From Dust to Casts: Plastic Bronchitis in a Drywall Worker Treated With Thoracic Duct Embolization

Plastic bronchitis is a rare pulmonary condition, most frequently observed in children, that can lead to respiratory failure due to airway obstruction. We present the case of a 50-year-old man with occupational exposure to drywall who experienced recurrent episodes of hypoxic respiratory failure, necessitating multiple intubations. He was initially diagnosed with interstitial lung disease and treated with corticosteroids, but showed minimal clinical improvement. Subsequent flexible bronchoscopy revealed a bronchial cast obstructing the left mainstem bronchus. As plastic bronchitis is typically associated with disorders that cause abnormal lymphatic drainage, thoracic duct embolization was performed. The patient also underwent cryoprobe-assisted bronchoscopy for cast removal. Performance of these 2 procedures led to improved oxygenation and resolution of hypoxic respiratory failure, with no further need for mechanical ventilation.