EUH Hunt Conference: What is plastic bronchitis?

The Bottom Line: Plastic bronchitis (PB) is an uncommon pulmonary disease characterized by production of cohesive and branching casts filling the airways. The diagnosis of PB is confirmed by a history of expectoration of branching airways casts, or by removing branching casts at the time bronchoscopy. Life-threatening respiratory distress can occur because of obstruction of airways with casts in children with congenital heart disease or as a consequence of lymphatic engorgement following surgical correction of congenital heart disease (Rubin 2016).

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Figure: Typical expectorated branching cast from a child with plastic bronchitis caused by congenital heart disease (Rubin 2016).

Reference: Rubin BK. “Plastic bronchitis.” Clinics in Chest Medicine. 2016 Sept; 37(3): 405-408.

Summary: Key points as outlined by Rubin (2016):

  • Plastic bronchitis associated with congenital heart disease or with lymphatic anomalies is caused by aberrant pulmonary lymphatic vessels and drainage. This true form of plastic bronchitis can usually be treated by selective lymphatic vessel ablation.
  • Plastic bronchitis is probably more common than reported. This speculation is based on the observation that many clinicians are unfamiliar with the disease and may fail to recognize milder forms of the syndrome.
  • Plastic bronchitis with cohesive branching airway casts should not be confused with the more common, but smaller and more etiologically distinct, casts that are associated with mucus plugging.
  • For nonlymphatic plastic bronchitis associated with eosinophils and Charcot-Leyden crystals within casts, the most effective therapy seems to be cast removal followed by high-dose or pulse corticosteroids.
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