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Plastic bronchitis: an unusual cause of respiratory distress in children
A M Cairns-Bazarian1, E E Conway, S Yankelowitz
1Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York 10467.
Insights
Plastic bronchitis is an uncommon cause of pediatric respiratory distress. Early diagnosis via bronchoscopy is crucial, as symptoms like wheezing can mimic asthma or foreign body aspiration.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Critical Care
Background:
- Plastic bronchitis presents a diagnostic challenge in pediatric respiratory distress.
- Symptoms like wheezing and cough are often misdiagnosed as reactive airway disease or foreign body aspiration.
Observation:
- This case highlights an unusual cause of severe respiratory distress in children.
- Chest radiographs may offer clues but are not definitive for diagnosis.
Findings:
- Diagnosis of plastic bronchitis is confirmed by bronchoscopy.
- Bronchoscopy allows for the identification and removal of obstructive bronchial casts.
Implications:
- A high index of suspicion for plastic bronchitis is essential in severe pediatric respiratory distress.
- Bronchoscopy should be considered for children refractory to conventional therapy with suggestive findings.
- This underscores the importance of considering diagnoses beyond asthma in wheezing children.
Abstract:
This case illustrates an unusual cause of respiratory distress in the pediatric population. A high degree of suspicion is necessary to make the diagnosis of plastic bronchitis. Wheezing and cough will lead to the diagnosis of reactive airway disease and/or foreign body aspiration. Chest radiographs may yield additional information, but the diagnosis is made by bronchoscopy and removal of the casts. Any child with severe respiratory distress refractory to aggressive conventional medical therapy and with a history or radiograph suggestive of plastic bronchitis should be considered a candidate for bronchoscopy. As clinicians, we must always remember the dictum, "All that wheezes is not asthma."