Plastic Bronchitis: An Old Disease Revisited

Jett, James R.; Tazelaar, Henry D.; Keim, Lon W.; Ingrassia, Theodore S.

doi:10.1016/s0025-6196(12)61013-1

Cited by 46 publications

(32 citation statements)

References 15 publications

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“…However, we were able to successfully remove the casts by gentle pulling. Although some patients have been documented who required assisted ventilation or who died from suffocation [1,5], plastic bronchitis is usually self-limited or responsive to medical therapy, with a good prognosis [1][2][3][4][5]. Our patient did not respond to oral corticosteroid or intrabronchial instillation of acetylcysteine and continued to deteriorate despite medical therapy.…”

Section: Discussionmentioning

confidence: 70%

“…Plastic bronchitis is defined as the presence of inspissated bronchial casts that may be expectorated or found at bronchoscopy or in surgical specimens [1][2][3]. Bronchial casts are usually associated with diffuse bronchial hypersecretory disorders, such as mucoid impaction, asthma, allergic bronchopulmonary aspergillosis or mucoviscidosis [4][5][6], and are also reported to be present in pneumonia [4], pericardial effusion [5], and heart failure [7].…”

Section: Discussionmentioning

confidence: 99%

“…The role of corticosteroids is uncertain, although they are likely to be beneficial in any allergic-mediated reaction [2]. Aerosolized acetylcysteine or bronchoscopic facilitation of drainage may be of benefit [1,10].…”

Section: Discussionmentioning

confidence: 99%

“…Bronchial casts are generally associated with diffuse bronchial hypersecretory disorders, such as asthma or mucoviscidosis [4][5][6], and are also reported to be present in pneumonia [4], pericardial effusion [5], and heart failure [7]. Plastic bronchitis is usually self-limited or responsive to medical therapy, with a good prognosis [1][2][3][4][5].…”

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confidence: 99%

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Plastic bronchitis

Park¹,

Elshami²,

Kang³

et al. 1996

Eur Respir J

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Plastic bronchitis is generally associated with some type of pulmonary disease and improves either spontaneously or with medical therapy. We present a case of plastic bronchitis with no known cause.The patients' symptoms were not responsive to medical therapy but were relieved after right middle lobectomy. Eur Respir J., 1996, 9, 612- Plastic bronchitis, also known as fibrinous bronchitis or pseudomembranous bronchitis, denotes the presence of inspissated bronchial casts that may be coughed up or found at bronchoscopy or in surgical specimens [1][2][3]. Bronchial casts are generally associated with diffuse bronchial hypersecretory disorders, such as asthma or mucoviscidosis [4][5][6], and are also reported to be present in pneumonia [4], pericardial effusion [5], and heart failure [7]. Plastic bronchitis is usually self-limited or responsive to medical therapy, with a good prognosis [1][2][3][4][5].We report a case of plastic bronchitis not related to a specific bronchopulmonary disease. Our case was not responsive to medical therapy but improved after right middle lobe resection. Case reportA 17 year old man was admitted to the hospital with a one month history of cough and yellow sputum, which were not relieved by antibiotics and the usual expectorants. He had been relatively healthy despite being on digoxin and diuretics following heart surgery for Tetralogy of Fallot 5 yrs prior to admission. On examination, the patient appeared acutely and chronically ill. Blood pressure was 110/70 mmHg, pulse rate 80 beats·min -1 , respiratory rate 20 breaths·min -1 , and body temperature 37˚C. A grade III systolic murmur was heard at the cardiac apex and inspiratory crackles were present over both lower lung fields. There was no pitting oedema or clubbing. White blood cell count was 6,500 cells·mm -3 , with 52% neutrophils, 42% lymphocytes, 2% monocytes and 4% eosinophils. Sputum cultures grew alpha-haemolytic streptococci but no fungi or other pathogens.Chest roentgenogram showed bilateral patchy infiltrations with cardiomegaly. The heart size was unchanged compared with that recorded 2 months before admission ( fig. 1a). High resolution computed tomography (HRCT) scan showed bilateral patchy consolidations, both centrally and peripherally. No evidence of interstitial oedema was present ( fig. 1b). Echocardiography revealed left atrial and ventricular enlargement with mitral regurgitation. These findings were unchanged compared to the findings 6 months prior to admission. Spirometry was normal, with a forced vital capacity (FVC) of 4.01 L (102% of predicted), forced expiratory volume in one second (FEV1) of 3.52 L (102% pred), and FEV1/FVC of 87%. Transfer factor of the lungs for carbon monoxide was 20.4 mL·mm -1 ·mmHg -1 (74% pred). Breathing room air, arterial blood pH was 7.38, arterial carbon dioxide tension (Pa,CO 2 ) 4.8 kPa (36.2 mmHg) and arterial oxygen tension (Pa,O 2 ) 11.4 kPa (85.5 mmHg). Fibreoptic bronchoscopy disclosed widespread hyperaemic mucosa with viscid purulent secretion in the large bron...

