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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
Summary
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.