (p<0.001), and air-leak syndrome (p<0.001) compared to non-PB patients. Conventional treatment including the use of neuraminidase inhibitors and antibiotics did not differ between the PB and non-PB patients, but PB patients required more anti-inflammatory treatment (p=0.019) and ventilator support (p<0.001). Combined univariate and multivariate analyses suggested that radiographic findings, including mediastinal emphysema (p=0.012) and lung consolidation (p=0.012), as well as increased levels of neutrophils (p=0.026), aspartate aminotransferase (p=0.004), and lactate dehydrogenase (p<0.001), were identified as risk factors for PB development in patients with influenza virus pneumonia. Although PB patients required more intensive care and had longer hospital stays, they all recovered well after treatment. Conclusion Influenza virus infection is linked to PB development in children. Identifying risk factors and early intervention such as bronchoscopy can improve the prognosis of children with PB.
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Affiliation(s)
- Qian Hu
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Jianle Wu
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Chengqian Wang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Wen Liang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Yulei Wang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Yuejie Zheng
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Feiqiu Wen
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Wenjian Wang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Uet Yu
- Department of Hematology and Oncology, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
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14
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田 小, 张 光, 王 崇, 谷 瑞, 李 媛, 李 沁, 罗 健, 罗 征. [Clinical characteristics of plastic bronchitis and risk factors for recurrence in children]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:626-632. [PMID: 37382133 PMCID: PMC10321426 DOI: 10.7499/j.issn.1008-8830.2211122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/23/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES To study the clinical characteristics of plastic bronchitis (PB) in children and investigate the the risk factors for recurrence of PB. METHODS This was a retrospective analysis of medical data of children with PB who were hospitalized in Children's Hospital of Chongqing Medical University from January 2012 to July 2022. The children were divided into a single occurrence of PB group and a recurrent PB group and the risk factors for recurrence of PB were analyzed. RESULTS A total of 107 children with PB were included, including 61 males (57.0%) and 46 females (43.0%), with a median age of 5.0 years, and 78 cases (72.9%) were over 3 years old. All the children had cough, 96 children (89.7%) had fever, with high fever in 90 children. Seventy-three children (68.2%) had shortness of breath, and 64 children (59.8%) had respiratory failure. Sixty-six children (61.7%) had atelectasis and 52 children (48.6%) had pleural effusion. Forty-seven children (43.9%) had Mycoplasma pneumoniae infection, 28 children (26.2%) had adenovirus infection, and 17 children (15.9%) had influenza virus infection. Seventy-one children (66.4%) had a single occurrence of PB, and 36 cases (33.6%) had recurrent occurrence of PB (≥2 times). Multivariate logistic regression analysis showed that involvement of ≥2 lung lobes (OR=3.376) under bronchoscopy, continued need for invasive ventilation after initial removal of plastic casts (OR=3.275), and concomitant multi-organ dysfunction outside the lungs (OR=2.906) were independent risk factors for recurrent occurrence of PB (P<0.05). CONCLUSIONS Children with pneumonia accompanied by persistent high fever, shortness of breath, respiratory failure, atelectasis or pleural effusion should be highly suspected with PB. Involvement of ≥2 lung lobes under bronchoscopy, continued need for invasive ventilation after initial removal of plastic casts, and concomitant multi-organ dysfunction outside the lungs may be risk factors for recurrent occurrence of PB.
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15
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Benjamin J, O'Leary C, Hur S, Gurevich A, Klein WM, Itkin M. Imaging and Interventions for Lymphatic and Lymphatic-related Disorders. Radiology 2023; 307:e220231. [PMID: 36943078 DOI: 10.1148/radiol.220231] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
The lymphatic system is critical in fluid balance homeostasis. Yet, until recently, lymphatic imaging has been outside of mainstream medicine due to a lack of robust imaging and interventional options. However, during the last 20 years, both clinical lymphatic imaging and interventions have shown dramatic advancement. The key to imaging advancement has been the interstitial delivery of contrast agents through lymphatic-rich tissues. These techniques include intranodal lymphangiography and dynamic contrast-enhanced MR lymphangiography. These methods provide the ability to image and recognize lymphatic anatomy and pathologic conditions. Percutaneous thoracic duct catheterization and embolization became the first widely accepted interventional technique for the management of chyle leaks. Advances in interstitial lymphatic embolization, as well as liver and mesenteric lymphatic interventions, have broadened the scope of possible lymphatic interventions. Also, recent techniques of lymphatic decompression allow for the treatment of a variety of lymphatic disorders. Finally, immunologic studies of central lymphatic fluid reveal the potential of lymphatic interventions on immunity. These advances herald an exciting new chapter for lymphatic imaging and interventions in the coming years.
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Affiliation(s)
- Jamaal Benjamin
- From the Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, Philadelphia, Pa (J.B., C.O., A.G., M.I.); Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104 (J.B., C.O., A.G., M.I.); Department of Radiology, Seoul National University, Seoul, Republic of Korea (S.H.); Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands (W.M.K.); and Department of Radiology, Division of Interventional Radiology University of Texas Southwestern Medical Center, Dallas, TX (J.B.)
| | - Cathal O'Leary
- From the Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, Philadelphia, Pa (J.B., C.O., A.G., M.I.); Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104 (J.B., C.O., A.G., M.I.); Department of Radiology, Seoul National University, Seoul, Republic of Korea (S.H.); Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands (W.M.K.); and Department of Radiology, Division of Interventional Radiology University of Texas Southwestern Medical Center, Dallas, TX (J.B.)
| | - Saebeom Hur
- From the Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, Philadelphia, Pa (J.B., C.O., A.G., M.I.); Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104 (J.B., C.O., A.G., M.I.); Department of Radiology, Seoul National University, Seoul, Republic of Korea (S.H.); Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands (W.M.K.); and Department of Radiology, Division of Interventional Radiology University of Texas Southwestern Medical Center, Dallas, TX (J.B.)
| | - Alexey Gurevich
- From the Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, Philadelphia, Pa (J.B., C.O., A.G., M.I.); Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104 (J.B., C.O., A.G., M.I.); Department of Radiology, Seoul National University, Seoul, Republic of Korea (S.H.); Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands (W.M.K.); and Department of Radiology, Division of Interventional Radiology University of Texas Southwestern Medical Center, Dallas, TX (J.B.)
| | - Willemijn M Klein
- From the Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, Philadelphia, Pa (J.B., C.O., A.G., M.I.); Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104 (J.B., C.O., A.G., M.I.); Department of Radiology, Seoul National University, Seoul, Republic of Korea (S.H.); Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands (W.M.K.); and Department of Radiology, Division of Interventional Radiology University of Texas Southwestern Medical Center, Dallas, TX (J.B.)
| | - Maxim Itkin
- From the Department of Radiology, Division of Interventional Radiology, Perelman School of Medicine, Philadelphia, Pa (J.B., C.O., A.G., M.I.); Center for Lymphatic Disorders, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104 (J.B., C.O., A.G., M.I.); Department of Radiology, Seoul National University, Seoul, Republic of Korea (S.H.); Department of Medical Imaging, Radboudumc, Nijmegen, the Netherlands (W.M.K.); and Department of Radiology, Division of Interventional Radiology University of Texas Southwestern Medical Center, Dallas, TX (J.B.)
