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Plastic bronchitis mimicking foreign body aspiration that needs a specific diagnostic procedure

O Noizet1, F Leclerc, S Leteurtre

  • 1Pediatric Intensive Care Unit, University Hospital of Lille, 59037 Lille, France.

Intensive Care Medicine
|February 21, 2003
PubMed

Insights

Plastic bronchitis, a rare cause of respiratory failure in children, can mimic asthma or foreign body aspiration. Prompt bronchoscopic extraction of bronchial casts is crucial for favorable outcomes.

Area of Science:

  • Pediatric Pulmonology
  • Emergency Medicine

Background:

  • Plastic bronchitis is an infrequent cause of acute, life-threatening respiratory failure in children.
  • It can present symptomatically, mimicking foreign body aspiration or status asthmaticus.

Observation:

  • Two pediatric cases of respiratory failure were admitted to the emergency department.
  • One case involved status asthmaticus with pneumomediastinum requiring mechanical ventilation.
  • The second case presented with a high suspicion of foreign body aspiration.

Findings:

  • Bronchoscopy revealed obstructive plugs, identified as bronchial casts after immersion in normal saline.
  • Predisposing factors included suspected allergy in one case and Hemophilus influenzae infection in the other.
  • Both patients had a favorable outcome following bronchoscopic extraction.

Implications:

  • Urgent bronchoscopic extraction of bronchial casts is vital for severe airway obstruction.
  • Plastic bronchitis may be underestimated due to the difficulty in recognizing casts.
  • Normal saline immersion aids in identifying bronchial casts in children with predisposing conditions like infections, allergies, acute chest syndrome, and congenital cardiopathies.
Abstract

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