Successful Management of Plastic Bronchitis in a Child Post Fontan: Case Report and Literature Review

Do, Paul; Randhawa, Inderpal; Chin, Terry; Parsapour, Kourosh; Nussbaum, Eliezer

doi:10.1007/s00408-012-9384-x

Cited by 36 publications

(53 citation statements)

References 60 publications

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“…The cause of increased permeability of the bronchial mucosa is not completely understood, but inflammation, which has been seen in lung biopsies of patients with PB, might initiate this process and is the reason that steroids have been shown to improve PB in some patients. 13 Treatment of PB by creation or dilation of a fenestration, optimization of the Fontan pathway, and medical therapies A, Maximal intensity projection of the T2-weighted MRI scan demonstrating a network of dilated peribronchial lymphatic channels (arrow) on the right. Also seen are dilated bilateral supraclavicular lymphatic networks and a dilated network in the abdomen (arrowheads).…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Plastic Bronchitis by Selective Lymphatic Embolization in a Fontan Patient

Dori¹,

Keller

Rychik³

et al. 2014

Pediatrics

115

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Plastic bronchitis is a rare and often fatal complication of singleventricle surgical palliation after total cavopulmonary connection. Although lymphatic abnormalities have been postulated to play a role in the disease process, the etiology and pathophysiology of this complication remain incompletely understood. Here we report on the etiology of plastic bronchitis in a child with total cavopulmonary connection as demonstrated by magnetic resonance (MR) lymphangiography. We also report on a new treatment of this disease. The patient underwent noncontrast T2-weighted MR lymphatic mapping and dynamic contrast MR lymphangiography with bi-inguinal intranodal contrast injection to determine the anatomy and flow pattern of lymph in his central lymphatic system. The MRI scan demonstrated the presence of a dilated rightsided peribronchial lymphatic network supplied by retrograde lymphatic flow through a large collateral lymphatic vessel originating from the thoracic duct. After careful analysis of the MRI scans we performed selective lymphatic embolization of the pathologic lymphatic network and supplying vessel. This provided resolution of plastic bronchitis for this patient. Five months after the procedure, the patient remains asymptomatic off respiratory medications. Pediatrics 2014;134:e590-e595

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Section: Discussionmentioning

confidence: 99%

Successful Treatment of Plastic Bronchitis by Selective Lymphatic Embolization in a Fontan Patient

Dori¹,

Keller

Rychik³

et al. 2014

Pediatrics

115

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“…After the bronchoscopy, the inflammation of the left lobes was resolved. Treatment with azithromycin, systemic and inhaled steroids, ( 6 ) and enalapril maleate was initiated, as was the use of nebulized 3% NaCl solution plus a bronchodilator. One week after treatment initiation, a control FB revealed only small fragments of casts, which were removed easily and completely.…”

Section: Case Reportmentioning

confidence: 99%

“…Após a broncoscopia, houve resolução da inflamação dos lobos esquerdos. Iniciou-se o tratamento com azitromicina, esteroides sistêmicos e inalados e maleato de enalapril, ( 6 ) além de nebulização de solução de NaCl a 3% associada a um broncodilatador. Uma semana após o início do tratamento, uma FB de controle revelou apenas pequenos fragmentos de moldes, que foram removidos fácil e completamente.…”

Section: Relato De Casounclassified

Add-on treatment with nebulized hypertonic saline in a child with plastic bronchitis after the Glenn procedure

et al. 2014

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Plastic bronchitis (PB), although a rare cause of airway obstruction, has mortality rates up to 50% in children after Fontan-type cardiac surgery. We present the case of an 18-month-old female patient with PB following pneumonia. At 6 months of age, the patient underwent the Glenn procedure due to functionally univentricular heart. Fiberoptic bronchoscopy revealed complete blockage of the left bronchus by mucoid casts. Pharmacotherapy consisted of glucocorticosteroids, azithromycin, and enalapril maleate. The child also received nebulized 3% NaCl solution, which proved to be beneficial. In children submitted to Fontan-type procedures, physicians must be alert for PB, which can be triggered by respiratory tract infection.

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“…Treatment frequently requires bronchoscopic evacuation of the mucoid casts from the tracheobronchial tree and remedy of any underlying abnormal cardiac physiology or medical problem, when possible or applicable. PB has also been described in patients with associated inflammatory pulmonary conditions such as cystic fibrosis, acute chest syndrome of sickle-cell disease, allergic bronchopulmonary aspergillosis, asthma as well as in those with a personal or family history of atopy [2,3].…”

Section: Introductionmentioning

confidence: 97%

Plastic bronchitis arising from solitary influenza B infection: A report of two cases in children

Nogan

Cass

Wiet

et al. 2015

International Journal of Pediatric Otorhinolaryngology

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Successful Management of Plastic Bronchitis in a Child Post Fontan: Case Report and Literature Review

Cited by 36 publications

References 60 publications

Successful Treatment of Plastic Bronchitis by Selective Lymphatic Embolization in a Fontan Patient

Successful Treatment of Plastic Bronchitis by Selective Lymphatic Embolization in a Fontan Patient

Add-on treatment with nebulized hypertonic saline in a child with plastic bronchitis after the Glenn procedure

Plastic bronchitis arising from solitary influenza B infection: A report of two cases in children

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