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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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Panchabhai TS, Mukhopadhyay S, Sehgal S, Bandyopadhyay D, Erzurum SC, Mehta AC. Plugs of the Air Passages: A Clinicopathologic Review. Chest 2016; 150:1141-1157. [PMID: 27445091 DOI: 10.1016/j.chest.2016.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/22/2016] [Accepted: 07/06/2016] [Indexed: 02/07/2023] Open
Abstract
Although mucus is a normal product of the tracheobronchial tree, some diseases of the respiratory tract are characterized by unusually thick (inspissated) forms of mucus that accumulate within the airways. These are known as mucus plugs. The pathologic composition of these plugs is surprisingly diverse and, in many cases, correlates with distinctive clinical, radiologic, and bronchoscopic findings. The best-known conditions that involve mucus plugs are allergic bronchopulmonary aspergillosis, plastic bronchitis, and asthma. Other lung diseases occasionally associated with plugs within the airways include Aspergillus tracheobronchitis, hyper-IgE syndrome, exogenous lipoid pneumonia, pulmonary alveolar proteinosis, and chronic eosinophilic pneumonia. In this review, we describe and illustrate the bronchoscopic, pathologic, and imaging findings in respiratory disorders characterized by mucus plugs or plugs composed of other similar materials. Recognition of the characteristic appearance and differential diagnosis of mucus plugs will hopefully facilitate diagnosis and management of these diseases.
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Affiliation(s)
- Tanmay S Panchabhai
- Norton Thoracic Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ
| | | | - Sameep Sehgal
- Department of Pulmonary Medicine, the Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | | | - Serpil C Erzurum
- Department of Pulmonary Medicine, the Respiratory Institute, Cleveland Clinic, Cleveland, OH; Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Atul C Mehta
- Department of Pulmonary Medicine, the Respiratory Institute, Cleveland Clinic, Cleveland, OH.
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Sheikh AY, Ahmadi-Kashani M, Mohindra V, Friedenberg A, Pramanik SB, Ogden WD. A Rare Case of Plastic Bronchitis in an Adult Patient After Cardiopulmonary Bypass. Ann Thorac Surg 2016; 101:1176-8. [PMID: 26897202 DOI: 10.1016/j.athoracsur.2015.05.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 05/19/2015] [Accepted: 05/26/2015] [Indexed: 11/30/2022]
Abstract
Plastic bronchitis is a rare life-threatening complication observed after cardiopulmonary bypass (CPB). We describe a case of a 54-year-old man in whom a fulminant case of plastic bronchitis developed after coronary artery bypass grafting (CABG) and mitral valve repair. A brief review of the literature is also presented.
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Affiliation(s)
- Ahmad Y Sheikh
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California.
| | - Mastaneh Ahmadi-Kashani
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Vibha Mohindra
- Division of Pulmonary and Critical Care, Department of Medicine, Santa Clara Valley Medical Center, San Jose, California
| | - Allison Friedenberg
- Division of Pulmonary and Critical Care, Department of Medicine, Santa Clara Valley Medical Center, San Jose, California
| | - Sharmila B Pramanik
- Department of Pathology, Santa Clara Valley Medical Center, San Jose, California
| | - William D Ogden
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
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Abstract
OBJECTIVE The purpose of this article is to describe 3 patients each of whom developed a different form of tracheobronchial aspergillosis. METHODS We describe our clinical experience with 3 patients who developed significant respiratory symptoms secondary to Aspergillus infection. All patients were followed closely until there was resolution of pulmonary problems or they succumbed to respiratory insufficiency. RESULTS The first patient had asthma and her clinical and bronchoscopic findings were compatible with the diagnosis of mucoid impaction syndrome caused by Aspergillus. Response to therapy was excellent with complete recovery. The second and third patients had what we believe was tracheobronchial pseudomembranous aspergillosis. The precise reason for this complication in the second patient is unknown. The third patient was immunosuppressed and developed tracheobronchial aspergillosis. Despite aggressive therapy, both of these patients died. Diagnostic bronchoscopy was helpful in detecting the airway abnormalities and for obtaining respiratory specimens for culture. CONCLUSIONS These cases show the diverse tracheobronchial manifestations of Aspergillus species. Diagnostic bronchoscopy was helpful in the diagnosis of airway involvement by aspergillus.
