Pediatrics: Fellow Case Report Poster- Pediatrics |

Plastic Bronchitis in a Previously Healthy Child FREE TO VIEW

Carlos Sendon, MD; Marlene Limon, MD; Jose Francisco Chocano, MD
Author and Funding Information

Eastern Virginia Medical School, Norfolk, VA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):957A. doi:10.1016/j.chest.2016.08.1060
Text Size: A A A
Published online

SESSION TITLE: Fellow Case Report Poster- Pediatrics

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Plastic bronchitis is an uncommon disease characterized by the formation of casts in the tracheobronchial three; it could produce severe airway obstruction. The casts are pasty and more cohesive than ordinary mucus. The casts can be mainly of fibrin with cellular infiltrates seen in asthma; cystic fibrosis, allergic broncho pulmonary aspergillosis, sickle cell disease, bacterial infections, ,influenza H1N1, and other viral infections; the mucus can be acellular consisting mainly of mucin with very few cells and usually in cyanotic congenital heart disease. Mortality is secondary to respiratory failure related to airway obstruction. We report a child diagnosed as plastic bronchitis with eosinophilic casts.

CASE PRESENTATION: Previously healthy 6 year old African American male with 1 month of cough and 1 day history of chest pain, in the emergency room he presented nor hypoxia, fever or dyspnea. A chest x-ray showed complete atelectasis of the left lung, a CT scan of the chest confirmed the complete collapse of the left lung and showed an abrupt blockage of the left main bronchus. A bronchoscopic evaluation found complete occlusion of the left main bronchus by soft material that extended from the left main stem into the left upper, and lower lobe bronchus. The histology showed mucus material with numerous necrotic and viable eosinophils and neutrophils, Charcot-Leyden crystals, Curschmann spirals, and rare Creola bodies. Stain for fungi were negative. The patient recovered well from the extraction of the mucus plug, and showed radiological improvement, he was discharged on penicillin, inhaled and oral steroids.

DISCUSSION: Plastic bronchitis is a disorder with casts development in the tracheobronchial tree causing airway obstruction. This condition usually occurs in the postoperative period after the Fontan operation for congenital heart disease or underlying inflammatory diseases. These findings of diffuse bronchial hypersecreation and mucoid impactation occurring in any level of the bronchial tree. We present a case of plastic bronchitis as differential diagnosis of foreign body aspiration in a previously healthy child.

CONCLUSIONS: This case report revealed a presentation of plastic bronchitis on a previously healthy child, open the possibility of presentation in any circumstances. Need of rule out plastic bronchitis in a setting or acute severe airway obstruction is a must.

Reference #1: Quisney M, Orman K, Thompson J, Ring J, Salim M. S Choumacher RA, Watson D, Norvick W, Deitcher SR, Joyner R (2000) Plastic Bronchitis occurring late after Fountain procedure: Treatment with aerosolized Urokynase, Crit care Med 28:2107-2111

Reference #2: Seear M, Huii H, Magree F, Bonn D, Cutz E (1997) Bronchial cats in Children a proposed classification based on the nine cases and review of the literature. Amj Resp Crit Care med 155: 364-370.

DISCLOSURE: The following authors have nothing to disclose: Carlos Sendon, Marlene Limon, Jose Francisco Chocano

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543