plastic bronchitis

PMID: 22430124
--Do P, Randhawa I, Chin T, Parsapour K, Nussbaum E., Successful Management of Plastic Bronchitis in a Child Post Fontan: Case Report and Literature Review. Lung. 2012 Mar 20. [Epub ahead of print]



QUICK LEARNING POINTS:
--Plastic bronchitis is a rare, potentially fatal, condition noted in patients after Fontan surgery.

--The mucoid impaction with cast formation occludes the major bronchi with firm, gelatinous material. 

--Acute management involves ABCs (airway, breathing, circulation), potentially requiring intubation for respiratory failure. 

--General airway clearance measures with bronchodilators and chest physiotherapy should be initiated.

--In emergent cases, immediate bronchoscopy, whether rigid or flexible, should be considered.  Bronchial casts are unique foreign bodies that may be friable or dissolvable, making lavage a necessary component of its removal.

--While bronchoscopy can be effective for acute therapy, it does not prevent recurrence nor should it be utilized on a chronic basis. 

BOTTOM LINE:

--Plastic bronchitis is a rare, potentially fatal, condition noted in patients after Fontan surgery.

--treatment toolbox: inhaled mucolytics, bronchodilators, intubation & bronchoscopy if necessary

Submitted by J. Gullo.




Reference(s): article, picture