[Plastic bronchitis]

Bronchitis plastica is a rare disorder that can occur at any age. It is characterised by formation of large, branching bronchial casts, which are often expectorated, but may be discovered only by bronchoscopy. In most cases, bronchial casts are secondary to underlying diseases of the lung, heart or lymph vessels. We report a case of plastic bronchitis associated with bilateral chylothorax. Progressive respiratory failure could be controlled by repeated bronchoscopic extraction of casts and inhalation of 20,000 units of heparin twice a day. Inhalation of heparin should be considered, when treatment of the underlying disorders is not successful and the casts consist largely of fibrin. Histological examination of the casts may be useful for therapeutic decisions and can point additionally to an underlying disease.