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Clinical Note |

Endoscopic Treatment of Plastic Bronchitis

Rodrigo C. Silva, MD; Jeffrey P. Simons, MD; David H. Chi, MD; Robert F. Yellon, MD; Cuneyt M. Alper, MD
Arch Otolaryngol Head Neck Surg. 2011;137(4):401-403. doi:10.1001/archoto.2011.43.
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Plastic bronchitis is a rare condition, characterized by the formation of thick mucus plugs that cause airway obstruction. It is seen in a variety of disorders, including congenital cyanotic heart disease following palliative surgery. We describe the case of a 5-year-old child with hypoplastic left-heart syndrome who had undergone a Fontan procedure and developed recurrent bronchial cast formation. These casts were treated aggressively with repeated rigid bronchoscopy and adjuvant medical therapy. We present a brief review of the pathogenesis, treatment options, and description of the challenges involved with endoscopic removal of bronchial casts.

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Figure 1.

Anteroposterior chest radiograph showing complete right lung opacification preoperatively.

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Figure 2.

Endoscopic view of the distal trachea, with cast obstructing the right main stem bronchus.

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Figure 3.

Bronchial cast ramifications. Rule is in centimeters.

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Figure 4.

Anteroposterior chest radiograph taken after the initial procedure.

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