OP-060 Pediatric plastic bronchitis. Case report

Aim Plastic bronchitis is a rare lung disease characterized by the formation of tracheobronchial casts in the airways. These casts are thick and rubbery and consist of mucinous material. This condition is usually associated with systemic diseases. In most cases, the disease can be diagnosed by chest x-ray and bronchoscopy. Material and Method In our case report, we present a 2-year-old boy with a negative past medical history. He was treated in primary care for dyspnea, cough and fever, but did not improve. His chest x-ray showed partial distelectasis in the left lung segments and compensatory hyperinflation in the right lung segments. The radiological findings were consistent with aspiration or pneumonia. The detailed history did not support aspiration of a foreign body into the airway. Because of the suspicion of pneumonia, we started a course of antibiotics and mucolytics. However, after one week of therapy, the condition of the left lung progressed. We decided to perform bronchoscopy. We started the examination with fiberoscopy because of the possibility of chronic foreign body aspiration. Bronchoscopy was performed, we saw a tracheobronchial cast in the left upper lobe, which was blocked down the bronchial tree (figure 1). We removed the cast by rigid bronchoscopy. Results We diagnosed plastic bronchitis. We made a thorough examination, which proved infection with Mycoplasma pneumoniae. Follow-up of the child showed good health. There were no respiratory infections. Lung auscultation was normal. Conclusions In some cases our thinking can be wrong because of the discrepancy of the chest x-ray. This case calls our attention that in the same persistent radiological discrepancies we must perform the bronchoscopy.