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Kim EJ, Park JE, Kim DH, Lee J. Plastic bronchitis in an adult with asthma. Tuberc Respir Dis (Seoul) 2012; 73:122-6. [PMID: 23166545 PMCID: PMC3492376 DOI: 10.4046/trd.2012.73.2.122] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 04/02/2012] [Accepted: 04/25/2012] [Indexed: 11/24/2022] Open
Abstract
Plastic bronchitis is a rare disease characterized by marked airway obstruction, via the formation of large gelatinous or rigid airway cast. In Korea, there were a few case reports with plastic bronchitis not in adults, but in children. So we report a case of an adult who was diagnosed as plastic bronchitis with eosinophilic casts, with no history of atopic and cardiac disease.
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Affiliation(s)
- Eun Jin Kim
- Department of Internal Medicine, CHA Gumi Medical Center, CHA University School of Medicine, Gumi, Korea
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Hashida F, Komori M, Nishiyama K, Taniguchi Y, Kondo I, Kawamata M, Ozaki M. Bronchoscopic removal of mucus casts in a boy with plastic bronchitis. Acta Anaesthesiol Scand 2007; 51:1283-4. [PMID: 17850571 DOI: 10.1111/j.1399-6576.2007.01396.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wang G, Wang YJ, Luo FM, Wang L, Jiang LL, Wang L, Mao B. Effective use of corticosteroids in treatment of plastic bronchitis with hemoptysis in Chinese adults. Acta Pharmacol Sin 2006; 27:1206-12. [PMID: 16923342 DOI: 10.1111/j.1745-7254.2006.00418.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate whether corticosteroids are effective in the treatment of plastic bronchitis with hemoptysis. METHODS A retrospective, clinical study was undertaken. Thirty two patients with only first episodes of plastic bronchitis with hemoptysis were divided into a steroid group (n=18) treated with glucocorticoids, and a non-steroid group (n=14). The supportive therapy was uniformly applied to both groups, except for glucocorticoids. Variables such as temperature and white blood cell counts were determined. Furthermore, the volume of hemoptysis and bronchial casts were evaluated in detail daily. RESULTS There was no difference in the demographic data and variables at baseline between both groups (all P>0.05). On days 5, 6, 7 and 8, the volume of hemoptysis was significantly decreased in the steroid group compared with the non-steroid group (43+/-15 mL vs 117+/-33 mL on d 5, 29+/-12 mL vs 97+/-23 mL on d 6, 18+/-10 mL vs 80+/-20 mL on d 7, and 13+/-8 mL vs 66+/-14 mL on d 8; all P<0.05), and on d 10 after fibreoptic bronchoscopy, the cases with bronchial casts was reduced evidently in the steroid group in comparison with the non-steroid group (OR=5.69, 95% CI=1.76-43.6; P=0.005). There was no significance in mechanical ventilation and mortality between both groups. CONCLUSION Despite some limitations of this study, it has been demonstrated that, on the basis of common supportive therapy, corticosteroids would be effective and safe for the treatment of plastic bronchitis with hemoptysis.
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Affiliation(s)
- Gang Wang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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Ferreres-Franco J, Blanquer-Olivas J, Pastor-Esplá E, Borrás-Pallé S, Galán-Gil G, Jordá-Miñana A. [Intermittent asphyxia syndrome caused by a bronchial cast in the subglottic region]. Arch Bronconeumol 2006; 41:638-40. [PMID: 16324604 DOI: 10.1016/s1579-2129(06)60299-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report the case of an intensive care unit patient with acute respiratory failure caused by severe community-acquired pneumonia with empyema. She required orotracheal intubation and mechanical ventilation. Following extubation the patient s condition improved until the onset of several choking episodes caused by a dislodged laryngotracheal cast in the subglottic region. We discuss the differential diagnosis of upper airway obstructions and of the entities related to bronchial cast formation, in particular the clinical and pathophysiological features of plastic bronchitis and the treatment options available.
