Pediatric plastic bronchitis: A case report and literature review

Angelos, Patrick C.; MacArthur, Carol J.

doi:10.1016/j.pedex.2009.02.002

Cited by 4 publications

(9 citation statements)

References 19 publications

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“…In addition, PB has been reported in patients with asthma and cystic fibrosis and, more recently, in children with H1N1 influenza [5, 7, 8]. Despite the variety of conditions that underlie PB, it seems to most often happen in children with congenital heart disease (CHD), particularly in patients with single-ventricle physiologies that have been surgically palliated with Fontan surgery [1, 5, 8, 18]. …”

Section: Introductionmentioning

confidence: 99%

Demographic Characteristics and Estimated Prevalence of Fontan-Associated Plastic Bronchitis

et al. 2012

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Plastic bronchitis (PB) is a poorly understood disease that can complicate any underlying pulmonary disease. However, it appears to most often occur in patients with surgically palliated congenital heart disease, particularly after the Fontan procedure. Few data exist about the prevalence and etiology of PB in this population. In an effort to establish data about prevalence, we conducted a retrospective study of an existing Fontan surgery database (n = 654) comprised of data, including sex, age at date of surgery, alive/dead status, New York Heart Association classification at last follow-up, right-ventricular end-diastolic pressure and pulmonary artery pressure before Fontan surgery, and the presence of a Fontan fenestration. An initial medical record review of 173 patients in the database who were followed at the University of Michigan identified seven patients with PB resulting in an estimated prevalence of 4 %. Subsequently, 14 % of 211 surveyed patients reported that they presently expectorate mucus or fibrin plugs (casts). Demographic and clinical variables did not differ between patients with or without possible PB. Collectively, these findings suggest that Fontan patients presently with PB may range from 4 to 14 %, indicating potential under-diagnosis of the disease. There were no remarkable physical or hemodynamic indicators that differentiated patients with or without possible PB. These data also highlight the need for more elaborate, prospective studies to improve our understanding of PB pathogenesis so that more definitive diagnostic criteria for this devastating disease can be established and its prevalence more accurately determined.

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Section: Introductionmentioning

confidence: 99%

Demographic Characteristics and Estimated Prevalence of Fontan-Associated Plastic Bronchitis

et al. 2012

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“…The true prevalence of plastic bronchitis is unknown 5 . Several pathways have been described including increases in pulmonary venous pressure, increased inflammatory response, trauma to bronchial lymphatic channels and ischemia of the bronchial tree 6–9 . Conditions associated with plastic bronchitis have been described as cyanotic congenital heart disease, asthma, lymphatic disorders, sickle cell anemia, pulmonary infections and lymphoma 6–10 .…”

Section: Discussionmentioning

confidence: 99%

“…Recently, types of plastic bronchitis have been classified based on cast histology by Seear et al . postulating a two‐type classification schedule 6,10 . Type I casts are inflammatory casts, which consist of fibrin with a dense eosinophilic infiltrate and are associated with underlying inflammatory diseases and bronchopulmonary disorders.…”

Section: Discussionmentioning

confidence: 99%

“…The cause of this type is less clear. Hypersecretion of airway mucous, abnormalities in lymphatic drainage and poor cardiac output leading to elevated central pulmonary venous pressures with coexistent protein‐losing enteropathy have been described as predominant factors causing plastic bronchitis 6,8,10 . More recently, Madsen et al .…”

Section: Discussionmentioning

confidence: 99%

“…More recently, Madsen et al . described plastic bronchitis as having four causative groups related to certain underlying medical conditions: (i) structural congenital heart disease associated with acellular mucinous casts; (ii) lymphatic disorders associated with chylous casts sometimes containing fibrin; (iii) asthma and atopic diseases associated with abundant eosinophils, Charcot–Leyden crystals, fibrin and neutrophils; and (iv) sickle cell disease associated with fibrinous material composition and pigmented histiocytes in the surrounding fluid 6,9 …”

Section: Discussionmentioning

confidence: 99%

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Bronchitis, tachypnea and cyanosis

Zlamy

Brunner

Horak³

et al. 2010

Pediatrics International

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Key words aspiration, atelectasis, bronchoscopy, foreign body, mucous plug, plastic bronchitis.Foreign body aspiration is a common and serious problem among children and represents an important cause of morbidity and mortality by acute airway obstruction and infection. We report an unusual case of bronchial obstruction by a purulent mucous cast mimicking foreign body aspiration in a child with bronchitis. The child showed acute respiratory distress with atelectasis of the left lung. Bronchoscopy was conducted and a cast was removed. Histopathological analysis of the specimen demonstrated a cast composed of protein, erythrocytes and fibrin, eosinophil-rich, with mixed infiltrate. The child recovered well after removal of the cast. This case illustrates that acute inflammatory processes during airway infections, which are known to contribute to mucous production, can lead to plastic bronchitis with acute obstruction of a main bronchus. Case ReportA 2-year-and-3-month-old boy presented to the outpatient ward with a 6-day history of fever (maximum 39.3°C) and recurrent episodes of coughing and wheezing. Oral antibiotic cefaclor therapy did not ensure recovery. The patient was presented with tachypnea (respiratory rate 40 b.p.m.), a heart rate of 120 b.p.m., cyanosis and minimal breath sounds in the left lung. Initial peripheral SpO 2 was 84% when breathing room air. The physical condition of the boy showed sudden deterioration with onset of acute respiratory distress and signs of circulatory redistribution. Capillary astrup detected SpO 2 of 50%, O2 pressure of 31 mmHg, CO2 pressure of 39 mmHg, pH 7.33, bicarbonate of 20.1 mmol/L and base excess of -5.3 mmol/L. After intubation, the boy was admitted to the pediatric intensive care unit. Laboratory parameters showed normal white and red blood cell counts, normal glucose, creatinine and transaminases and a C-reactive protein of 2.72 mg/dL (standard value <0.70 mg/dL). A chest X-ray showed a hazy left lung with atelectasis and a mediastinal shift to the ipsilateral side (Fig. 1). Bronchoscopy was carried out in order to rule out a foreign body. A 3-cm long and 0.5-cm thick foreign body, macroscopically appearing as meat, was removed from the left main bronchus. Histopathological examination revealed a cast composed of protein, erythrocytes and fibrin, eosinophil-rich, with mixed infiltrate (Fig. 2). With these findings, a foreign body as cause of acute obstruction was excluded. All cultures remained negative. Removing the plug led to respiratory and circulatory stabilization of the patient. Chest X-ray revealed almost normal left lung aeration (Fig. 3). Treatment with intravenous cefuroxime and inhalation with salbutamol and budesonide improved the obstructive bronchitis and pneumonia. After 5 days the patient was discharged with oral cefuroxime for 5 days. His diagnosis was bronchial obstruction due to a purulent mucous cast in the left main bronchus caused by former bronchitis. DiscussionWe describe the case of a child with acute airway obstruction who underwent bronc...

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