Large Bronchial Casts

Fairshter, Ronald D.; Riley, Charles A.; Hewlett, Robert I.

doi:10.1001/archinte.1979.03630420018009

Cited by 32 publications

(16 citation statements)

References 12 publications

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“…Prevention of reoccurrence of the disease has been achieved by inhalation of heparin in one case [11]. Bronchoscopic removal of the casts may be beneficial but is difficult, especially in cases of unusually large bronchial casts, because of their friability and adherence to the bronchial mucosa [3,4]. However, we were able to successfully remove the casts by gentle pulling.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…Mucoid impaction differs from plastic bronchitis in several ways: the plugs tend to be in the large segmental bronchi of the upper lobe; they are generally tightly adherent to the wall; and they are retained rather than being expectorated. Mucoid impaction has a strong correlation with asthma [4]. SANERKIN et al [8] reviewed the histopathological features of mucoid plugs and bronchial casts in four conditions, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Therapy for plastic bronchitis consists of specific measures to treat the underlying pulmonary condition as well as manoeuvres designed to remove or facilitate the expectoration of bronchial casts [4]. The role of corticosteroids is uncertain, although they are likely to be beneficial in any allergic-mediated reaction [2].…”

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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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: 99%

Section: Discussionmentioning

confidence: 99%

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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Treatment of cast bronchitis with low‐dose oral azithromycin

Schultz

Oermann

2003

Pediatric Pulmonology

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Cast or plastic bronchitis is an unusual disorder that is rarely encountered in the pediatric population. It is characterized by the expectoration of large, branching plugs of airway debris. These "casts" conform to the shape of portions of the tracheobronchial tree, and give the disorder its name. Cast bronchitis is typically seen in association with several primary pulmonary disorders and cyanotic congenital heart disease. It can be classified as inflammatory or acellular, based on the histologic characteristics of the casts. The presence of large, obstructive plugs filling the airways of lobes or entire lungs can result in a variety of clinical signs and symptoms, and may ultimately lead to respiratory failure and death. Conventional treatment of cast bronchitis has focused on the clearance of obstructing material from the airways combined with therapy for any underlying cardiopulmonary disease. Unfortunately, this approach has not proven very effective, and patient mortality remains high. We report on a case in which a patient with cast bronchitis was treated with long-term, low-dose oral azithromycin. This therapy resulted in clinical, spirometric, and radiographic improvement of the patient.

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