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16
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Murashita M, Oyasu T, Kodate A, Matsuura Y, Sadamoto Y, Endo A, Bando K, Sageshima H, Tsuchida T. A case of plastic bronchitis with a remarkable response to steroids. Respir Med Case Rep 2023; 43:101850. [PMID: 37124059 PMCID: PMC10139978 DOI: 10.1016/j.rmcr.2023.101850] [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: 01/08/2023] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 05/02/2023] Open
Abstract
Plastic bronchitis can cause fatal airway obstruction. An 85-year-old woman with no medical history presented to the emergency department of our hospital with progressing respiratory failure and hemoptysis. Bronchoscopy revealed a fibrin-type cast thrombus in the trachea, and plastic bronchitis was diagnosed. Initial treatment involved airway thrombus removal, and the patient survived. However, bleeding persisted for 6 days, and respiratory status showed slight improvement despite ventilatory management. Steroids were administered for concomitant acute respiratory distress syndrome, and there was marked improvement in both airway hemorrhage and respiratory failure. The patient was extubated, the steroid dose was reduced, and no rebleeding was observed. The patient was discharged from the hospital 1 month after the onset of symptoms. Blood tests were positive for the myeloperoxidase-anti-neutrophil cytoplasmic antibody; however, no biopsy was performed, and no specific symptoms were observed. A definitive diagnosis was therefore not reached. The causes of plastic bronchitis are numerous, and there are no standardized diagnostic criteria or treatment guidelines for this condition. The present case suggests that steroids may be effective in some patients with plastic bronchitis.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Takumi Tsuchida
- Corresponding author. Department of Emergency and Critical Care Medicine, Sapporo City General Hospital, Department of Emergency Medicine, N11W13 Chuo-ku, Sapporo, 060-8604, Japan.
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17
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Predictive Value of Adenoviral Load for Bronchial Mucus Plugs Formation in Children with Adenovirus Pneumonia. Can Respir J 2022; 2022:9595184. [PMID: 35979256 PMCID: PMC9377942 DOI: 10.1155/2022/9595184] [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] [Received: 01/12/2022] [Revised: 06/08/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background. The study aimed to explore risk factors for bronchial mucus plugs (BMP) formation in children with adenovirus (AdV) pneumonia. Methods. A retrospective study was conducted on children with AdV pneumonia who underwent bronchoscopy from January 2019 to December 2019. Children were divided into the BMP group and the control group, depending on whether BMP was formed or not. The clinical information and treatment proposals of the two groups of children were counted and analyzed via multiple logistic regression analysis, ROC curve analysis, and correlation analysis. Results. Among 453 patients with AdV pneumonia, 185 (40.84%) were in the BMP group. Among all the cases, there were 188 patients with a single AdV infection, including 64 (34.04%) in the BMP group and 124 (65.96%) in the control group. The incidence of dyspnea, poor spirits, mixed infections, and other symptoms in the BMP group was higher than in the control group. Children in the BMP group had a longer heat range. C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer (DD), and AdV load levels were higher in the MBP group. AdV load, Mycoplasma coinfection, DD, heat range, and LDH were independent risk factors for BMP, among which AdV load was the most significant (AUC = 0.819). AdV load was positively correlated with other risk factors, respectively. AdV load and heat range were independent risk factors for BMP patients with a single AdV infection. Conclusion. AdV load might have important clinical value in predicting BMP development in AdV pneumonia.
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18
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Ma Y, Gu Y, Zhang X, Gu W, Wang T, Sun H, Dai Y, Yan Y, Wang Y, Wang M, Sun H, Hao C, Fan L, Chen Z. High Expression of MUC5AC, MUC5B, and Layilin Plays an Essential Role in Prediction in the Development of Plastic Bronchitis Caused by MPP. Front Microbiol 2022; 13:911228. [PMID: 35770160 PMCID: PMC9234514 DOI: 10.3389/fmicb.2022.911228] [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] [Received: 04/02/2022] [Accepted: 04/25/2022] [Indexed: 11/22/2022] Open
Abstract
Plastic bronchitis (PB) is a rare respiratory condition which can result in severe respiratory complications such as respiratory failure and death. Mycoplasma pneumoniae infection is a main etiology cause of plastic bronchitis. However, the pathogenesis of plastic bronchitis complicated by Mycoplasma pneumoniae pneumonia (MPP) has not yet been fully elucidated. Our article aims to explore biomarkers for early prediction of MPP cases complicated with plastic bronchitis. We utilized a protein chip to screen for significantly different proteins among the groups of healthy, general Mycoplasma pneumoniae pneumonia (GMPP) and refractory Mycoplasma pneumoniae pneumonia (RMPP) patients, where layilin exhibited a potent change across biology information technology. Next, we demonstrated the high expression of MUC5AC, MUC5B, and layilin in bronchoalveolar lavage fluid (BALF) of MPP cases complicated with plastic bronchitis. Further study suggested that the level of layilin had a positive correlation with both MUC5AC and MUC5B. A receiver operating characteristic (ROC) analysis was performed to assess the diagnostic values of MUC5AC, MUC5B, and layilin in MPP cases with PB. Data show that the three indicators have similar diagnostic ability for MPP children with plastic bronchitis. Then, we used different concentrations of community-acquired respiratory distress syndrome (CARDS) toxin or lipid-associated membrane proteins (LAMPs) to simulate an in vitro experiment. The in vitro assay revealed that CARDS toxin or LAMPs induced A549 cells to secrete MUC5AC, MUC5B, layilin, and proinflammatory factors. These findings suggest that MUC5AC, MUC5B, and layilin are correlated with MPP. The high expression of MUC5AC, MUC5B, and layilin play an essential role in prediction in the development of plastic bronchitis caused by MPP. The high expression of MUC5AC, MUC5B, and layilin may be relevant to the severity of illness.
