Bronchoscopic and histologic findings during lymphatic intervention for plastic bronchitis

Abstract

The predominance of neutrophilic proteinaceous casts and high percentage of positive BAL infectious studies support short-term fibrinolytic and anti-infective therapies in PB in select patients. Flexible bronchoscopy enables safe assessment of cast burden. PCL effectively treats PB and reduces respiratory therapies.

Efficacy of fiberoptic bronchoscopy and bronchoalveolar lavage in childhood‐onset, complicated plastic bronchitis

“…7,10 These results, consistent with the short-term fibrinolysis of PB, confirmed that early FOB and BAL were effective in the treatment of PB. 18 Concurring with published reports, 2,3,5,11,20 FOB appears to be safe in children, even in young or extremely premature infants. Some serious complications of the procedure, such as those of transbronchial biopsy, chronic pulmonary infiltrates, and PB, may necessitate extensive BAL.…”

“…1,7,9,10,14 Hence, in our study, early FOB and BAL were performed to make a definite diagnosis of PB and clear airway obstructions. 17,18 Cases two and three demonstrated expectorated casts consistent with PB before and after FOB, respectively. Eight cases revealed bronchial tree-like casts extracted via suctioning during FOB.…”

Nonsystemic allergic bronchopulmonary aspergillosis in cystic fibrosis: A suggested paradigm for the evolution from topical to systemic disease

“…Rarer conditions such as eosinophilic pneumonias and connective tissue diseases are highly unlikely in this child's presentation. Rare entities related to bronchial impaction known as cast/plastic bronchitis while not phenotypically suggestive in our case, cannot be conclusively ruled out and were found to be associated with rare eosinophils and Aspergillus in BAL in one series …”

Pediatric Pulmonology Year in Review 2018: Rare lung disease, neuromuscular disease, and diagnostic testing

“…Percutaneous lymphatic intervention (PCL) is a procedure that attempts to interrupt abnormal pulmonary lymphatic perfusion through embolization of the thoracic duct . Geanacopoulos et al reported on 62 CHD patients who underwent flexible bronchoscopy with bronchoalveolar lavage (BAL) and contemporaneous PCL for postsurgical PB at Children's Hospital of Philadelphia. Of 23 bronchial casts analyzed, all contained lymphocytes, and 19 (83%) were proteinaceous.…”

“…Percutaneous lymphatic intervention (PCL) is a procedure that attempts to interrupt abnormal pulmonary lymphatic perfusion through embolization of the thoracic duct. 2 Geanacopoulos et al 3 for respiratory support and most pulmonary medications at a median of 20 months after intervention. Most also reported a decrease in frequency of cast expectoration.…”