Abstract
Background
Plastic bronchitis is a rare cause of acute obstructive respiratory failure in children. Life-threatening events are much more frequent in patients with repaired cyanotic congenital heart disease, and most frequent following a Fontan operation. Commonly, the diagnosis is not made until bronchial casts are expectorated. Detailed CT findings in plastic bronchitis have not been described.
Objective
To describe the CT findings in plastic bronchitis in children after a Fontan operation.
Materials and methods
Three children with plastic bronchitis after a Fontan operation were evaluated by chest CT. Bronchial casts were spontaneously expectorated and/or extracted by bronchoscopy. Airway and lung abnormalities seen on CT were analyzed in the three children.
Results
CT demonstrated bronchial casts in the central airways with associated atelectasis and consolidation in all children. The affected airways were completely or partially obstructed by the bronchial casts without associated bronchiectasis. The airway and lung abnormalities rapidly improved after removal of the bronchial casts.
Conclusion
CT can identify airway and lung abnormalities in children with plastic bronchitis after a Fontan operation. In addition, CT can be used to guide bronchoscopy and to monitor treatment responses, and thereby may improve clinical outcomes.
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References
Seear M, Hui H, Magee F et al (1997) Bronchial casts in children: a proposed classification based on nine cases and a review of the literature. Am J Respir Crit Care Med 155:364–370
Brogan TV, Finn LS, Pyskaty DJ Jr et al (2002) Plastic bronchitis in children: a case series and review of the medical literature. Pediatr Pulmonol 34:482–487
Goo HW, Park IS, Ko JK et al (2003) CT of congenital heart disease: normal anatomy and typical pathological conditions. Radiographics 23(Spec No):S147–S165
Goo HW, Park IS, Ko JK et al (2005) Computed tomography for the diagnosis of congenital heart disease in pediatric and adult patients. Int J Cardiovasc Imaging 21:347–365
Noizet O, Leclerc F, Leteurtre S et al (2003) Plastic bronchitis mimicking foreign body aspiration that needs a specific diagnostic procedure. Intensive Care Med 29:329–331
Bowen A, Oudjhane K, Odagiri K et al (1985) Plastic bronchitis: large, branching, mucoid bronchial casts in children. AJR 144:371–375
Werkhaven J, Holinger LD (1987) Bronchial casts in children. Ann Otol Rhinol Laryngol 96:86–92
Liston SL, Porto D, Siegel LG (1986) Plastic bronchitis. Laryngoscope 96:1347–1351
Kuperman T, Wexler ID, Shoseyov D et al (2006) Plastic bronchitis caused by neoplastic infiltrates in a child. Pediatr Pulmonol 41:893–896
Languepin J, Scheinmann P, Mahut B et al (1999) Bronchial casts in children with cardiopathies: the role of pulmonary lymphatic abnormalities. Pediatr Pulmonol 28:329–336
Madsen P, Shah SA, Rubin BK (2005) Plastic bronchitis: new insights and a classification scheme. Paediatr Respir Rev 6:292–300
Goo HW, Yang DH, Park IS et al (2007) Time-resolved three-dimensional contrast-enhanced magnetic resonance angiography in patients who have undergone a Fontan operation or bidirectional cavopulmonary connection: initial experience. J Magn Reson Imaging 25:727–736
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Goo, H.W., Jhang, W.K., Kim, Y.H. et al. CT findings of plastic bronchitis in children after a Fontan operation. Pediatr Radiol 38, 989–993 (2008). https://doi.org/10.1007/s00247-008-0937-3
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DOI: https://doi.org/10.1007/s00247-008-0937-3