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Affiliation(s)
- Yu Ma
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Yeqi Gu
- Department of Pediatrics, Changzhou Wujin People's Hospital, Changzhou, China
| | - Xinxing Zhang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Wenjing Gu
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Ting Wang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Huiming Sun
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Yinfang Dai
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Yongdong Yan
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Yuqing Wang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Meijuan Wang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Huiquan Sun
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Chuangli Hao
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
| | - Liping Fan
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
- Liping Fan
| | - Zhengrong Chen
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, China
- *Correspondence: Zhengrong Chen
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19
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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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20
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Huang JJ, Yang XQ, Zhuo ZQ, Yuan L. Clinical characteristics of plastic bronchitis in children: a retrospective analysis of 43 cases. Respir Res 2022; 23:51. [PMID: 35248022 PMCID: PMC8898471 DOI: 10.1186/s12931-022-01975-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background With an increase in the diagnosis of plastic bronchitis (PB) cases, to enhance paediatricians’ knowledge and add to the few existing studies, we explored the clinical characteristics, diagnosis, and treatment of PB in children. Methods The clinicopathological data of 43 children admitted to the Xiamen Children’s Hospital and the Women and Children’s Hospital, affiliated to the Xiamen University from December 2016 to December 2019, were retrospectively analysed. Results All the children had cough, with 41 of them having associated fever. A peak temperature > 40 ℃ was observed in 25 children. Twenty-six children had shortness of breath, 27 had reduced respiratory sounds on the affected side, and 35 had audible moist rales on the affected side. Lactate dehydrogenase in all children increased to different degrees, and 29 had elevated D-dimer and fibrinogen degradation products. Lung imaging showed pulmonary consolidation and atelectasis, mainly in the bilateral lower lung lobes, in all the children. However, 31 had pleural effusion, mainly a small parapneumonic effusion. The infections were mainly caused by adenovirus and Mycoplasma pneumoniae. The casts in all 43 children were sucked or clamped out under bronchoscopy, and 10 were found to have type I PB on pathological examination. All children were treated with anti-infective therapy in addition to bronchoscopic cast removal. Thirty-one children were treated with methylprednisolone, and 16 with gamma globulin. Except for one child who was non-adherent to treatment, all other children showed improvement, or were cured and discharged from the hospital. Follow-up lung imaging at 3 months revealed that the lungs were fully re-expanded in 40 children. At the 6-month follow-up, six children had small airway lesions, four had obliterative bronchiolitis, and one had bronchiectasis. Conclusions Paediatric PB often occurs secondary to respiratory tract infections and progresses rapidly, with hyperpyrexia, cough, and shortness of breath as the main clinical manifestations. Pulmonary consolidation, atelectasis, and pleural effusion are seen on lung imaging, and early bronchoscopy and removal of casts in the trachea and bronchi are effective treatment options.
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21
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Kallam EF, Kasi AS, Patki R, Silva GL, Simon DM, Caltharp S, Guglani L. Bronchoscopic interventions for plastic bronchitis in children without structural heart disease. Eur J Pediatr 2021; 180:3547-3554. [PMID: 34159443 DOI: 10.1007/s00431-021-04161-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/16/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
Plastic bronchitis (PB) is a rare and life-threatening complication encountered in several disease states that leads to airway obstruction by branching casts. PB is most often reported in children with cyanotic congenital heart disease where recurrence is common, and mortality is high. There is limited data on optimal management strategies or recurrence of non-structural heart disease-related PB in children. We describe the clinical features, management, and outcomes in our cohort of children with non-structural heart disease-related PB. Among the 12 identified patients, asthma was the most common (67%) diagnosis. Ventilatory requirements ranged from room air to one patient who required extracorporeal membrane oxygenation (ECMO). Most patients (92%) required bronchoscopy, and cryotherapy was successfully utilized in two patients to relieve refractory obstructive airway casts. All patients received chest physiotherapy, and 11 patients were treated with two or more medications. There was one mortality despite ECMO, and one-third had recurrent PB, all of whom had asthma.Conclusion: Asthma is a risk factor for recurrent PB. Bronchoscopic interventions including cryotherapy are safe and effective treatment options in patients with refractory PB. What is Known: • Plastic bronchitis is a rare but life-threatening cause of airway obstruction caused by branching casts that are generally reported in patients with congenital heart disease. What is New: • In children without structural heart disease, asthma is a risk factor for recurrent plastic bronchitis. Cryotherapy via bronchoscopy is a safe and effective intervention in patients with refractory plastic bronchitis.
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Affiliation(s)
- Erin F Kallam
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep (PACS), Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Ajay S Kasi
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep (PACS), Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Rucha Patki
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep (PACS), Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - George Lucas Silva
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep (PACS), Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Dawn M Simon
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep (PACS), Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Shelley Caltharp
- Department of Pathology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Lokesh Guglani
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep (PACS), Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.
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22
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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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23
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Kanakis M, Martens T, Kostolny M, Petsios K, Giannopoulos N, Muthialu N. Reappraisal of lung manifestations in the setting of Fontan circulation. Asian Cardiovasc Thorac Ann 2021; 30:627-634. [PMID: 34747207 DOI: 10.1177/02184923211056711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fontan circulation is a well-established palliation in patients with functional single ventricles. Absence of a sub-pulmonary pumping chamber creates a unique physiology in which blood flow is mainly guided by negative intrathoracic and elevated central venous pressures. Various pulmonary anatomic or pathophysiologic changes can jeopardize optimal Fontan circulation. Long-term survival of patients who have undergone the contemporary total cavopulmonary connection is satisfactory. Thorough literature review in conjunction with accumulated clinical experience can lead clinicians to extract conclusions regarding Fontan and lung interactions indicating the purpose of this review.
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Affiliation(s)
- Meletios Kanakis
- Department of Pediatric and Congenital Heart Surgery, 69106Onassis Cardiac Center, Athens, Greece
| | - Thomas Martens
- Department of Cardiac Surgery, 54498Ghent University Hospital, Gent, Belgium
| | - Martin Kostolny
- Cardiothoracic Unit, 4956Great Ormond Street Hospital for Children, London, UK.,Slovak Medical University, Bratislava, Slovakia
| | - Konstantinos Petsios
- Department of Pediatric and Congenital Heart Surgery, 69106Onassis Cardiac Center, Athens, Greece
| | - Nicholas Giannopoulos
- Department of Pediatric and Congenital Heart Surgery, 69106Onassis Cardiac Center, Athens, Greece
| | - Nagarajan Muthialu
- Cardiothoracic Unit, 4956Great Ormond Street Hospital for Children, London, UK
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López-Alba A, Aldao-Argüelles I, de Granda-Orive JI. Plastic bronchitis and Noonan syndrome. Arch Bronconeumol 2021; 57:705. [PMID: 35699014 DOI: 10.1016/j.arbr.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/22/2021] [Indexed: 06/15/2023]
Affiliation(s)
- Adrián López-Alba
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain.
| | - Iago Aldao-Argüelles
- Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
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25
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Yoshida M, Funata K, Koinuma G, Miyairi I. Plastic Bronchitis Associated with Influenza. J Pediatr 2021; 238:336-337. [PMID: 34147497 DOI: 10.1016/j.jpeds.2021.06.021] [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: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Michiko Yoshida
- Department of Medical Subspecialties, Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Keiko Funata
- Department of Medical Subspecialties, Division of Pulmonology, National Center for Child Health and Development, Tokyo, Japan
| | - Goro Koinuma
- Department of Medical Subspecialties, Division of Pulmonology, National Center for Child Health and Development, Tokyo, Japan
| | - Isao Miyairi
- Department of Medical Subspecialties, Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan; Deparment of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
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26
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Ntiamoah P, Mukhopadhyay S, Ghosh S, Mehta AC. Recycling plastic: diagnosis and management of plastic bronchitis among adults. Eur Respir Rev 2021; 30:30/161/210096. [PMID: 34407979 DOI: 10.1183/16000617.0096-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/26/2021] [Indexed: 11/05/2022] Open
Abstract
Plastic bronchitis is a rare, underdiagnosed and potentially fatal condition. It is characterised by the formation and expectoration of branching gelatinous plugs that assume the shape of the airways. These airway plugs differ from the allergic mucin that characterises allergic bronchopulmonary aspergillosis and mucoid impaction of the bronchi. Plastic bronchitis is most often encountered in the paediatric population following corrective cardiac surgery, such as the Fontan procedure. It also occurs in adults. Plastic bronchitis in adults is rare, heterogeneous in its aetiology, and can lead to respiratory distress or even life-threatening airway obstruction. Plastic bronchitis in adulthood should not be overlooked, particularly in patients with chronic inflammatory lung diseases. This review presents current understanding of the presentation, aetiology, pathogenesis, pathology and management of plastic bronchitis in adults.