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Affiliation(s)
- J Ferreres-Franco
- Unidad de Cuidados Intensivos, Hospital Clínico de Valencia, Valencia, Spain.
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Vandenbos F, Deswardt P, Hyvernat H, Burel-Vandenbos F, Bernardin G. [Acute airway obstruction during chemotherapy-induced agranulocytosis with fever]. REVUE DE PNEUMOLOGIE CLINIQUE 2006; 62:34-6. [PMID: 16604039 DOI: 10.1016/s0761-8417(06)75411-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Acute airway obstruction caused by mucoid impaction can cause sometimes life-threatening respiratory distress. Bronchial plugging is usually observed in subjects with chronic diseases such as asthma, allergic bronchopulmonary aspergillosis, or cystic fibrosis. In children, it can be related to heart failure. Acute airway obstruction in a patient without a chronic respiratory disease is exceptional. We report the case of a patient who developed bronchial plugs obstructing the bronchi during a period of agranulocytosis induced by chemotherapy. The patient experienced acute respiratory distress with asphyxia. The plugs were composed of fibrin and required several fibroscopic procedures for clearance. To our knowledge, this is the first case report of acute airway obstruction by plugging during a period of agranulocytosis.
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Affiliation(s)
- F Vandenbos
- Service de Pneumologie, Hôpital Intercommunal de Fréjus/Saint Raphaël, 240, avenue de Saint-Lambert, BP 110, 83608 Fréjus Cedex.
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Ferreres-Franco J, Blanquer-Olivas J, Pastor-Esplá E, Borrás-Pallé S, Galán-Gil G, Jordá-Miñana A. Síndrome asfíctico intermitente provocado por molde bronquial en zona subglótica. Arch Bronconeumol 2005. [DOI: 10.1157/13081254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wakeham MK, Van Bergen AH, Torero LE, Akhter J. Long-term treatment of plastic bronchitis with aerosolized tissue plasminogen activator in a Fontan patient. Pediatr Crit Care Med 2005; 6:76-8. [PMID: 15636664 DOI: 10.1097/01.pcc.0000149320.06424.1d] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report the successful treatment of plastic bronchitis with aerosolized tissue plasminogen activator. DESIGN Case report. PATIENTS A 4-yr-old boy with congenital heart disease, who developed plastic bronchitis 33 months after a Fontan operation INTERVENTIONS Long-term treatment with aerosolized tissue plasminogen activator. MEASUREMENTS AND MAIN RESULTS We describe the case of a boy who developed recurrent episodes of life-threatening airway obstruction secondary to plastic bronchitis. Following the failure of multiple therapeutic interventions, his condition improved significantly with aerosolized tissue plasminogen activator. Several attempts to wean him off this treatment resulted in clinical deterioration. He has remained on long-term aerosolized tissue plasminogen activator. CONCLUSION Treatment of plastic bronchitis with aerosolized tissue plasminogen activator may benefit patients in whom other therapies have failed.
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Affiliation(s)
- Martin K Wakeham
- Pediatric Critical Care, Advocate Hope Children's Hospital, Oak Lawn, IL 60453, USA.
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Abstract
We report a case of perioperative management of a toddler with plastic bronchitis complicated by tracheal obstruction. We discuss our management of this case as well as the diverse group of patients who may present with this disease. We also reviewed the literature regarding medical management of cast bronchitis.
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Affiliation(s)
- Sabina DiCindio
- Department of Anesthesia and Critical Care, Nemours Children's Clinic-Wilmington, Alfred I.duPont Hospital for Children, Wilmington, DE 19899, USA.
