Cryotherapy via Flexible Bronchoscopy for Pediatric Plastic Bronchitis: A Case Report

BACKGROUND Plastic bronchitis (PB) is a rare pediatric condition characterized by the formation of large mucus casts in the bronchi, leading to airway obstruction and hypoxia. Bronchoscopic cryotherapy has several applications, including in the removal of bronchial foreign bodies. This report describes the case of a 4-year-old girl with obstructive PB treated with flexible bronchoscopy and cryoextraction. CASE REPORT A 4-year-old girl with a 4-day history of cough and progressive dyspnea was admitted due to left lower lobe pneumonia and pleural effusion identified on chest X-ray. Initial treatment with piperacillin/tazobactam and methylprednisolone, along with nebulization for 2 days, provided symptomatic relief. However, a follow-up computed tomography (CT) scan confirmed persistent pneumonia and bronchial obstruction, leading to further inpatient management. On the second day of hospitalization, the patient underwent flexible bronchoscopy and cryoextraction, successfully removing multiple casts, with the largest measuring approximately 6 cm in length. A chest X-ray on the sixth day showed significant resolution of pneumonia. Bronchoscopy on the seventh day revealed patency of the previously obstructed bronchial lumen, leading to the patient's discharge on the eighth day. After 2 months of follow-up, the child's pulmonary imaging has essentially returned to normal. CONCLUSIONS This report describes a case of obstructive PB, highlighting the diagnosis and management challenges of this condition and the potential role of cryoextraction in removing the bronchial mucus cast.