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What Is Plastic Bronchitis?

Plastic bronchitis is a lymphatic flow disorder that can cause severe breathing difficulties. It is a condition where buildup in your airways forms into casts that look similar to tree branches. The casts are made of mucus and cellular materials and have a soft, rubbery consistency. You might cough them up as your 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.

Symptoms of plastic bronchitis

Symptoms of plastic bronchitis include a chronic dry or wet cough that can eject the rigid casts from your 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.

Penn Medicine Interventional Radiologists determined the cause of plastic bronchitis is the abnormal flow of lymph — colorless fluid that carries white blood cells and proteins through the lymphatic system — from the main lymphatic duct in the chest (called the thoracic duct) into the structures in the lungs. 

Diagnosis of Plastic Bronchitis

Plastic bronchitis is usually diagnosed through a clinical exam along with 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 a DCMRL study, very small needles are placed through your groin into your lymph nodes using ultrasound guidance. Contrast material is injected in to the lymph nodes, allowing the interventional radiologist to see where the "leakage" of the lymph is occurring in your lungs.

DCMRL study showing contrast

Treatment at Penn Medicine

For more than 20 years, our internationally recognized program has been dedicated to providing advanced care for patients with plastic bronchitis.

Two procedures we perform while the patient is under general anesthesia:

  • Intranodal lymphangiography
  • Lymphatic embolization

Intranodal lymphangiography is an imaging procedure that is used to see the lymphatic vessels under x-ray in order to provide guidance for the lymphatic embolization procedure.

Lymphatic embolization is the procedure to repair lymphatic leaks. A small tube (catheter) is inserted into the main lymphatic vessel (thoracic duct) through your abdomen 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 a bronchoscopy, which is a standard procedure where a bronchoscope is inserted through your nose or mouth into your airway in order to view your lungs.

View of lungs with blue bronchoscopy technique

View of lungs with blue bronchoscopy technique

After leak locations are identified, special glue, endovascular coils, or a combination of agents is used to close the thoracic duct and repair the leaks.

You may be able to leave the hospital 3 to 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.

Interventional Pulmonology

We use advanced techniques to diagnose and treat complex conditions of the airway, lungs and pleura (lining of the lungs).

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