CTICasesPlastic Bronchitis
Imaging findings
Initial chest radiograph shows right lower lobe consolidation. Subsequent radiograph post-lymphangiography shows partial clearing and a right pleural effusion. Lymphangiogram shows extensive mediastinal lymphatic dilatation. Bronchoscopic images demonstrate large, rubbery, branching mucinous casts (slippery slugs) being extracted from the airways. Pathology shows proteinaceous cast material, and lymph node biopsies were negative for lymphoma.
Key takeaways
Plastic bronchitis is a rare, severe disorder characterized by the formation of large, cohesive mucinous or proteinaceous casts that obstruct the bronchial tree. It is most commonly associated with congenital heart disease (post-Fontan), asthma, or lymphatic anomalies. Obstruction can cause severe dyspnea and choking, and diagnostic lymphangiography can sometimes induce therapeutic sclerosis of leaky lymphatics.
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