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Affiliation(s)
- Prince Ntiamoah
- Dept of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Subha Ghosh
- Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Atul C Mehta
- Dept of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
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27
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Zeng L, Wei J, Tang Y, Liu E, Li Q, Zang N. Clinical Characteristics of Human Adenovirus Plastic Bronchitis in 10 Pediatric Cases: A Retrospective Study of Seven Years. Virol Sin 2021; 36:550-554. [PMID: 34156646 PMCID: PMC8218560 DOI: 10.1007/s12250-021-00394-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 04/25/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Lingjian Zeng
- Department of Respiratory Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorder, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Jianhua Wei
- Department of Respiratory Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorder, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Yuyi Tang
- Department of Respiratory Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorder, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Enmei Liu
- Department of Respiratory Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorder, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Qubei Li
- Department of Respiratory Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorder, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.
| | - Na Zang
- Department of Respiratory Medicine, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorder, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.
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28
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Shah SK, Sabzghabaei N. Everything That Wheezes Is Not Asthma: A Case Report. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2021; 34:119-123. [PMID: 34143674 DOI: 10.1089/ped.2021.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: This case report provides the general pediatrician with insight on a unique presentation of an already rare disease. Plastic bronchitis (PB) is an exceedingly rare disease that presents with the formation of casts in the endobronchial tree. This typically occurs in patients with congenital heart defects that have undergone repair, however, it is atypical to be seen in otherwise healthy patients. Influenza A, lymphatic abnormalities, and single ventricle physiology are the only proven causes of PB. Asthma, toxic inhalation, and acute chest syndrome, however, are a few of the many conditions that have been proposed to predispose patients toward developing PB. Case Presentation: Thus, it is important to discuss the case of a 9-year-old boy with a history of uncontrolled asthma who presented with cough, chills, weight loss, and fevers. This patient was initially treated with broad-spectrum antibiotics due to concerns for necrotizing pneumonia, but due to failure in improvement, a direct laryngoscopy and bronchoscopy was performed, revealing the diagnosis of PB. Although this patient had a history of uncontrolled asthma, this was the only predisposing respiratory condition that put him at risk of developing PB. This patient went on to be treated with corticosteroids, chest physiotherapy, inhaled fibrinolytics, and direct fibrinolytic therapy with marked improvement in symptoms and imaging. Conclusion: PB, though rare, is a condition that all pediatricians must keep in their minds when patients present with respiratory symptoms with an unclear etiology. The delay in diagnosis and treatment of patients with PB can be detrimental as expectoration of these casts can result in asphyxiation and death. This article goes on to remind all providers, at all levels, the importance of conducting a thorough history/physical examination, creating a broad differential, and treating each patient holistically.
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Affiliation(s)
- Sagar K Shah
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
| | - Natalie Sabzghabaei
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, USA
- Department of Hospital Medicine, Detroit, Michigan, USA
- Carman and Ann Adams Department of Pediatrics, Detroit, Michigan, USA
- Central Michigan University College of Medicine, Mount Pleasant, Michigan, USA
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29
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Retrospective Study of an Adenovirus Pneumonia Outbreak in Shenzhen in 2017. Virol Sin 2021; 36:555-558. [PMID: 34046814 PMCID: PMC8158460 DOI: 10.1007/s12250-021-00393-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 04/21/2021] [Indexed: 12/17/2022] Open
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30
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Murata Y, Ishihara S, Sato Y, Ohta T. Plastic Bronchitis Associated with Influenza: An Adult Case. Intern Med 2021; 60:1647-1648. [PMID: 33361673 PMCID: PMC8188024 DOI: 10.2169/internalmedicine.5313-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yuichi Murata
- Department of Internal Medicine, Kitakyushu Municipal Medical Center, Kitakyushu City Hospital Organization, Japan
| | - Sayoko Ishihara
- Department of Internal Medicine, Kitakyushu Municipal Medical Center, Kitakyushu City Hospital Organization, Japan
| | - Yoriko Sato
- Department of Internal Medicine, Kitakyushu Municipal Medical Center, Kitakyushu City Hospital Organization, Japan
| | - Takanori Ohta
- Department of Internal Medicine, Kitakyushu Municipal Medical Center, Kitakyushu City Hospital Organization, Japan
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31
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Sanjuán Benita L, de la Mata Navazo S, García Mancebo J, Butragueño Laiseca L. [Plastic bronchitis and Glenn-stage heart disease]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00176-4. [PMID: 33992579 DOI: 10.1016/j.anpedi.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/09/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Lucía Sanjuán Benita
- Sección de Unidad de Cuidados Intensivos Pediátricos, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - Sara de la Mata Navazo
- Sección de Unidad de Cuidados Intensivos Pediátricos, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Julia García Mancebo
- Sección de Unidad de Cuidados Intensivos Pediátricos, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Laura Butragueño Laiseca
- Sección de Unidad de Cuidados Intensivos Pediátricos, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid, España; Mother-Child Health and Development Network (RedSAMID) of Carlos III Health Institue, Madrid, España
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32
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Yoshida M, Miyahara Y, Orimo K, Kono N, Narita M, Ohya Y, Matsumoto K, Nakagawa S, Ueki S, Morita H, Miyairi I. Eosinophil Extracellular Traps in the Casts of Plastic Bronchitis Associated With Influenza Virus Infection. Chest 2021; 160:854-857. [PMID: 33971146 DOI: 10.1016/j.chest.2021.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/27/2021] [Accepted: 05/03/2021] [Indexed: 12/22/2022] Open
Affiliation(s)
- Michiko Yoshida
- Division of Infectious Diseases, Department of Medical Subspecialties, Tokyo, Japan
| | - Yoko Miyahara
- Division of Critical Care Medicine, Department of Critical Care and Anesthesia, Tokyo, Japan
| | - Keisuke Orimo
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Naoko Kono
- Division of Infectious Diseases, Department of Medical Subspecialties, Tokyo, Japan
| | - Masami Narita
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Matsumoto
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Satoshi Nakagawa
- Division of Critical Care Medicine, Department of Critical Care and Anesthesia, Tokyo, Japan
| | - Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Hideaki Morita
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, Department of Medical Subspecialties, Tokyo, Japan; Department of Pediatrics, Hamamatsu University School of Medicine, Tokyo, Japan.
