Bronchial casts in children: a proposed classification based on nine cases and a review of the literature.

Abstract

Bronchial casts are characterized by the formation of obstructive airway plugs that may be large enough to fill the branching pattern of an entire lung. The condition is rare but can occur at any age. Casts may be secondary to underlying diseases such as asthma and cystic fibrosis, but there are often no predisposing factors. There is no accepted classification system for bronchial casts; but only a confusion of descriptive terms such as mucoid impaction, fibrinous bronchitis, and pseudomembranous bronchitis. Based on a review of nine well-documented cases and the available literature, we have separated bronchial casts into two well-defined groups: Type 1 (inflammatory), consisting of casts composed mainly of fibrin with a dense eosinophilic inflammatory infiltrate; and Type 2 (acellular), consisting of casts composed mainly of mucin with little or no cellular infiltrate and occurring only in children with congenital cyanotic heart disease. Acute mortality was high in both groups. Survivors of Type 1 casts seem to be well controlled with inhaled steroids. Optimal therapy for patients with Type 2 casts is not clear; the prognosis probably depends on underlying cardiac status. We hope that this simple classification will provide a framework for further study of this obscure condition.

Treatment of Plastic Bronchitis in a Fontan Patient With Tissue Plasminogen Activator: A Case Report and Review of the Literature

“…1 3 proposed that bronchial casts may be divided into 2 distinct clinicopathologic groups. Inflammatory casts are composed primary of fibrin with little mucin and have an eosinophilic infiltrate.…”

“…Plastic bronchitis occurs in a wide variety of noncardiac conditions, including asthma, [3][4][5][6] pneumonia, 1 lymphangiomatosis, 7-9 allergic bronchopulmonary aspergillosis, 10 cystic fibrosis, 11 bronchiectasis, 6,12 acute chest syndrome associated with sickle cell disease, 13 smoke inhalation, 14 and idiopathic states. 1,3,4,9,15,16 In pediatric patients with congenital heart disease, 15 cases of plastic bronchitis have been described previously in the literature (Table 1).…”

“…1,3,4,9,15,16 In pediatric patients with congenital heart disease, 15 cases of plastic bronchitis have been described previously in the literature (Table 1). Including our patient, 12 children with palliated single-ventricle physiology have been reported.…”

“…Supportive care, therapeutic bronchoscopy, and treatment of underlying disease states form the basis for treatment of plastic bronchitis. 1,3,4 Because plastic bronchitis is a rare disorder associated with variable disease states, specific therapeutic options are based primarily on anecdotal experience. Thoracic duct ligation has been curative in 2 cases, 7,17 and pericardectomy may be beneficial.…”

Successful Management of Plastic Bronchitis in a Child Post Fontan: Case Report and Literature Review

“…Seear et al in 1997 [11] delineated a novel scheme for subtype classification. Type 1 casts were considered inflammatory and consistent with a fibrin structure and eosinophilia.…”