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Ishman S, Book DT, Conley SF, Kerschner JE. Plastic bronchitis: an unusual bronchoscopic challenge associated with congenital heart disease repair. Int J Pediatr Otorhinolaryngol 2003; 67:543-8. [PMID: 12697358 DOI: 10.1016/s0165-5876(03)00004-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Plastic bronchitis is a rare disorder characterized by the formation of branching mucoid bronchial casts. Several pathophysiologic conditions are associated with development of these intrabronchial casts, including congenital heart defects. The management of plastic bronchitis presents an unusual and interesting bronchoscopic challenge. We describe a patient who underwent a Fontan procedure for correction of a congenital heart defect and subsequently developed respiratory distress secondary to plastic bronchitis on two occasions. In both cases, endoscopic intervention was required to remove these casts. A review of the literature, including the proposed etiologies, diagnosis, and current medical and surgical management, is also undertaken.
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Affiliation(s)
- Stacey Ishman
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee 53226, USA
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Khalid M, Zeitouni M, Bazarbashi M, Sharawani N, Mandeel B, Saleemi S. Bronchopulmonary mucoid impaction (bronchial casts). Ann Saudi Med 2003; 23:57-9. [PMID: 17146226 DOI: 10.5144/0256-4947.2003.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Mohammed Khalid
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Brogan TV, Finn LS, Pyskaty DJ, Redding GJ, Ricker D, Inglis A, Gibson RL. Plastic bronchitis in children: a case series and review of the medical literature. Pediatr Pulmonol 2002; 34:482-7. [PMID: 12422347 DOI: 10.1002/ppul.10179] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Plastic bronchitis is characterized by marked obstruction of the large airways by bronchial casts. We reviewed our experience and the literature to determine whether mortality rates are determined by underlying disease or cast type. We present 3 children with obstructive bronchial casts. One 3-year-old patient with Noonan's syndrome developed respiratory failure following surgery for tetralogy of Fallot requiring support with extracorporeal membrane oxygenation (ECMO) the first such case. There were 42 cases in the literature of children with plastic bronchitis. Casts may be divided into two types. Type I casts are inflammatory, consisting mainly of fibrin with cellular infiltrates, and occur in inflammatory diseases of the lung. Type II, or acellular casts, consist mainly of mucin with a few cells, and usually occur following surgery for congenital cardiac defects. Patients categorized by underlying disease included 31% with asthma or allergic disease, 40% with underlying cardiac defects, and 29% with other diseases. Mortality was 16%, but increased to 29% in patients with cardiac defects. Deaths occurred as long as 1 year after surgical repair for underlying defects. There were no deaths in patients with asthma. Life-threatening events were statistically higher in patients with cardiac defects (41%) than in those with asthma (0%, P = 0.02). Higher mortality in patients with type II casts compared to type I casts did not reach statistical significance (28% vs. 6%; P = 0.06). In conclusion, patients presenting with plastic bronchitis are at high risk for serious complications, especially with underlying cardiac disease.
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Affiliation(s)
- Thomas V Brogan
- Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA
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Migden DR. Bronchial cast. N Engl J Med 2002; 347:696; author reply 696. [PMID: 12200567 DOI: 10.1056/nejm200208293470919] [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] [Indexed: 11/19/2022]
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19
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Freedom RM, Hamilton R, Yoo SJ, Mikailian H, Benson L, McCrindle B, Justino H, Williams WG. The Fontan procedure: analysis of cohorts and late complications. Cardiol Young 2000; 10:307-31. [PMID: 10950328 DOI: 10.1017/s1047951100009616] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- R M Freedom
- Department of Pathology and Laboratory Medicine, the Hospital for Sick Children, Toronto, Canada.
