Clinical characteristics of plastic bronchitis and risk factors for recurrence in children / 中国当代儿科杂志

OBJECTIVES@#To study the clinical characteristics of plastic bronchitis (PB) in children and investigate the the risk factors for recurrence of PB.@*METHODS@#This was a retrospective analysis of medical data of children with PB who were hospitalized in Children's Hospital of Chongqing Medical University from January 2012 to July 2022. The children were divided into a single occurrence of PB group and a recurrent PB group and the risk factors for recurrence of PB were analyzed.@*RESULTS@#A total of 107 children with PB were included, including 61 males (57.0%) and 46 females (43.0%), with a median age of 5.0 years, and 78 cases (72.9%) were over 3 years old. All the children had cough, 96 children (89.7%) had fever, with high fever in 90 children. Seventy-three children (68.2%) had shortness of breath, and 64 children (59.8%) had respiratory failure. Sixty-six children (61.7%) had atelectasis and 52 children (48.6%) had pleural effusion. Forty-seven children (43.9%) had Mycoplasma pneumoniae infection, 28 children (26.2%) had adenovirus infection, and 17 children (15.9%) had influenza virus infection. Seventy-one children (66.4%) had a single occurrence of PB, and 36 cases (33.6%) had recurrent occurrence of PB (≥2 times). Multivariate logistic regression analysis showed that involvement of ≥2 lung lobes (OR=3.376) under bronchoscopy, continued need for invasive ventilation after initial removal of plastic casts (OR=3.275), and concomitant multi-organ dysfunction outside the lungs (OR=2.906) were independent risk factors for recurrent occurrence of PB (P<0.05).@*CONCLUSIONS@#Children with pneumonia accompanied by persistent high fever, shortness of breath, respiratory failure, atelectasis or pleural effusion should be highly suspected with PB. Involvement of ≥2 lung lobes under bronchoscopy, continued need for invasive ventilation after initial removal of plastic casts, and concomitant multi-organ dysfunction outside the lungs may be risk factors for recurrent occurrence of PB.

Characteristics of severe adenovirus pneumonia complicated with plastic bronchitis in children / 中国小儿急救医学

Objective:To summarize the clinical characteristics and investigate risk factors associated with the development of plastic bronchitis(PB)in pediatric patients who have severe pneumonia caused by adenovirus(HAdVs)infections.Methods:We retrospectively reviewed the clinical manifestations, laboratory results, radiological examinations, and treatment courses of 258 children who were diagnosed as HAdVs associated severe pneumonia between 1st January, 2015 and 31st October, 2019 at Shenzhen Children′s Hospital.According to the presence of PB, patients were divided into PB group( n=45)and non-PB group( n=213). Results:In PB group, the male to female ratio was 1.65∶1(including 28 boys and 17 girls)and the median age was 41.0(18.5, 65.5)months.Patients younger than 6 years of age accounted for 80.0%(36/45)and older patients accounted for 20.0%(9/45). The major clinical symptoms of patients in PB group were high fever(95.6%, 43/45), cough(100.0%, 45/45)and conjunctivitis(33.3%, 15/45). Physical examinations revealed that most patients had tachypnea(80.0%, 36/45)and crackles(80.0%, 36/45). Compared to patients in non-PB group, the duration of fever in PB group was significant longer( Z=-13.519, P<0.001). Compared to non-PB group, there was a significant decrease of the lymphocyte count[2.24(1.44, 3.84)×10 9/L vs.1.75(1.21, 3.03)×10 9/L] and a significantly increase of the procalcitonin level[0.46(0.19, 1.73)ng/mL vs.1.54(0.37, 2.96)ng/mL] in PB group( P<0.05). Chest radiological examinations revealed that patients in PB group had higher rates to develop pleural effusion(62.2% vs.42.3%) and atelectasis(57.8% vs.22.1%) of the lungs compared to non-PB group( P<0.05). The majority of patients improved after resolution of symptoms(97.8%, 44/45) in PB group.Only one patient(2.2%, 1/45) died due to discontinuation of treatment.Conjunctivitis( P<0.001, OR=108.514, 95% CI 17.476-673.791), tachypnea( P<0.001, OR=18.788, 95% CI 5.172-68.246), pleural effusion( P=0.007, OR=3.363, 95% CI 1.389-8.139) were independent risk factors associated with the development of PB in children with HAdVs associated severe pneumonia. Conclusion:Pre-school age children are at higher risk to develop HAdVs related severe pneumonia that complicated with PB.Fever and cough remain the main clinical symptoms.The presence of PB is associated with longer period of fever and higher risks to have pleural effusion and atelectasis.Conjunctivitis, tachypnea orpleural effusion are higher risk to develop PB in those with HAdVs associated severe pneumonia.

