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Plastic Bronchitis

Western Journal of Emergency Medicine
Western Journal of Emergency Medicine
Publication Date
  • Clinical Practice
  • Images In Emergency Medicine
  • Biology
  • Medicine


Volume XII, no. 1 : February 2011 118 Western Journal of Emergency Medicine images in emergenCy mediCine Plastic Bronchitis Annie Quysner, MD Salim Surani, MD, MPH Daniel Roberts, MD Christus Spohn Texas A&M Emergency Medicine Residency Program Supervising Section Editor: Sean Henderson, MD Submission history: Submitted September 4, 2010; Revision received September 28, 2010; Accepted October 11, 2010 Reprints available through open access at [West J Emerg Med. 2011;12(1):118-119.] Figure 2. Bronchial Cast showing complete casting of right upper lobe (RUL), right middle lobe (RML) and right lower lobe (RLL). Figure 1. Computed tomography of the chest showing consolidation of right lower lobe with arrow showing pulgged bronchioles. A 45-year-old male with a one-month history of dyspnea and cough presented with productive sputum consisting of bronchial casts for several days prior to admission. Chest computed tomography showed bilateral opacifications (Figure 1). Several casts were expectorated daily (Figure 2). Pulmonary function tests revealed moderate restrictive lung disease. Bronchoscopy showed evidence of a cast in the right lung. Cast pathology and bronchial washings revealed no evidence of atypical cells or fungi, few inflammatory cells and a predominance of fibrin. No microorganisms were found. The patient was treated with antibiotics, as well as nebulized N-acetyl cysteine, with improvement in cast expectoration. The patient was asymptomatic at his two-week follow up. Repeat chest radiograph and pulmonary function tests were normal. The patient was diagnosed with plastic bronchitis. The underlying pathology of plastic bronchitis is not well understood. It is characterized by the presence of large, thick, mucofibrinous plugs filling the broncho-pulmonary tree, leading to severe respiratory distress.1,2 While commonly seen among children, few cases have been described among adults. It usually occurs in pat

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