Retrograde thoracic duct embolization for adult-onset plastic bronchitis with idiopathic lymphatic flow anomaly

We report a case of a patient who developed adult-onset plastic bronchitis (PB) due to aberrant lymphatic anatomy, which resulted in direct lymph drainage into the left lower lobe bronchus. After failure of medical management, successful thoracic duct embolization was performed targeting the aberrant lymphatic duct via transnodal lymphangiography and a retrograde transvenous lymphatic access. Following intervention, the patient reported no adverse events and complete resolution of symptoms without any chronic cough or cast expectoration. The case supports the advantages of transcatheter lymphatic embolotherapy including its minimally invasive nature and short recovery period and hospital stay. Additionally, the case provides evidence for the use of transcatheter thoracic duct n-butyl cyanoacrylate (n-BCA) embolization for managing lymphatic malformations in patients presenting with plastic bronchitis.