Early warning analysis of plastic bronchitis in children and clinical study of flexible bronchoscopy / 中华实用儿科临床杂志

Objective:To study the clinical characteristics and etiological distribution characteristics of plastic bronchitis in children, analyze its early warning indicators, and evaluate the clinical diagnosis and treatment effect of flexible bronchoscopy.Methods:The clinical data of 232 children with severe pneumonia admitted to Guiyang Maternal and Child Health Hospital from January 2019 to February 2021 were retrospectively analyzed.The children were divided into the plastic bronchitis group and non-plastic bronchitis group according to bronchoscopic results.The gender, age, clinical manifestations, auxiliary examinations, imaging features, bronchoscopy findings and treatment of the children were collected, compared and analyzed, comparison between two groups by t test and χ2 test. Results:A total of 232 children were included in this study, including 98 cases in the plastic bronchitis group and 134 cases in the non-plastic bronchitis group.The main symptoms of both groups were fever, cough and shortness of breath.The age of onset in the plastic bronchitis group was (54.640±37.085) months, and the age of onset in the non-plastic bronchitis group was (14.870±19.813) months.The difference in the age of onset between the two groups was statistically significant ( t=9.656, P<0.001). The average hospitalization days of the plastic and non-plastic bronchitis groups were (16.133±6.227) d and (12.690±4.287) d, respectively.Significant difference was found in the average hospitalization days between the two groups ( t=4.721, P<0.001). The average fever days of the plastic bronchitis group were (10.090±3.473) d, and the average fever days of the non-plastic bronchitis group were (6.030±4.850) d. There was significant difference in the average fever days between the two groups ( t=5.654, P<0.001). The age of onset, hospitalization days, and fever days of the plastic bronchitis group were larger than those of the non-plastic bronchitis group (all P<0.001). The physical examination suggested that 40% (39/98) of patients in the plastic bronchitis group had reduced the breath sounds, and this percentage was significantly higher than that in the non-plastic bronchitis group[6%(8/134)]. The plastic bronchitis group had lower partial pressure of blood oxygen (PO 2) and oxygen saturation (SO 2) levels than the non-plastic bronchitis group (all P<0.01). The plastic bronchitis group had a higher percentage of neutrophils (N), C-reactive protein (CRP) level, procalcitonin (PCT) level, lactate dehydrogenase (LDH) level and D-dimer level than the non-plastic bronchitis group (all P<0.01). According to the imaging results, in the plastic bronchitis group, lung consolidation was found in 72 cases (73%, 72/98), atelectasis in 32 cases (33%, 32/98), and pleural effusion in 33 cases (34%, 33/98). In the non-plastic bronchitis group, 65%(87/134) cases had lung consolidation, 5%(7/134) cases had atelectasis, 3.7% (5/134) cases had pleural effusion.The first pathogen detected in 46.9% of the patients in the plastic bronchitis group was Mycoplasma pneumoniae (MP), and the percentage was significantly higher that in the non-plastic bronchitis group (11.1%). Flexible bronchoscopy was performed on both groups at their admission.The plastic bronchitis group received the flexible bronchoscopy check for (2.960±1.157) times on average, and the non-plastic bronchitis group was tested for (1.140±0.371) times on average.Of 98 children in the plastic bronchitis group, 95 cases were improved and discharged, 2 cases were transferred, and 1 case died.All 134 children in the non-plastic bronchitis group were improved and discharged. Conclusions:Preschool and school-age children, fever ≥10 d, PCT, CRP, LDH, D-dimer levels are early warning signs of plastic bronchitis clinically.MP is still the primary pathogen causing plastic bronchitis.Flexible bronchoscopy technique is a key measure for timely diagnosis and effective treatment of plastic bronchitis.