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33
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Jia SL, Ni FF, Ma YJ, Wu YH, Ma WK, Gao XJ. Clinical Analysis of Primary Nephrotic Syndrome Complicated by Plastic Bronchitis in Children. KLINISCHE PADIATRIE 2021; 233:63-68. [PMID: 33684950 DOI: 10.1055/a-1288-3670] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To summarize the clinical features of primary nephrotic syndrome (PNS) complicated by plastic bronchitis (PB) in children to provide guidance for treatment. METHODS We conducted a retrospective review of the clinical data of 25 children hospitalized with NS complicated by PB in our Hospital between 10/2016 and 03/2019, and summarized the clinical manifestations, imaging and fiberoptic bronchoscopy (FOB) examinations, treatment course and outcome of them. RESULTS 1). The 25 children, with a nephrotic syndrome (NS) course of one to 36 months, were all diagnosed with PB after FOB, among which 8 cases (32%) had respiratory failure and required ventilatory support. All of them started with respiratory symptoms such as fever and cough, and then suffered from dyspnea and progressive aggravation after 1-3 day(s) of onset, with rapid occurrence of bidirectional dyspnea and even respiratory failure in severe cases. 2). Laboratory test for pathogens: influenza A virus H1N1 (11 cases), influenza B virus (9 cases), adenovirus (3 cases) and mycoplasma pneumoniae (2 cases). There was no statistically significant difference (P>0.05) between children with common NS complicated by influenza virus (IV) infection (not accompanied by dyspnea) and those with kidney disease who developed PB in the white blood cell count, lymphocyte count, the inflammatory biomarkers C-reactive protein (CRP), procalcitonin (PCT) and humoral immunity (IgG level), yet the total IgG level was found significantly higher and the blood albumin level lower in the latter (P<0.05). 3). The 25 children were all examined with the FOB and treated with lavage, 15 of which had typical bronchial tree-like casts and 10 broken and stringy casts. Based on histopathological classification, all children were of Type I. 4). Twenty children (80%) with influenza were administered the antiviral drug Oseltamivir, 20 (80%) were treated with antibiotics, oral hormones were replaced with the same dosage of intravenous Methylprednisolone for 5 cases (20%), and 20 (80%) were intravenously administered gamma globulins (400-500 mg/kg x 3 days). These children showed a remarkable improvement after treatment and there were no deaths. CONCLUSION NS children are at high risk of influenza virus infection. Children with a severe case of NS are more susceptible to PB. If symptoms like shortness of breath, wheezing and progressive bidirectional dyspnea occur, FOB examination and lavage treatment should be performed as early as possible. Hyper-IgE-emia and hypoproteinemia may be the high risk factors for PNS complicated by PB in children. ZIEL: Ziel der Studie war es, durch Zusammenfassung der klinischen Merkmale des primären nephrotischen Syndroms (PNS) mit komplizierender plastischer Bronchitis (PB) im Kindesalter eine Orientierungshilfe für die Therapie der Erkrankung zu geben. METHODIK Wir führten eine retrospektive Prüfung der klinischen Daten von 25 Kindern durch, die zwischen Oktober 2016 und März 2019 in unser Krankhaus aufgenommen wurden, und erstellten eine Zusammenfassung der klinischen Symptome, Untersuchungen mit bildgebenden Verfahren und fiberoptischer Bronchoskopie (FOB), des Therapieverlaufs und des Outcomes der Patienten. ERGEBNISSE 1). Bei den 25 Kindern bestand ein nephrotisches Syndrom (NS) über einen Zeitraum von einem bis 36 Monaten. Bei allen Patienten wurde die Diagnose PB nach FOB gestellt, wobei in 8 Fällen (32%) eine beatmungspflichtige respiratorische Insuffizienz vorlag. Alle Patienten zeigten anfänglich Symptome einer Atemwegserkrankung wie Fieber und Husten, gefolgt von Atemnot und progredienter Verschlechterung 1 bis 3 Tage nach Erkrankungsbeginn. Dabei kam es rasch zum Auftreten bidirektionaler Atemnot, in schweren Fällen bis hin zur respiratorischen Insuffizienz. 2). Laboruntersuchung auf Erreger: Influenza-A-Virus H1N1 (11 Fälle), Influenza-B-Virus (9 Fälle), Adenovirus (3 Fälle) und Mycoplasma pneumoniae (2 Fälle). Es fand sich kein statistisch signifikanter Unterschied (P>0,05) zwischen Kindern, die ein "gewöhnliches" NS mit komplizierender Influenza-Virus (IV)-Infektion (ohne begleitende Atemnot) aufwiesen, und Kindern mit Nierenerkrankung, die eine PB entwickelten, hinsichtlich der Leukozyten- und Lymphozytenwerte sowie der Entzündungsmarker C-reaktives Protein (CRP), Procalcitonin (PCT) und humorale Immunität (IgG-Wert). Allerdings wurde bei der letzteren Patientengruppe ein signifikant höherer Gesamt-IgG-Wert und ein signifikant niedriger Albumin-Spiegel im Blut nachgewiesen (P<0.05). 3). Bei allen 25 Kindern erfolgte eine FOB und Therapie mit Lavage, bei 15 Kinder fanden sich typische verzweigte Ausgüsse der Bronchialäste und bei 10 Patienten desintegrierte und zähe Ausgüsse. Gemäß der histopathologischen Klassifikation waren alle Kinder vom Typ I. 4). Zwanzig Kinder (80%) mit Influenza erhielten das Virostatikum Oseltamivir, 20 Kinder (80%) eine Antibiotikatherapie, in 5 Fällen (20%) wurden oral gegebene Hormone durch intravenös in derselben Dosis verabreichtes Methylprednisolon ersetzt und 20 Kinder (80%) erhielten intravenös verabreichte Gammaglobuline (400-500 mg/kg Körpergewicht x 3 Tage). Diese Kinder zeigten eine bemerkenswerte Verbesserung nach der Therapie und es traten keine Todesfälle auf. SCHLUSSFOLGERUNG Bei Kindern mit NS besteht ein hohes Risiko für eine Influenza-Virus-Infektion. Kinder mit schwerem NS sind anfälliger für PB. Bei Auftreten von Symptomen wie Atemnot, Giemen und Brummern sowie progredienter bidirektionaler Dyspnoe sollte baldmöglichst eine FOB-Untersuchung und eine therapeutische Lavage durchgeführt werden. Erhöhte IgE-Werte im Blut und Hypoproteinämie stellen möglicherweise Risikofaktoren für PNS mit komplizierender PB im Kindesalter dar.
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Affiliation(s)
- Shi-Lei Jia
- Department of Nephrology, Shenzhen Children's Hospital, Shenzhen, China
| | - Fen-Fen Ni
- Department of Nephrology, Shenzhen Children's Hospital, Shenzhen, China
| | - Yi-Jiao Ma
- Department of Nephrology, Shenzhen Children's Hospital, Shenzhen, China
| | - Yu-Hui Wu
- Pediatric intensive-care unit, Shenzhen Children's Hospital, Shenzhen, China
| | - Wei-Ke Ma
- Pediatric intensive-care unit, Shenzhen Children's Hospital, Shenzhen, China
| | - Xiao-Jie Gao
- Department of Nephrology, Shenzhen Children's Hospital, Shenzhen, China
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López-Alba A, Aldao-Argüelles I, de Granda-Orive JI. Plastic Bronchitis and Noonan Syndrome. Arch Bronconeumol 2021; 57:S0300-2896(21)00046-6. [PMID: 33663876 DOI: 10.1016/j.arbres.2021.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/17/2021] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Adrián López-Alba
- Servicio de Medicina Interna. Hospital Universitario 12 de Octubre, Madrid, España.
