CTICasesPlastic Bronchitis
Imaging findings
Chest radiography shows recurrent, migratory lower-lobe atelectasis and peribronchial opacities. CT of the chest and abdomen demonstrates extensive, ill-defined soft tissue thickening and infiltration throughout the mediastinum and the paraspinal abdominal regions, raising initial concern for lymphoma. Conventional lymphangiography reveals markedly dilated, abnormal thoracic lymphatic ducts with retrograde reflux of the injected contrast medium (Lipiodol) into the right pulmonary parenchymal lymphatics. A post-procedure chest radiograph demonstrates a new, large right pleural effusion and contrast tracking within thoracic lymph nodes.
Key takeaways
Plastic bronchitis is a rare, life-threatening disorder characterized by the formation of large, cohesive, branching airway casts that can cause severe respiratory distress and asphyxiation. It is frequently caused by abnormal thoracic lymphatic drainage, where retrograde lymphatic flow spills chylous fluid into the bronchial tree, which then gels into casts. Treatment options include transcatheter thoracic duct embolization or chemical sclerosis/embolization using lymphangiographic contrast agents like Lipiodol, which can help seal the leaking lymphatic vessels.
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