Abstract
Plastic bronchitis (PB) is thought to be due to increased central venous pressure (CVP) causing exudation of proteinaceous lymphatic content into the airway resulting in cast formation and is often seen in pediatric patients status post total cavopulmonary connection for congenital heart conditions ( 1 Madsen P. Shah S.A. Rubin B.K. Plastic bronchitis: new insights and a classification scheme. Paediatr Respir Rev. 2005; 6: 292-300 Abstract Full Text Full Text PDF PubMed Scopus (141) Google Scholar ). Casts are either expectorated or can lead to asphyxiation. When conservative medical management fails, surgical thoracic duct (TD) ligation and image-guided TD embolization are therapeutic alternatives ( 1 Madsen P. Shah S.A. Rubin B.K. Plastic bronchitis: new insights and a classification scheme. Paediatr Respir Rev. 2005; 6: 292-300 Abstract Full Text Full Text PDF PubMed Scopus (141) Google Scholar , 2 Nadolski G.J. Itkin M. Feasibility of ultrasound-guided intranodal lymphangiogram for thoracic duct embolization. J Vasc Interv Radiol. 2012; 23: 613-616 Abstract Full Text Full Text PDF PubMed Scopus (191) Google Scholar , 3 Dori Y. Keller M.S. Rychik J. Itkin M. Successful treatment of plastic bronchitis by selective lymphatic embolization in a fontan patient. Pediatrics. 2014; 134: e590-e595 Crossref PubMed Scopus (100) Google Scholar ). However, image-guided TD embolization is a technically challenging procedure that may be precluded by prior surgical TD ligation.
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