What Is Plastic Bronchitis?

Plastic bronchitis is a condition characterized by a buildup in the airways that forms into casts that exactly replicate the shape of the bronchial tree. The casts, which are made of mucus and cellular materials and have a soft, rubbery consistency, are often coughed up as the lungs try to clear the airways.

Cast of plastic bronchitis

Cast of plastic bronchitis

Plastic bronchitis can be extremely debilitating and in some rare cases life threatening, requiring removal of the cast using bronchoscopy (a procedure that allows the doctor see into the lungs and remove the casts).

Symptoms of plastic bronchitis

Symptoms of plastic bronchitis include: chronic dry or wet cough and expectoration of the rigid casts from the throat or lungs.

In many cases patients also complain of shortness of breath and may require supplementary oxygen.

Causes of plastic bronchitis

Plastic bronchitis is associated with congenital heart disease in children (such as single ventricle defects) and diseases of the lymphatic system in adults.

Interventional Radiologists at Penn Medicine have been able to determine that the cause of plastic bronchitis in adults is the abnormal flow of the lymph (fluid that passes through the lymphatic system)  from the main lymphatic duct in the chest (called the thoracic duct) into the structures in the lungs. This condition is called Pulmonary Lymphatic Perfusion Syndrome. 

Diagnosis of Plastic Bronchitis

The diagnosis of the plastic bronchitis is based on clinical examination and imaging procedures such as a CAT scan and a study called Dynamic Contrast Enhanced Magnetic Resonance Lymphangiography (DCMRL).

Chest CAT scan of a patient with active plastic bronchitis

Chest CAT scan of a patient with active plastic bronchitis

During the Dynamic Contrast Enhanced Magnetic Resonance Lymphangiography (DCMRL) study, very small needles are placed in the groin lymph nodes using ultrasound guidance. Contrast material is injected in to the lymph nodes, allowing the physician to see where the “leakage” of the lymph is occurring in the lungs.

DCMRL study showing contrast

Treatment at Penn Medicine

Our internationally recognized program is one of only two in the nation dedicated to providing advanced care for patients.

Two procedures are performed to treat plastic bronchitis under general anesthesia:

• Intranodal lymphangiography

• Lymphatic embolization

Intranodal lymphangiography is performed in order to visualize the lymphatic vessels under x-ray to provide the guidance for the lymphatic embolization procedure.

Lymphatic embolization is the procedure to repair the lymphatic leak/s. A small tube (catheter) is inserted into the main lymphatic vessel (thoracic duct) and x-ray dye is injected to identify the leakage point. To further confirm the leakage, a technique called “blue bronchoscopy” is performed. During “blue bronchoscopy”, special blue dye is injected into the thoracic duct while performing bronchoscopy (a standard procedure for viewing the airways).

View of lungs with blue bronchoscopy technique

Blue bronchoscopy

After the location of the leak/s are identified, the closure of the thoracic duct is completed using special glue, endovascular coils or a combination of agents to repair the leak/s.

Most patients are able to leave the hospital 3-4 days after receiving the treatment.

Penn Programs & Services for Plastic Bronchitis

Lymphatic Disorders

Penn Interventional Radiology is a world leader in treating lymphatic flow disorders and conditions of the lymphatic system.

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