Mucoid Impaction of the Bronchi

Urschel, Harold C.; Paulson, Donald L.; Shaw, Robert R.

doi:10.1016/s0003-4975(10)66532-0

Cited by 42 publications

(17 citation statements)

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“…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]. Prevention of reoccurrence of the disease has been achieved by inhalation of heparin in one case [11].…”

Section: Discussionmentioning

confidence: 99%

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%

Plastic bronchitis

Park¹,

Elshami²,

Kang³

et al. 1996

Eur Respir J

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“…None of the three showed atelectasis. Department of Thoracic Surgery, University of Texas (Urschel, Paulson, and Shaw, 1966), with an .analysis of 85 cases, including those of Shaw (1951), Shaw, Paulson, and Kee (1957), and, as far -as we can gather, Hutcheson et al (1960). In this series there are no individual histories apart from -Shaw's original 10 cases.…”

Section: Microscopic Changesmentioning

confidence: 96%

“…As the latter have a different agegroup and aetiology they are not strictly compar-able to the asthma-bronchitis cases. Our analysis is compared with the series of Urschel et al (1966) in Tables I to III. No case of single lower lobe impaction appeared in the series we have analysed, although the lower lobe was involved along with an upper or middle lobe in 13 of the 14 multiple impactions and in one case of bilateral lower lobe involvement (Smith and Clark, 1964, case 3).…”

Section: Microscopic Changesmentioning

confidence: 99%

“…RADIOLOGICAL APPEARANCES These are not considered here, as they have been amply described by others (Shaw et al, 1957;Harvey et al, 1957;Wilson, 1964;Urschel et al, 1966). philia accompanying febrile attacks may lead to the diagnosis of Loeffler's syndrome (Harvey et al, 1957).…”

Section: Microscopic Changesmentioning

confidence: 99%

“…Postural drainage and physiotherapy are also recommended. Surgery is reserved for cases where the diagnosis is in doubt, or for lung abscess or bronchiectasis with extensive destruction of lung tissue (Urschel et al, 1966). PATHOGENESIS Hutcheson et al (1960) reviewed the pathology of 27 specimens of lung removed surgically by the Texas University team, and suggested the following as factors predisposing to impaction:…”

Section: Microscopic Changesmentioning

confidence: 99%

See 2 more Smart Citations

Mucoid impaction of the bronchi in relation to asthma and plastic bronchitis

Morgan¹,

Bogomoletz²

1968

Thorax

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Clinical aerosols II. Therapeutic aerosols

Lourenço¹

1982

Archives of Internal Medicine

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The current uses of clinical aerosols such as water, saline, mucolytics, bronchodilators, cromolyn sodium, corticosteroids, and antimicrobials have been reviewed. The benefits of water, saline, and detergent aerosols continue to be surrounded by uncertainty and controversy. Aerosolized mucolytic and proteolytic agents have not been conclusively shown to be of substantial value in the improvement of respiratory disorders. Favorable bronchodilator therapy is achieved with aerosols of certain sympathomimetic and anticholinergic agents. However, successful therapy depends on the dose administered and the site of aerosol deposition in the lung. The prophylactic use of cromolyn sodium in patients with asthma is another useful application of aerosols. Topically active corticosteroid aerosols are increasingly being used since they may reduce risks of systemic effects from corticosteroids. Research on uncommonly aerosolized agents has widened the spectrum of therapeutic applications of aerosols.

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Mucoid Impaction of the Bronchi

Cited by 42 publications

References 10 publications

Plastic bronchitis

Plastic bronchitis

Mucoid impaction of the bronchi in relation to asthma and plastic bronchitis

Clinical aerosols II. Therapeutic aerosols

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