Plastic Bronchitis

Plastic bronchitis is a condition where children and adults cough the casts of their lungs (Figure). This condition can be extremely debilitating an in some rare cases be life threatening. In some patients it requires bronchoscopy in order to remove the casts.

This condition often happens in the patients with congenital heart disease, such as single ventricle and underwent surgery that is called Fontan. However, in some patients this condition occurs spontaneously.

Over the last few years we demonstrated the cause of this condition is the abnormal flow of the lymph from the thoracic duct into lung parenchyma, the condition we called Pulmonary Lymphatic perfusion Syndrome (PLPS).

In patients with plastic bronchitis, we initially perform DCMRL, in order to identify the location of the leak (Figure). We will then perform intranodal lymphangiography, following by lymphatic embolization procedure. This procedure is commonly performed under general anesthesia and combined with bronchoscopy, in order to remove the residual casts and pinpoint the leakage point by “blue bronchoscopy” (reference). During “blue bronchoscopy” we will inject special blue dye in the thoracic duct, while performing the bronchoscopy. This test will identify the areas of the lymphatic submucosal perfusion (Figure) that will be then targeted for the embolization.