Etiological characteristics and changes of plastic bronchitis in children in single center / 中国小儿急救医学

Objective:To investigate the etiological characteristics and changes of plastic bronchitis(PB)in children from 2010 to 2019 at Shenzhen Children′s Hospital, and provide reference basis for improving the understanding of PB etiology.Methods:The clinical data of children diagnosed with infectious-associated PB at Shenzhen Children′s Hospital from Jan 2010 to Dec 2019 were retrospectively analyzed, and the etiological characteristics and changes were summarized.Results:There were 94 cases of mycoplasma pneumoniae, 38 cases of influenza virus, 41 cases of adenovirus, 16 cases of mixed infection, 11 cases of bacteria, and 57 cases of unclear etiology in 266 infectious-associated PB children.The distribution of PB in each age group: 15 cases were infants, 63 cases were toddlers, 112 cases were preschoolers, and 76 cases were school-age children.Adenovirus was the main pathogen of PB in infants and toddlers(60.0%, 28.6%), and mycoplasma pneumoniae(34.8%, 60.5%) as well as influenza virus(13.4%, 22.4%) were the main pathogen in preschool and school-age children, with statistically significant difference( P<0.001). From 2010 to 2019, the annual positive rates of pathogens were 62.5%, 60.0%, 66.7%, 74.1%, 64.0%, 50.0%, 93.3%, 57.1%, 75.0%, and 84.7%, respectively.PB was caused by mycoplasma pneumoniae infection every year.From 2016 to 2019, PB caused by mycoplasma pneumoniae infection increased year by year, while PB caused by adenovirus infection increased every other year. Conclusion:Mycoplasma pneumoniae was the most common pathogen of PB, followed by adenoviruses and influenza viruses, while bacteria, fungi and other viruses were relatively rare.In the infant group, adenovirus infection was predominant, while in preschool and school-age children group, mycoplasma pneumoniae and influenza virus infection were predominant.

Clinical characteristics and risk factors for plastic bronchitis caused by severe mycoplasma pneumonia in children / 中国小儿急救医学

Objective:To summarize the clinical characteristics of plastic bronchitis caused by severe mycoplasma pneumoniae pneumonia in children, to find the risk factors for plastic bronchitis, and to provide references for judging the prognosis and comprehensively formulating treatment plans.Methods:We retrospectively analyzed the clinical data(146 cases)of children with severe mycoplasma pneumoniae pneumonia who underwent bronchoscopy in the Department of Pediatric Respiratory Medicine of Shengjing Hospital of China Medical University from January 2017 to December 2019.According to whether it was plastic bronchitis, all patients were divided into plastic bronchitis group(68 cases) and non-plastic bronchitis group(78 cases), and the gender, age, laboratory examination indicators, imaging characteristics and treatment of children were collected under the circumstances.The single factor with clinical significance and statistical significance would be subjected to multivariate Logistic regression analysis.Results:There were no significant differences in gender, age, heat duration, white blood cell count, C-reactive protein value, and interleukin-6 value between the two groups(all P>0.05). The percentage of neutrophils, alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, D-dimer, number of cases of pleural effusion, length of hospital stay, and number of endoscopy in the plastic bronchitis group were higher than those in non-plastic bronchitis group, the number of right upper lobe consolidation cases was less than that in the non-plastic bronchitis group, and the differences were statistically significant( P<0.05). Multiple Logistic regression analysis showed that pleural effusion( OR=4.898, 95% CI 2.195-10.926) and lactate dehydrogenase ( OR=1.051, 95% CI 1.003-1.101) were independent predictors of plastic bronchitis in children with severe mycoplasma pneumoniae pneumonia. Conclusion:For children with severe mycoplasma pneumoniae pneumonia, if lung CT shows that the upper lobe of the non-right lung is uniformly compacted and complicated with pleural effusion, lactate dehydrogenase is significantly increased, and attention should be paid to the possibility of plastic bronchitis.Timely improvement of fiberoptic bronchoscopy may shorten the course of the disease and reduce the occurrence of complications.

