Plastic bronchitis

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC

Plastic bronchitis
A specimen of plastic bronchitis
Synonyms	Bronchial cast syndrome
Pronounce	N/A
Specialty	N/A
Symptoms	Cough, dyspnea, wheezing, chest pain
Complications	Respiratory failure, pneumonia
Onset	Can occur at any age, often in children
Duration	Varies, can be acute or chronic
Types	N/A
Causes	Congenital heart disease, lymphatic disorders, asthma, respiratory infections
Risks	History of cardiac surgery, Fontan procedure
Diagnosis	Chest X-ray, CT scan, bronchoscopy
Differential diagnosis	Asthma, pneumonia, foreign body aspiration
Prevention	N/A
Treatment	Bronchoscopy, corticosteroids, mucolytics, physiotherapy
Medication	Steroids, bronchodilators
Prognosis	N/A
Frequency	Rare
Deaths	Can be fatal if untreated

Plastic bronchitis is a rare and serious condition characterized by the formation of large, branching bronchial casts that can obstruct the airways. These casts are typically composed of fibrin, mucus, and cellular debris, and they can vary in size and consistency. The condition is most commonly seen in children, particularly those with underlying congenital heart disease or after Fontan surgery.

Pathophysiology

The exact mechanism of cast formation in plastic bronchitis is not fully understood. However, it is believed to involve a combination of increased lymphatic flow, inflammation, and altered mucus production. In patients with congenital heart disease, increased central venous pressure and lymphatic congestion may contribute to the development of bronchial casts.

Clinical Presentation

Patients with plastic bronchitis typically present with symptoms of airway obstruction, such as cough, dyspnea, and wheezing. In severe cases, patients may experience respiratory distress and cyanosis. The expectoration of bronchial casts can be a dramatic event, often providing temporary relief of symptoms.

Diagnosis

The diagnosis of plastic bronchitis is usually made based on clinical presentation and the expectoration of bronchial casts. Bronchoscopy can be used to visualize and remove casts from the airways. Imaging studies, such as chest X-ray and CT scan, may show areas of atelectasis or airway obstruction.

Treatment

Treatment of plastic bronchitis involves both the removal of bronchial casts and addressing the underlying cause. Bronchoscopic removal of casts can provide immediate relief of symptoms. Medical management may include the use of mucolytics, bronchodilators, and corticosteroids. In cases related to congenital heart disease, surgical or interventional procedures may be necessary to reduce central venous pressure and improve lymphatic drainage.

Prognosis

The prognosis of plastic bronchitis varies depending on the underlying cause and the effectiveness of treatment. In some cases, the condition can be life-threatening, particularly if large casts cause significant airway obstruction. Early diagnosis and appropriate management are crucial for improving outcomes.

See Also

• Bronchial cast
• Congenital heart disease
• Fontan procedure
• Respiratory distress