| | - Iago Aldao-Argüelles
- Servicio de Medicina Interna. Hospital Universitario 12 de Octubre, Madrid, España
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35
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Kawakami N, Ito M, Takahashi K, Moriya T, Saito H, Wakai Y, Saito K. Pseudomembranous Tracheobronchitis With Severe Tracheal Stenosis and Masked Bronchial Obstruction. J Emerg Med 2021; 60:e39-e44. [PMID: 33353810 DOI: 10.1016/j.jemermed.2020.10.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/02/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pseudomembranous tracheobronchitis (PMTB) is a rare condition characterized by the formation of endobronchial pseudomembranes. PMTB overlaps with necrotizing tracheobronchitis or plastic bronchitis. The reported infectious etiology mainly includes invasive aspergillosis. PMTB can cause serious airway obstruction; however, urgent tracheotomy is rarely required. CASE REPORT A 46-year-old woman was transferred to the emergency department (ED) with a 1-week history of progressive dyspnea and cough that was preceded by fever and sore throat. She was previously healthy except for a 20-year history of mild palmoplantar pustulosis. Stridor was evident. Nasolaryngoscopy performed in the ED revealed severe tracheal stenosis caused primarily by mucosal edema and secondarily by pseudomembranes. Initially, tracheitis was considered the sole cause of dyspnea. Although she underwent urgent tracheotomy to prevent asphyxia, her respiration deteriorated progressively. Bronchoscopy revealed massive pseudomembranes obstructing the bilateral bronchi, which led to the clinical diagnosis of PMTB. Subsequent toilet bronchoscopy markedly improved her ventilation. The causative pathogen was not identified despite extensive work-up, including molecular biological testing. Histopathologic examination of the pseudomembranes revealed fibrin with abundant neutrophils, which was consistent with PMTB. Associated conditions, including immunodeficiency, were not found. Her condition improved with antibiotics and repeated toilet bronchoscopy. WHY SHOULD AN EMERGENCY PHYSICIANS BE AWARE OF THIS?: PMTB is an important differential diagnosis of airway emergencies. PMTB can present with critical edematous tracheal stenosis and masked bronchial pseudomembranous obstruction. Emergency physicians should include PMTB in the differential diagnosis in adult patients with acute central airway obstruction because it requires prompt multimodal treatment.
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Affiliation(s)
- Naoki Kawakami
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Masaru Ito
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kazuhiko Takahashi
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Tomohiro Moriya
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Hiroaki Saito
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Yoko Wakai
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Kazuhito Saito
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
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36
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Lymphatic Disorders and Management in Patients with Congenital Heart Disease. Ann Thorac Surg 2020; 113:1101-1111. [PMID: 33373590 DOI: 10.1016/j.athoracsur.2020.10.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/11/2020] [Accepted: 10/05/2020] [Indexed: 11/20/2022]
Abstract
Congenital heart disease can lead to significant lymphatic complications such as chylothorax, plastic bronchitis, protein losing enteropathy and ascites. Recent improvements in lymphatic imaging and the development of new lymphatic procedures can help alleviate symptoms and improve outcomes.
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Itkin M, Chidekel A, Ryan KA, Rabinowitz D. Abnormal pulmonary lymphatic flow in patients with paediatric pulmonary lymphatic disorders: Diagnosis and treatment. Paediatr Respir Rev 2020; 36:15-24. [PMID: 32792289 DOI: 10.1016/j.prrv.2020.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 01/10/2023]
Abstract
Pulmonary lymphatic disorders are characterized by the presence of the abnormal lymphatic tissues in the thoracic cavity, presenting clinically as chylothorax, chylopericardium, chyloptysis, interstitial lung disease and plastic bronchitis. These conditions include: neonatal chylothorax, cardiac and non-cardiac plastic bronchitis, non-traumatic chylothorax, post congenital cardiac surgery chylothorax and complex lymphatic malformations. Recently developed lymphatic imaging techniques, such as intranodal lymphangiography and dynamic contrast enhanced magnetic resonance lymphangiography demonstrated abnormal pulmonary lymphatic flow from thoracic duct into pulmonary parenchyma as a pathophysiological mechanism of these diseases. Novel minimally invasive lymphatic interventions, such as thoracic duct embolization, interstitial lymphatic embolization and surgical lympho-venous anastomosis, provide an effective treatment of these conditions.
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Affiliation(s)
- Maxim Itkin
- Center for Lymphatic Imaging, Penn Medicine, United States; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
| | - Aaron Chidekel
- Department of Pediatrics, Division of Pulmonology and Sleep Medicine, Nemours/duPont Hospital for Children, Wilmington, DE, United States; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Kelly A Ryan
- Cardiac Center, Nemours/duPont Hospital for Children, Wilmington, DE, United States; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Deborah Rabinowitz
- Dept of Medical Imaging, Division of Interventional Radiology, Nemours/duPont Hospital for Children, Wilmington, DE, United States; Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
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38
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Li Y, Williams RJ, Dombrowski ND, Watters K, Daly KP, Irace AL, Visner GA, Rahbar R, Fynn-Thompson F. Current evaluation and management of plastic bronchitis in the pediatric population. Int J Pediatr Otorhinolaryngol 2020; 130:109799. [PMID: 31812839 PMCID: PMC9187852 DOI: 10.1016/j.ijporl.2019.109799] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To describe a multidisciplinary approach for the treatment of plastic bronchitis (PB) in children. METHODS Retrospective chart review of children with PB between 1997 and 2017. Data regarding clinical presentation, diagnosis, management, and outcomes were analyzed. RESULTS Of 34 patients presenting with PB, 24 had single ventricle (SV) heart disease, 9 had pulmonary disease, and one had no underlying disease. Median (IQR: interquartile range) age at the time of PB diagnosis was 5.5 years (IQR: 9.0). Presenting symptoms included cough productive of casts (n = 27, 79%), wheezing (n = 5, 15%), dyspnea (n = 18, 53%), hypoxia (n = 31, 91%), and respiratory failure (n = 9, 26%). Diagnosis was made based on clinical evaluation, bronchoscopy findings, and/or pathology of casts. Treatment methods included bronchoscopy for cast removal (25% of SV patients, 91% of non-SV patients), chest physiotherapy (SV: 92%, non-SV: 45%), albuterol (SV: 79%, non-SV: 73%), inhaled steroids (SV: 75%, non-SV: 18%), nebulized hypertonic saline (SV: 29%, non-SV: 9%), nebulized heparin (SV: 8%, non-SV: 55%), nebulized tissue plasminogen activator (tPA; SV: 33%, non-SV: 9%), inhaled Dornase Alfa (SV: 54%, non-SV: 9%), antibiotics (SV: 46%, non-SV: 45%), systemic steroids (SV: 13%, non-SV: 45%), and lymphatic embolization (SV: 8%, non-SV: 45%). Of SV patients, 11 had no recurrence, 5 underwent heart transplantation, one awaits transplant, and 3 died due to cardiac disease. Three patients with respiratory disease had recurrent PB and one died from MRSA pneumonia. CONCLUSION PB is a highly morbid disease with limited treatment options. Bronchoscopy and chest physiotherapy for airway clearance are among the most-utilized therapies.