Analysis of clinical characteristics and risk factors of plastic bronchitis caused by Mycoplasma pneumoniae infection / 中华实用儿科临床杂志

Objective:To analyze the clinical characteristics of patients suffering from plastic bronchitis (PB) caused by Mycoplasma pneumoniae (MP) and explore its risk factors as well. Methods:A retrospective analysis on clinical and laboratory data of PB children caused by MP and treated in Department of Respiratory in Children′s Hospital of Soochow University from January 2011 to December 2017, compared with MP pneumonia(MPP) children without PB in the same period.Meanwhile, Logistic regression analysis was performed. Results:Among the 306 MPP children, there were 50 cases in the PB group and 256 cases in the non-PB group.Compared with children in the non-PB group, children in PB group were higher in terms of age [(82.74±35.17)months vs.(66.63±35.67) months], percentage of neutrophils (0.705 8±0.139 1 vs.0.605 7±0.162 6), C reactive protein(CRP) [17.4(10.21, 42.86) mg/L vs.11.43(4.55, 23.66) mg/L], D-dimer(DD) [1 071 (279.5, 2 386.5) μg/L vs.523 (233, 1 099.5) μg/L], lactate dehydrogenase(LDH) [491.1 (342.3, 607.4) U/L vs.394.9 (319.1, 512.8) U/L], erythrocyte sedimentation rate(ESR)[25.0 (17.0, 36.0) mm/1 h vs.15.5(9.0, 28.0) mm/1 h], aspartate aminotranferase(AST) [33.5(26.1, 49.3) U/L vs.29.2(24.0, 37.2) U/L], alanine aminotransferase (ALT) [19.1(11.45, 31.50) U/L vs.13.6 (10.3, 23.15) U/L], IgA [1.46(0.98, 2.12) mg/L vs.1.15 (0.64, 1.60) mg/L], CD3 -CD (16+56)+ (0.155 0±0.088 6 vs.0.120 2±0.071 5), allergy history [44.0%(22/50 cases) vs.25.8%(65/256 cases)], mixed infection [38.0% (19/50 cases) vs.24.6%(63/256 cases)], and microscopic mucosal erosion [10.0%(5/50 cases) vs.2.3%(6/256 cases)] (all P<0.05). Logistic regression analysis displayed that allergy history ( OR= 5.604, 95% CI: 1.937-16.216), age ( OR = 3.142, 95% CI: 1.425-6.929), percentage of neutrophils ( OR=2.387, 95% CI: 1.088-5.238), CRP ( OR=3.959, 95% CI: 1.072-14.662), and DD ( OR=7.824, 95% CI: 2.824-21.673) were independent risk factors for PB caused by MP infection (all P<0.05). The cut-off values of age, percentage of neutrophils, CRP, and DD were 64 months, 0.70, 35 mg/L, and 2 000 μg/L. Conclusions:Children with PB caused by MP often develop in older and allergic children who have stronger inflammatory reactions, immune disorders, and hyperfibrinolysis.