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Quasney MW, Orman K, Thompson J, Ring JC, Salim M, Schoumacher RA, Watson D, Novick W, Deitcher SR, Joyner R. Plastic bronchitis occurring late after the Fontan procedure: treatment with aerosolized urokinase. Crit Care Med 2000; 28:2107-11. [PMID: 10890673 DOI: 10.1097/00003246-200006000-00074] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the use of aerosolized urokinase in a patient with plastic bronchitis after a Fontan procedure. DESIGN Case report. SETTING Pediatric intensive care unit in a university-affiliated children's hospital. PATIENTS Report of one patient with acute respiratory failure secondary to plastic bronchitis. INTERVENTIONS Aerosolized urokinase, multiple bronchoscopies, corticosteroids, mucolytics, bronchodilators, and atrial pacing. MEASUREMENTS AND MAIN RESULTS Airway obstruction secondary to recurring casts improved with the treatments. Histologic analysis of the casts demonstrated less fibrin after treatments with aerosolized urokinase. No adverse events were noted. CONCLUSIONS The addition of aerosolized urokinase to this patient's treatment regimen helped to resolve life-threatening airway obstruction secondary to fibrin casts.
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Affiliation(s)
- M W Quasney
- Department of Pediatrics, Crippled Children's Foundation Research Center, Memphis, TN 38103, USA.
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Itabashi S, Kano M, Endo K, Sasaki H. A resuscitated case from asphyxia by large bronchial cast. TOHOKU J EXP MED 1999; 187:183-8. [PMID: 10228989 DOI: 10.1620/tjem.187.183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 62-year-old woman with bronchiectasis suffered from asphyxia due to a large bronchial cast that obstructed the bronchial tree. Immediate bronchoscopic suction of a bronchial cast of 17 cm in length through the intubated tube relieved the patients without any complications. Large bronchial casts appear to be rare in this century but it should be considered in patients with acute exacerbation of excessive sputa not only in patients with asthma or allergy but also in patients with respiratory tract infection.
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Affiliation(s)
- S Itabashi
- Department of Respiratory Medicine and Anesthesiology, Shiogama City Hospital, Shiogama, Japan
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Freedom RM. The Edgar Mannheimer Memorial lecture. From Maude to Claude: the musings of an insomniac in the era of evidence-based medicine. Cardiol Young 1998; 8:6-32. [PMID: 9680268 DOI: 10.1017/s1047951100004601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- R M Freedom
- The University of Toronto Faculty of Medicine Head, The Hospital for Sick Children, Ontario, Canada
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Raghuram N, Pettignano R, Gal AA, Harsch A, Adamkiewicz TV. Plastic bronchitis: an unusual complication associated with sickle cell disease and the acute chest syndrome. Pediatrics 1997; 100:139-42. [PMID: 9200374 DOI: 10.1542/peds.100.1.139] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- N Raghuram
- Egleston Children's Hospital, Emory University School of Medicine, Atlanta, GA 30322, USA
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Abstract
Lymphangiomatosis is a rare disorder of the lymphatic system that is known to cause chylothorax. Chyloptysis may occur but chylous bronchial cast formation is rare. A case is reported of lymphangiomatosis in a 34 year old woman whose initial manifestation was cough productive of bronchial casts. Two years later the patient developed a chylothorax. Ligation of the thoracic duct through a low thoracotomy was curative.
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Affiliation(s)
- L G Nair
- Department of Pulmonary and Critical Care Medicine, Norwalk Hospital, Connecticut 06850, USA
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Abstract
Plastic bronchitis is a rare disorder characterized by the formation and, sometimes dramatic expectoration of long, branching bronchial casts. DIsorders associated with bronchial casts either produce an increase in the volume or viscosity of secretions, such as allergic bronchopulmonary aspergillosis, asthma, cystic fibrosis, pneumonia, and chronic bronchitis; or there are obstructions or structural abnormalities that decrease mucous clearance, such as bronchiectasis. The diagnostic evaluation should include serum laboratory studies, specimen cultures, skin tests, chest radiograph and CT scan, pulmonary function tests, and bronchoscopy. Therapy should be directed towards the underlying disorder and should also include maneuvers to facilitate removal of casts to prevent complications, such as secondary pneumonia.
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Affiliation(s)
- N L Kao
- University of Illinois College of Medicine at Rockford 61107, USA
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Affiliation(s)
- B R Borbely
- Department of Medicine, Medical Center of Delaware, Newark
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