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Affiliation(s)
- Youjin Li
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Ryan J Williams
- Department of Cardiology, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Natasha D Dombrowski
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Karen Watters
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, 02115, USA
| | - Kevin P Daly
- Department of Cardiology, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | - Alexandria L Irace
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Gary A Visner
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA; Division of Pulmonary and Respiratory Diseases, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, 02115, USA
| | - Francis Fynn-Thompson
- Department of Cardiology, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA.
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39
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Nakamoto H, Kayama S, Harada M, Honjo T, Kubota K, Sawamura S. Airway emergency during general anesthesia in a child with plastic bronchitis following Fontan surgery: a case report. JA Clin Rep 2020; 6:6. [PMID: 32025939 PMCID: PMC6974346 DOI: 10.1186/s40981-020-0311-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/14/2020] [Indexed: 11/28/2022] Open
Abstract
Background Plastic bronchitis (PB) is a complication of Fontan surgery, results in the formation of mucus plug in the tracheobronchial tree, causing potentially fatal airway obstruction. We report critical airway emergency during general anesthesia in a child with plastic bronchitis. Case presentation A 5-year-old boy was scheduled for intrapulmonary lymphatic embolization through percutaneous catheterization under general anesthesia. He underwent Fontan surgery at the age of 2 and frequently developed respiratory failure due to plastic bronchitis. After induction of general anesthesia and tracheal intubation, mechanical ventilation became difficult even with an inspiratory pressure ≥ 50 mmHg due to airway obstruction. He expectorated a large mucus plug through the tracheal tube after administration of sugammadex, naloxone, and flumazenil, and respiratory condition was stabilized thereafter. Conclusion General anesthesia for a patient with plastic bronchitis should be planned with extracorporeal membrane oxygenation or cardiopulmonary bypass stand by.
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Affiliation(s)
- Hirofumi Nakamoto
- Department of Anesthesiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
| | - Satoru Kayama
- Department of Anesthesiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Mae Harada
- Department of Anesthesiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Takahiro Honjo
- Department of Anesthesiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Kinuko Kubota
- Department of Anesthesiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Shigehito Sawamura
- Department of Anesthesiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
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40
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Kevat A, Wensley D, Popescu O, Seear M. Bronchial casts. J Paediatr Child Health 2020; 56:165-167. [PMID: 31373728 DOI: 10.1111/jpc.14587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/21/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Ajay Kevat
- Division of Respiratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - David Wensley
- Department of Pediatrics, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.,Division of Critical Care, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Oanu Popescu
- Department of Pathology and Laboratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Michael Seear
- Division of Respiratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
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41
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Shah JH, Whitmore MJ. Interventional Radiology's Role in the Treatment of Pediatric Thoracic Disease. Semin Roentgenol 2019; 54:395-406. [PMID: 31706372 DOI: 10.1053/j.ro.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jay H Shah
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA; Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Emory + Children's Pediatric Institute, Children's Healthcare of Atlanta at Egleston, Atlanta, GA.
| | - Morgan J Whitmore
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA
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42
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Siddiqi NH, Kraman SS, Pressman B. Adult-Onset Plastic Bronchitis with Novel Lymphatic Anatomy: Cured with Endo-Lymphatic Embolization. Respiration 2019; 98:171-173. [PMID: 31362298 DOI: 10.1159/000499108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/22/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Nasir H Siddiqi
- Department of Radiology, University of Kentucky Healthcare System, Lexington, Kentucky, USA,
| | - Steve S Kraman
- Department of Internal Medicine, University of Kentucky Healthcare System, Lexington, Kentucky, USA
| | - Brent Pressman
- Department of Radiology, University of Kentucky Healthcare System, Lexington, Kentucky, USA
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43
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Grizales CL, González LM, Castrillon MA, Sua LF, Lores J, Aguirre M, Fernández-Trujillo L. Plastic bronchitis: A case report. Respir Med Case Rep 2019; 28:100876. [PMID: 31245273 PMCID: PMC6582060 DOI: 10.1016/j.rmcr.2019.100876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 10/31/2022] Open
Abstract
Plastic bronchitis is a rare and underdiagnosed disease characterized by the formation and expectoration of bronchial casts of amorphous material, which can be potentially fatal. It is more frequent in pediatric population. Symptoms can range from chronic cough and dyspnea to respiratory failure depending on the area of the compromised airway. Casts are classified as type I when constituted by inflammatory cells and accompany diseases such as asthma and pneumonias; and type II when acellular and are associated with congenital heart diseases following procedures such as Fontan. We report the case of a male schoolchild with a history of complex congenital heart disease, treated with palliative surgery, evaluated in the emergency department for cough and respiratory distress. The mother referred expulsion of gelatinous material after coughing. During clinical evaluation, expulsion of bronchial casts was evidenced, suggesting a plastic bronchitis. He underwent a diagnostic and therapeutic bronchoscopy and received initial treatment with respiratory therapy, nebulized hypertonic saline solution, mucolytics, dornase alpha and nebulized heparin. The hospitalization revealed a stenosis of the right pulmonary artery, which was corrected with stent. The patient progressed satisfactorily with improvement of cough and expectoration. He was discharged with combined treatment, nebulized medications and those concerning his underlying disease.
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Affiliation(s)
- Clara L Grizales
- Department of Pediatric, Pediatric Pulmonology Service, Fundación Valle del Lili University Hospital, Cali, Colombia.,Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Lina M González
- Department of Pediatric, Fundación Valle del Lili University Hospital, Cali, Colombia.,Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Maria A Castrillon
- Department of Pediatric, Fundación Valle del Lili University Hospital, Cali, Colombia.,Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Luz F Sua
- Department of Pathology and Laboratory Medicine, Fundación Valle del Lili University Hospital, Cali, Colombia.,Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Juliana Lores
- Clinical Research Center, Fundación Valle del Lili University Hospital, Cali, Colombia
| | - Marisol Aguirre
- Clinical Research Center, Fundación Valle del Lili University Hospital, Cali, Colombia.,Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Liliana Fernández-Trujillo
- Department of Internal Medicine, Pulmonology Service, Interventional Pulmonology, Fundación Valle del Lili University Hospital, Cali, Colombia.,Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
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44
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Peyton C. Protein-Losing Enteropathy and Plastic Bronchitis After the Fontan Operation. Crit Care Nurse 2019; 38:e5-e12. [PMID: 30504504 DOI: 10.4037/ccn2018784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Protein-losing enteropathy and plastic bronchitis remain challenging to treat despite recent treatment advances. Protein-losing enteropathy and plastic bronchitis have been diagnosed in patients with cardiomyopathy, constrictive pericarditis, and congestive heart failure. This article focuses on patients with protein-losing enteropathy or plastic bronchitis following the Fontan procedure. Patients with single-ventricle physiology who have undergone the Fontan procedure are at risk for these conditions. Fontan physiology predisposes patients to chronically low cardiac output, increased central venous pressure, and congestive heart failure. These altered hemodynamics lead to increased mesenteric vascular resistance, resulting in venous hypertension and congestion in protein-losing enteropathy. Plastic bronchitis is a complex disease in which chronic high lymphatic pressures from Fontan physiology cause acellular bronchial casts to develop. These entities may also occur in patients with normal Fontan hemodynamics. This article also covers medical and surgical interventions for protein-losing enteropathy and plastic bronchitis. (Critical Care Nurse 2018;38[6]:e5-e12).