Advance in the diagnosis and treatment of plastic bronchitis in children / 国际儿科学杂志

As a clinical syndrome involving multiple systems, plastic bronchitis(PB)raises a widely interest among researchers due to its complex etiology and unclear pathogenesis.It is currently believed that PB is related to bronchial asthma, cystic fibrosis, sickle cell disease and respiratory tract infection.The main characteristic of PB is the formation of dendritic casts in the bronchus, causing local or extensive obstruction, acute dyspnea, even respiratory failure, and death.Besides, the lack of effective management may result in recurrent respiratory infection, seriously affecting children′s quality of life.The disease is rare in pediatrics, and its clinical and imaging manifestations have no specificity, which can easily lead to misdiagnosis and missed diagnosis.Hence, it is extremely important for early diagnosis and timely removal of plastic substances blocking the airway.

Analysis of risk factors for plastic bronchitis in children with refractory Mycoplasma pneumoniae pneumonia / 中华实用儿科临床杂志

Objective@#To explore the risk factors for refractory Mycoplasma pneumoniae pneumonia (RMPP) in patients with plastic bronchitis.@*Methods@#A retrospective analysis was performed in RMPP children receiving bronchoscopy admitted to the Children′s Hospital of Soochow University from January 2013 to December 2017.According to the bronchoscopic findings, the patients were divided into plastic bronchitis group and non-plastic bronchitis group.The children′s gender, age, clinical manifestations, laboratory findings, imaging features, bronchoscopy findings and treatment were collected.Logistic regression was used to analyze the risk factors for plastic bronchitis in children with RMPP.@*Results@#A total of 198 children with RMPP were enrolled in the study, including 151 (76.3%) children in the non-plastic bronchitis group and 47 (23.7%) children in the plastic bronchitis group.There was no difference in the ratios of gender, age, proportion of fever, cough and wheezing between the 2 groups(all P>0.05). Compared with the non-plastic bronchitis group, children stayed longer at hospital in the plastic bronchitis group [13(8, 23) d vs. 9(7, 19) d](P<0.01). The longer the duration of fever (OR=6.10, 95% CI: 1.60-23.50), the lower the percen-tage of lymphocytes (L%) (OR=0.90, 95% CI: 0.81-0.98), and the higher the lactate dehydrogenase (LDH) (OR=1.03, 95% CI: 1.01-1.08), the higher the C reactive protein (CRP) (OR=1.10, 95% CI: 1.01-1.16) was, which was an independent risk factor for morphine bronchitis in RMPP (all P<0.05). The duration of fever, L%, CRP and LDH were 11 days, 30%, 50 mg/L and 550 U/L, respectively.@*Conclusions@#The duration of fever ≥11 days, the L%<30%, LDH>550 U/L, and CRP>50 mg/L ware independent risk factors for bronchitis in RMPP.

Research progress on plastic bronchitis / 中华实用儿科临床杂志

Plastic bronchitis is a rare,multisystem,clinical syndrome characterized by endobronchial,tubular,and localized or extensive obstruction resulting in acute fatal respiratory distress.The disease is more common in infectious diseases in China,but it is reported abroad after the operation of congenital heart disease.The treatment of plastic bronchitis is a challenging problem with a high mortality rate and no effective treatment has been introduced.The bronchoscope as an acute phase can only relieve symptoms of treatment recognized by domestic and foreign scholars,drug treatment is various,but there is no uniform standard,bronchodilators,hypertonic saline,leukotriene modifiers,macrolides,glucocorticoid,mucolytic agent,heparin,fibrinolytic agents,heart replacement and cardiopulmonary replacement therapy has been mentioned in clinical application.The pathogenesis of plastic bronchitis is not clear and the clinical manifestations are diverse.Early diagnosis and treatment are particularly important.

