Bronchoscopic and histologic findings during lymphatic intervention for plastic bronchitis

Area of Science:

• Medical Interventions
• Pulmonary Medicine
• Cardiology

Background:

• Plastic bronchitis (PB) is a rare condition often seen in patients with surgically repaired congenital heart disease (CHD).
• Percutaneous lymphatic intervention (PCL) is an emerging treatment for PB.

Purpose of the Study:

• To characterize bronchoalveolar lavage (BAL) and bronchial cast morphology in PB patients with surgically repaired CHD undergoing PCL.
• To correlate respiratory and bronchoscopic findings with post-intervention outcomes.

Main Methods:

• Retrospective review of patients with PB and surgically repaired CHD who underwent PCL and bronchoscopy.
• Collection of pre-intervention data, bronchoscopy notes, BAL analysis (cell counts, virology, cultures), and bronchial cast morphology.
• Evaluation of respiratory outcomes via telephone questionnaire.

Main Results:

• Sixty-two patients were analyzed with a median follow-up of 20 months.
• Bronchoscopy was safe, with no reported airway bleeding, obstruction, or prolonged intubation.
• BAL analysis revealed positive fungal, bacterial, and viral studies. Cast analysis showed proteinaceous material with lymphocytes, neutrophils, and eosinophils.
• Significant reductions in respiratory medications, support, and casting frequency were observed post-PCL.

Conclusions:

• Neutrophilic proteinaceous casts and positive BAL infectious studies suggest potential roles for fibrinolytic and anti-infective therapies.
• Flexible bronchoscopy is a safe method for assessing cast burden.
• PCL is an effective treatment for PB, leading to reduced respiratory support needs.