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Aggressive bronchoscopic management of plastic bronchitis
Diego Preciado1, Susan Verghese, Sukgi Choi
1Division of Pediatric Otolaryngology-Head and Neck Surgery, Children's National Medical Center, George Washington University, Washington, DC 20010, USA. dpreciad@cnmc.org
International Journal of Pediatric Otorhinolaryngology
|June 16, 2010
Summary
Plastic bronchitis, a rare condition causing airway obstruction, frequently affects children post-Fontan procedure. Early diagnosis and aggressive cast removal are crucial for managing this life-threatening airway disease.
Area of Science:
- Pulmonary Medicine
- Pediatric Cardiology
Background:
- Plastic bronchitis is a rare, severe airway disease characterized by mucofibrinous cast formation.
- It leads to life-threatening airway obstruction and pulmonary failure.
Observation:
- This case series reviews three pediatric patients who developed recurrent plastic bronchitis following a Fontan procedure for single ventricle physiology.
- All patients required multiple bronchoscopies for cast removal, and two needed extracorporeal membrane oxygenation (ECMO) due to respiratory failure.
Findings:
- Plastic bronchitis is an uncommon condition with an unknown etiology, particularly observed in children after Fontan operations.
- While pulmonary function initially normalized, one patient experienced recurrence and subsequently expired due to pulmonary failure.
Implications:
- Management is challenging, necessitating early diagnosis, aggressive cast removal, and intensive medical support.
- The complex cardiopulmonary physiology in Fontan patients, including risks of arrhythmias, hypoxemia, and pulmonary hypertension, complicates treatment.
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