Bronquitis plástica como causa de obstrucción del tubo orotraqueal: a propósito de un caso / Plastic bronchitis as a cause of endotracheal tube obstruction: report of a case

La bronquitis plástica es una enfermedad poco frecuente pero potencialmente mortal por obstrucción de la vía aérea, que puede ocurrir a cualquier edad. Debido a su poca frecuencia no tiene un tratamiento bien definido y el que se pueda encontrar está basado en experiencias anecdóticas. Ante un episodio de aumento de presiones en el ventilador con una marcada diferencia entre la presión pico y la plateau debe sospecharse de obstrucción del tubo orotraqueal y de ser necesario proceder a cambiarlo sobre todo si el paciente empieza a desaturar e inestabilizarse.

Plastic bronchitis is a rare but potentially fatal disease because of obstruction of the airway, which can occur at any age. Due to its infrequency, it doesn´t have a well-defined treatment and that we can found is based on anecdotal experiences. In the presence of increased pressure on the mechanical ventilator with a marked difference between the peak pressure and plateau pressure, we should suspect of endotracheal tube obstruction and if necessary, we must change it, especially if the patient begins to desaturate and become unstable.

Case Analysis of Budesonide Suspension Combined with Fiber Bronchoscope for Influenza A(H1N1/H3N2) Infection Complicated with Plastic Bronchitis in Children / 中国药房

OBJECTIVE:To analyze the pathological characteristics and therapy method for influenza A(H1N1/H3N2)in-fection complicated with plastic bronchitis (PB). METHODS:Clinical information of 3 children with influenza A (H1N1/H3N2) infection complicated with PB were reported to summarize the experience of aerosol inhalation of Budesonide suspen-sion combined with fiber bronchoscope lavage. Based on literatures,this rare disease were analyzed. RESULTS:Among 3 chil-dren,2 children suffered from influenza A H1N1 infection and one child influenza A H3N2 infection complicated with PB;2 of them got basic disease,i.e. bronchial asthma and primary renal syndrome. 3 children were diagnosed as severe pneumonia,re-spiratory failure and pulmonary atelectasis;2 of them suffered from mediastinal emphesema and subcutaneous emphysema. The branchlike foreign bodies,removed by fiber bronchoscope,were fibrin complicated with neutrophile granulocyte,eosinophile granulocyte and leukomonocyte infiltration by pathological examinations. It was diagnosed as PB. 3 children received symptom-atic support treatment as assisted respiration,respiratory tract management and anti-infective treatment,and aerosol inhalation of Budesonide suspension combined with fiber bronchoscope lavage. And then they were cured and discharged from the hospi-tal. CONCLUSIONS:PB is one complication of influenza A pneumonia and severe. Fiber bronchoscope must be carried out as soon as possible based on aerosol inhalation of Budesonide suspension once PB is suspected,so as to diagnose early and treat promptly.

Clinical study of tissue-type plasminogen activator therapy for children's plastic bronchitis / 中华实用儿科临床杂志

Objective To evaluate the clinical efficacy of tissue-type plasminogen activator (tPA) treatment of children with plastic bronchitis.Methods The study retrospectively reviewed the clinical data of the children with plastic bronchitis who were admitted to Tianjin Children's Hospital from September 2013 to January 2015 and were treated with tissue-type plasminogen activator.This study analyzed the effect and safety of tPA treatment,including clinical and radiological changes and follow-ups.Results A lot of plastic secretions were safely removed from the bronchial tubes in all children and clinical manifestations including breathing,body temperature,transcutaneous oxygen saturation and image changes were significantly improved.Conclusions Bronchoscopy is an effective way to treat plastic bronchitis,but with the use of tPA a better clinical efficacy could be achieved.The method is safe and effective and should be applied early in the patients in order to prevent the occurrence of severe airway obstruction complications.

