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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.
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.
Objective:
To report two children admitted to our emergency department with respiratory failure, one for status asthmaticus with pneumomediastinum and requiring mechanical ventilation and the other for high suspicion of foreign body aspiration.
Interventions:
Bronchoscopy revealed obstructive plugs and permitted their extraction and their identification as bronchial casts after the immersion in normal saline. Allergy was suspected in the first one, and Hemophilus influenzae infection was present in the second. The outcome was favorable.
Conclusions:
Plastic bronchitis is an infrequent cause of acute life-threatening respiratory failure that can mimic foreign body aspiration or status asthmaticus. Bronchoscopic extraction must be performed urgently in the case of severe obstruction. This entity is probably underestimated as the casts with their specific ramifications are difficult to recognize. We recommend the immersion in normal saline of all plugs discovered in children with predisposing diseases mainly represented by infections, allergy, acute chest syndrome, and congenital cardiopathies.
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