Bronchial casts in children with cardiopathies: The role of pulmonary lymphatic abnormalities

Expectoration of bronchial casts, a condition also called plastic bronchiti s, is very rare in children. Bronchial casts may be associated with broncho pulmonary diseases associated with mucus hypersecretion, bronchopulmonary b acterial infections, congenital and acquired cardiopathies, or pulmonary ly mphatic abnormalities. A classification based on anatomy and pathology has been proposed which identifies an "acellular" group associated with congeni tal cardiopathies and palliative surgery. We report on 3 cases with bronchial casts associated with cardiopathy. Obse rvations suggest that the formation of bronchial casts may result from lymp hatic leakage into the bronchi. The 3 cases on which we report were immunod eficient and had pulmonary lymphatic abnormalities. The bronchial casts con tained lymphocytes and lipids, as determined by histologic examination. In the absence of congenital pulmonary or diffuse lymphatic dysplasia assoc iated with cardiopathy, the principal factors resulting in the formation of bronchial casts appear to be surgical trauma to the lymphatic channels sur rounding the bronchi, pleural adhesions, and high systemic venous blood pre ssure. The prognosis for these patients is poor, and possibilities for trea tment are limited. Pediatr Pulmonol. 1999;28:329-336. (C) 1999 Wiley-Liss, Inc.