Clinical analysis of plastic bronchitis in 7 children / 中华实用儿科临床杂志

Objective To analyze 7 cases of plastic bronchitis in children,review the literature,and improve the understanding of the clinical features,diagnosis and treatment of the disease.Methods Seven children (6 male and 1 female) aged from 2 to 12 years with plastic bronchitis presenting cough,wheezing and dyspnea,who were treated in Nanjing Children's Hospital Afiliated to Nanjing Medical University from Sep.2006 to Mar.2012,were analyzed,respectively.The treatment of the 7 cases included flexible bronchoscopy or rigid bronchoscopy,supplemented by oxygen therapy,antibiotics,and atomizing inhalation.Results All 7 children had acute onset,in which 6 cases presented cough and polypnea,1 case presented emptysis.With the development of the disease,hypoxemia occurred.The chest Xray and Computerized Tomography examination showed pulmonary atelectasis in all 7 cases,while atelectasis and emphysema coexisted in 3 cases,pleural effusion in 3 cases.According to the obstructive site,1 case was in left bronchus and 6 cases in right.One case received rigid bronchoscopy,and 1 case received flexible bronchoscopy after taking rigid bronchoscopy,while 5 cases received flexible bronchoscopy.Five cases were cured after first operation,2 cases had second flexible bronchoscopy,and endogenous bronchial-shaped casts were removed under bronchoscopy.Pathological results showed the casts were classified as 6 cases of type Ⅰ,inflammatory,and 1 case of type Ⅱ,acellular.Four cases improved markedly,and 3 cases were cured.Conclusions Plastic bronchitis in children is a life-threatening disorder.Flexible bronchoscopy or rigid bronchoscopy extraction of branching plastic casts must be performed urgently for early diagnosis and good therapeutic result.

Clinical analysis of 24 children with plastic bronchitis / 中华实用儿科临床杂志

Objective To investigate the clinical characteristics of plastic bronchitis (PB) so as to improve the awareness of the disease.Methods Twenty-four children with PB were collected from Jul.2009 to Mar.2012 in Shenzhen Children's Hospital.The clinical manifestation,bronchoscopy,histology of the cast,clinical course and outcome were reviewed retrospectively.Results Of the 24 children with PB,18 cases were male,6 cases were female,and the range of age was 1 year and 2 months to 10 years and 3 months,with the median age of 3 years and 4 months.Three patients had an underlying chronic disease,1 case had asthma,1 case had hydronephrosis,and 1 case had ventricular septal defect repair before 1 year and 8 months.All the cases had fever,cough and sputum,while 10 cases had wheeze,and 5 cases had respiratory distress.All cases were diagnosed as pneumonia or severe pneumonia,of which 14 case had atelectasis,10 cases had parapneumonic effusion,5 cases suspected of foreign body inhalation,3 cases had pneumothorax,and 3 cases had mediastinal hernia.Fourteen cases were admitted to PICU,6 patients developed respiratory failure,and 9 patients required mechanical ventilation.Flexible bronchoscopy and bronchial lavage were performed in all cases and showed bronchial cast.Histological examination of the bronchial cast revealed that fibrinous material containing large quantity of eosinophils,neutrophils,and lymphocytes in 23 patients,and no inflammatory cells in 1 patient.After a bronchial cast was removed,all patients were improved greatly,and no patient dead.Conclusions Plastic bronchitis is a rare pediatric critical disease,which has high mortality.In children with rapid and progressive respiratory distress with lung atelectasis,pleural effusion or consolidation on chest radiograph,PB should be considered.Bronchial endoscopy is the most effective method for treatment of PB.

Report of 5 cases of pediatric plastic bronchitis and review of related literature / 中华全科医师杂志

To report the clinical course of 5 cases of pediatric plastic bronchitis and review the related literature.A total of 113 cases of pediatric plastic bronchitis occurring in China from 2000 to 2012 were retrieved through the databases of CNKI and Wanfang Med Online.Retrospective analyses were performed for the main symptoms,courses,etiologies,imaging findings,histopathological classifications,therapies and prognosis of 118 cases.Pediatric plastic bronchitis was one of critical diseases.Most of them had a rapid onset and a mortality rate.Bronchoscopy examination was essential for definite diagnosis and effective treatment.Airway management and chest physiotherapy were primary adjuvant tools.Early diagnosis and bronchoscopic treatment might result in improved prognosis.

