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Thoracic Air Leakage in the Presentation of Cast Bronchitis

Jonah Kruger, MD; Chaim Shpringer, MD; Elie Picard, MD; Eitan Kerem, MD
Author and Funding Information

From the Department of Pediatrics (Drs. Kruger and Kerem), Hadassah-Hebrew University Medical Center, Mount Scopus, Israel; Pulmonology Institute (Dr. Shpringer), Hadassah-Hebrew University Medical Center, Ein Kerem, Israel; and the Department of Pediatric Pulmonology (Dr. Picard), Shaare Zedek Medical Center, Jerusalem, Israel.

Jonah Kruger, MD, Hadassah-Hebrew University Medical Center, Mount Scopus, Department of Pediatrics, PO Box 24035, Jerusalem 91240, Israel; e-mail: jonahkruger@hotmail.com


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;136(2):615-617. doi:10.1378/chest.08-0383
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Background:  Cast bronchitis is a rare but potentially fatal condition caused by the accumulation of mucus in the bronchial tree usually secondary to infection, inflammation, or vascular stasis. Air leakage is an uncommon presentation of cast bronchitis. We report on three children with cast bronchitis who presented with acute air leakage as the main clinical feature.

Methods:  All three patients underwent bronchoscopic evaluation that led to a diagnosis and removal of bronchial casts.

Results:  Pathologic examination of casts from all three patients showed a mucoid substance with eosinophilic infiltration. The outcome for all patients was favorable.

Conclusions:  Acute respiratory failure presenting with wheezing and thoracic air leakage refractory to standard asthma therapy should raise suspicion of cast bronchitis, and urgent bronchoscopy should be performed.

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