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Plastic bronchitis

Park¹,

Elshami²,

Kang³

et al. 1996

Eur Respir J

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“…8 The mucus casts which have been described as "bronchial cast" or "plastic bronchitis" are the obstructive plugs that form in the bronchial tree. 9 They may vary in size from small segments to complete casts of an entire lung. The expectoration of a large cast is a dramatic clinical finding and the condition consequently attracts attention out of proportion to its rarity.…”

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confidence: 99%

Bronchopulmonary Mucoid Impaction (Bronchial Casts)

et al. 2003

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Impaction (Bronchial Casts). 2003; 23(1-2): 57-59Significant mucoid impaction has been described with asthma, allergic bronchopulmonary aspergillosis, 1,2 cystic fibrosis, 2,3 bronchial atresia with intrapulmonary sequestration, 2,4 and endobronchial lesion 2,5 with postobstructive mucoid impaction. Some case reports have shown an association with endotracheal intubation 6 and transtracheal oxygen catheter insertion, 7 and also in children with cyanotic heart diseases.8Only a few case reports of mucoid impaction of unknown etiology are described in the literature. To the best of our knowledge, ours is the first case report in the Kingdom of Saudi Arabia. In our patient, a careful assessment of past medical history and the ensuing work-up ruled out asthma, allergic bronchopulmonary aspergillosis and other secondary causes of pulmonary mucoid impaction, thus establishing the diagnosis of mucoid impaction of unknown etiology. 8 The mucus casts which have been described as "bronchial cast" or "plastic bronchitis" are the obstructive plugs that form in the bronchial tree.9 They may vary in size from small segments to complete casts of an entire lung. The expectoration of a large cast is a dramatic clinical finding and the condition consequently attracts attention out of proportion to its rarity. 10,11 Case ReportA 20-year-old female was referred to our hospital with a one-year history of productive cough and exertional dyspnea. Chest x-ray showed left parahilar mass and persistent bilateral lower lobe infiltrates, which were not responding to multiple courses of antibiotics and to the empirical anti-tuberculous (TB) treatment. Her past history was significant only for 15 mm PPD skin test. Other examinations were unremarkable. Figure1.CT chest on initial presentation. Bilateral lower lobesinfiltrate and left parahilar density. Laboratory DataInvestigations were significant for esonophilia of 1000 IL. Renal profile and other laboratory data were within normal limits. Sputum culture and sensitivity were normal. Chest x-ray showed bilateral lower lobe infiltrates and left parahilar density. Chest CT scan confirmed the chest-x-ray findings (Figure 1). Pulmonary function tests were within normal limits.After initial workup, the patient underwent fiberoptic bronchoscopy, which revealed thick whitish secretions impacted in the right lower lobe, left upper lobe and left lower lobe bronchus, which proved difficult to be removed

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Picture of the Month—Diagnosis

2011

Arch Pediatr Adolesc Med

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Plastic Bronchitis: An Old Disease Revisited

Cited by 46 publications

References 15 publications

Plastic bronchitis

Plastic bronchitis

Bronchopulmonary Mucoid Impaction (Bronchial Casts)

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