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Affiliation(s)
- Christine Peyton
- Christine Peyton is a clinical nurse specialist at the Heart Institute at Children's Hospital Colorado, Aurora, Colorado.
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45
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Engelhardt K, Pirolli T, Raman L, Abu-Hijleh M, Hupp S. Successful Use of Pulmonary Cryotherapy for Tracheobronchial Thrombus Extraction and Recanalization of the Tracheobronchial Tree During a Pediatric Venovenous Extracorporeal Membrane Oxygenation Run. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2019; 32:28-30. [PMID: 31508253 DOI: 10.1089/ped.2018.0911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/19/2018] [Indexed: 11/13/2022]
Abstract
Impacted pediatric tracheobronchial thrombus is an uncommon diagnosis. There are no clearly proven therapeutic options for airway casts due to a similar process, plastic bronchitis. Cryotherapy, specifically cryoextraction, has shown potential as a therapeutic option in adults with tracheobronchial thrombus and cast. We describe the novel application of this method in a complex pediatric patient.
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Affiliation(s)
- Kevin Engelhardt
- Division of Pediatric Intensive Care, Department of Pediatrics, University of Texas Southwestern, Dallas, Texas.,Children's Health Dallas, Critical Care, Dallas, Texas
| | - Timothy Pirolli
- Department of Cardiothoracic Surgery, University of Texas Southwestern, Dallas, Texas.,Children's Health Dallas, Heart Center, Dallas, Texas
| | - Lakshmi Raman
- Division of Pediatric Intensive Care, Department of Pediatrics, University of Texas Southwestern, Dallas, Texas.,Children's Health Dallas, Critical Care, Dallas, Texas
| | - Muhanned Abu-Hijleh
- Pulmonary and Critical Care Medicine, University of Texas Southwestern, Dallas, Texas
| | - Susan Hupp
- Division of Pediatric Intensive Care, Department of Pediatrics, University of Texas Southwestern, Dallas, Texas.,Children's Health Dallas, Critical Care, Dallas, Texas
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46
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Impact of Non-cardiac Comorbidities in Adults with Congenital Heart Disease: Management of Multisystem Complications. INTENSIVE CARE OF THE ADULT WITH CONGENITAL HEART DISEASE 2019. [PMCID: PMC7123096 DOI: 10.1007/978-3-319-94171-4_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevalence and impact of non-cardiac comorbidities in adult patients with congenital heart disease increase over time, and these complications are often specifically a consequence of the long-term altered cardiovascular physiology or sequelae of previous therapies. For the ACHD patient admitted to the intensive care unit (ICU) for either surgical or medical treatment, an assessment of the burden of multisystem disease, as well as an understanding of the underlying cardiovascular pathophysiology, is essential for optimal management of these complex patients. This chapter takes an organ-system-based approach to reviewing common comorbidities in the ACHD patient, focusing on conditions that are directly related to ACHD status and may significantly impact ICU care.
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47
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An Emerging Diagnostic and Therapeutic Procedure When Facing Lung Collapse in a Fontan Patient. Ann Am Thorac Soc 2018; 15:1217-1220. [PMID: 30272495 DOI: 10.1513/annalsats.201801-035cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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48
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Plastic Bronchitis in an AIDS Patient with Pulmonary Kaposi Sarcoma. Case Rep Pulmonol 2018; 2018:9736516. [PMID: 30363701 PMCID: PMC6180928 DOI: 10.1155/2018/9736516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/18/2018] [Indexed: 11/17/2022] Open
Abstract
Plastic bronchitis is the expectoration of bronchial casts in the mold of the tracheobronchial tree. It is a rare occurrence of unknown etiology that has been primarily described in children with congenital heart disease. In this case report, we present the first reported case of plastic bronchitis in a patient with pulmonary Kaposi sarcoma and underlying HIV infection.
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49
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Ryu H, Choi K, Qu Y, Kwon T, Lee JS, Han J. Label-free Neutrophil Enrichment from Patient-derived Airway Secretion Using Closed-loop Inertial Microfluidics. J Vis Exp 2018. [PMID: 29939191 DOI: 10.3791/57673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Airway secretions contain a large number of immune-related cells, e.g., neutrophils, macrophages, and lymphocytes, which can be used as a major resource to evaluate a variety of pulmonary diseases, both for research and clinical purposes. However, due to the heterogeneous and viscous nature of patient mucus, there is currently no reliable dissociation method that does not damage the host immune cells in the patient airway secretion. In this research, we introduce a sample preparation method that uses inertial microfluidics for the patient's immune assessment. Regardless of the heterogeneous fluidic properties of the clinical samples, the proposed method recovers more than 95% of neutrophils from airway secretion samples that are diluted 1,000-fold with milliliters of clean saline. By recirculating the concentrated output stream to the initial sample reservoir, a high concentration, recovery, and purity of the immune cells are provided; recirculation is considered a trade-off to the single-run syringe-based operation of inertial microfluidics. The closed-loop operation of spiral microfluidics provides leukocytes without physical or chemical disturbance, as demonstrated by the phorbol 12-myristate 13-acetate (PMA)-induced elastase release of sorted neutrophils.
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Affiliation(s)
- Hyunryul Ryu
- Research Laboratory of Electronics, Massachusetts Institute of Technology
| | - Kyungyong Choi
- Research Laboratory of Electronics, Massachusetts Institute of Technology; Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology
| | - Yanyan Qu
- Department of Medicine, University of Pittsburgh
| | - Taehong Kwon
- Research Laboratory of Electronics, Massachusetts Institute of Technology; Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology
| | - Janet S Lee
- Department of Medicine, University of Pittsburgh; Vascular Medicine Institute, University of Pittsburgh
| | - Jongyoon Han
- Research Laboratory of Electronics, Massachusetts Institute of Technology; Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology; Department of Biological Engineering, Massachusetts Institute of Technology;
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50
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Delgado Pecellín I, Moreno Ortega M, Carrasco Hernández L, Marín Barrera L, Muñoz Zara P, Moreno Valera MJ, Quintana Gallego ME. Persistent Atelectasis in a Patient With Cystic Fibrosis: Are Antibiotics Always Needed? Arch Bronconeumol 2018; 55:54-55. [PMID: 29804946 DOI: 10.1016/j.arbres.2018.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/04/2018] [Accepted: 03/05/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Isabel Delgado Pecellín
- Unidad de Fibrosis Quística, Hospital Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.
| | - María Moreno Ortega
- Unidad de Fibrosis Quística, Hospital Virgen del Rocío, Sevilla, España; Unidad de Neumología y Alergia. Hospital Virgen del Rocío, Sevilla, España
| | - Laura Carrasco Hernández
- Unidad de Fibrosis Quística, Hospital Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
| | | | - Pilar Muñoz Zara
- Servicio de Neumología, Hospital Juan Ramón Jiménez, Huelva, España
| | - María José Moreno Valera
- Unidad de Neumología y Alergia. Hospital Virgen del Rocío, Sevilla, España; Unidad de Gestión Clínica de Neonatal, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - María Esther Quintana Gallego
- Unidad de Fibrosis Quística, Hospital Virgen del Rocío, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
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