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Open Access 17-04-2018 | Image Puzzle – Answer

Cough up your lungs

Auteurs: L. A. J. Rammeloo, N. A. Blom

Gepubliceerd in: Netherlands Heart Journal | Uitgave 6/2018

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Answer

Plastic bronchitis, expectoration of an airway cast

This rubbery bronchial cast is composed of proteinaceous and chylous material deposited from lymphatic fluid into the airways due to high intrathoracic lymphatic pressures.
This large branching cast of the airways was expectorated by a 6-year-old patient, almost 2 years after palliation of tricuspid atresia with a total cavopulmonary connection (Fontan circulation).
The formation of these casts, also known as plastic bronchitis, is a rare condition and almost always associated with underlying disease. In cardiac conditions, those with high venous and high lymphatic pressures are suspected [1].
Bronchial casts can sometimes fill the large parts of the airways, and present as an acute, life-threatening emergency.
There are several treatment options with varying degrees of success. Treatment of the underlying cardiac conditions can resolve the formation of these casts. Interventional closure of leaking intrathoracic lymph vessels is a promising treatment option in patients after palliative treatment of the heart defect with residual high venous and lymphatic pressures [2].

Conflict of interest

L.A.J. Rammeloo and N.A. Blom declare that they have no competing interests.
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie en de Nederlandse Hartstichting. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

Literatuur
1.
go back to reference Eberlein MH, Drummond MB, Haponik EF. Plastic bronchitis: a management challenge. Am J Med Sci. 2008;335(2):163–9.CrossRefPubMed Eberlein MH, Drummond MB, Haponik EF. Plastic bronchitis: a management challenge. Am J Med Sci. 2008;335(2):163–9.CrossRefPubMed
2.
go back to reference Dori Y, Keller MS, Rome JJ, et al. Percutaneous lymphatic embolization of abnormal pulmonary lymphatic flow as treatment of plastic bronchitis in patients with congenital heart disease. Circulation. 2016;133:1160–70.CrossRefPubMed Dori Y, Keller MS, Rome JJ, et al. Percutaneous lymphatic embolization of abnormal pulmonary lymphatic flow as treatment of plastic bronchitis in patients with congenital heart disease. Circulation. 2016;133:1160–70.CrossRefPubMed
Metagegevens
Titel
Cough up your lungs
Auteurs
L. A. J. Rammeloo
N. A. Blom
Publicatiedatum
17-04-2018
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Netherlands Heart Journal / Uitgave 6/2018
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-018-1116-2

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