Advances in the diagnosis and treatment of children with plastic bronchitis / 国际儿科学杂志

Children with plastic bronchitis,characterized by unknown origin,insidious onset,rapid progress,severe symptom and high mortality,is a relatively rare disease.Also,it is difficult to diagnose and treat with plastic bronchitis characterized by marked airway obstruction,via the formation of large gelatinous or rigid airway cast.It is associated with certain diseases including bronchial asthma,cystic fibrosis,accompanied with acute chest syndrome with sickle cell disease,congenital heart disease and bacterial and viral respiratory infection.Clinicians should be aware of this disease,and early bronchoscopy should be intervened.

Advances in plastic bronchitis / 国际儿科学杂志

Plastic bronchitis is a “multiple-system” involved syndrome that is characterized by the formarion of thick,arborizing mucofibrinous tracheobronchial casts,which can result in hard breathing or pulmonary failure.Plastic bronchitis in children occurs following correction of complex cardiac defects,or in children with inflammatory pulmonary conditions.It is a condition of unknown causes and has different clinical manifestations.Early diagnosis is very important and so far endoscopic removal of the casts is the most effective measure.

Plastic bronchitis in children: 2 cases / 소아과

Plastic bronchitis is a rare disorder characterized by the formation of extensive, obstructing endobronchial casts. It is associated with asthma and complex cardiac defects such as those requiring the Fontan procedure. The treatment of plastic bronchitis comprises conventional therapy involving spontaneous expectoration and bronchoscopic removal and specific therapy with several new drugs. Herein, we describe the cases of 2 patients diagnosed with plastic bronchitis accompanied with a different underlying disease, which were treated with inhaled corticosteroid and low-dose oral clarithromycin.

Fatal plastic bronchitis with eosinophilic casts in a previously healthy child / 소아과

Plastic bronchitis is a rare disease characterized by the recurrent formation of branching mucoid bronchial casts that are large and more cohesive than those that occur in ordinary mucus plugging. Casts may vary in size and can be spontaneously expectorated, but some require bronchoscopy for removal. Plastic bronchitis can therefore present as an acute life-threatening emergency if obstruction of the major airways occurs. Three of 22 reported patients with eosinophilic casts were fatal, with death due to central airway obstruction. Here, we report a child with no history of atopy, allergy, or congenital heart disease who was diagnosed with plastic bronchitis with eosinophilic casts. Although he was administered intravenous (iv) antibiotics; iv corticosteroids; and a vigorous pulmonary toilet regimen, including chest physiotherapy and routine bronchoscopic removal of casts, he had brain death secondary to hypoxic brain damage. Plastic bronchitis can be fatal when casts obstruct the major airways, as in the present case. Clinicians should intervene early if a patient exhibits signs and symptoms consistent with plastic bronchitis.

Fatal plastic bronchitis with eosinophilic casts in a previously healthy child / 소아과

Plastic bronchitis is a rare disease characterized by the recurrent formation of branching mucoid bronchial casts that are large and more cohesive than those that occur in ordinary mucus plugging. Casts may vary in size and can be spontaneously expectorated, but some require bronchoscopy for removal. Plastic bronchitis can therefore present as an acute life-threatening emergency if obstruction of the major airways occurs. Three of 22 reported patients with eosinophilic casts were fatal, with death due to central airway obstruction. Here, we report a child with no history of atopy, allergy, or congenital heart disease who was diagnosed with plastic bronchitis with eosinophilic casts. Although he was administered intravenous (iv) antibiotics; iv corticosteroids; and a vigorous pulmonary toilet regimen, including chest physiotherapy and routine bronchoscopic removal of casts, he had brain death secondary to hypoxic brain damage. Plastic bronchitis can be fatal when casts obstruct the major airways, as in the present case. Clinicians should intervene early if a patient exhibits signs and symptoms consistent with plastic bronchitis.