CT Features of Lymphatic Plastic Bronchitis in Adults: Correlation with Multimodality Lymphatic Imaging

Area of Science:

• Radiology
• Pulmonology
• Medical Imaging

Background:

• Plastic bronchitis (PB) is a rare condition characterized by proteinaceous casts in the airways.
• Distinguishing between lymphatic and non-lymphatic causes of PB is crucial for appropriate management.
• Current diagnostic methods may not always clearly differentiate the etiology of PB.

Purpose of the Study:

• To differentiate CT patterns of lymphatic and non-lymphatic causes of plastic bronchitis (PB).
• To compare CT findings, specifically ground-glass opacity (GGO), with lymphatic imaging.
• To assess the diagnostic utility of GGO in identifying lymphatic PB.

Main Methods:

• Retrospective analysis of chest CT images from 44 patients with PB.
• Comparison of GGO location and extent with symptoms and lymphatic imaging results.
• Statistical analysis including logistic regression and calculation of sensitivity and specificity.

Main Results:

• Ground-glass opacity (GGO) was significantly more frequent in patients with lymphatic PB (91%) compared to non-lymphatic PB (33%) (P < .001).
• GGO was a significant predictor of lymphatic PB (odds ratio, 21).
• The sensitivity and specificity of GGO for lymphatic PB were 91% and 67%, respectively.

Conclusions:

• Multifocal GGO, potentially with a "crazy paving" pattern, is characteristic of lymphatic PB.
• Identifying GGO on CT scans should prompt further lymphatic workup.
• This imaging finding aids in the diagnosis of frequently misdiagnosed lymphatic PB.