title: Use of serial rigid bronchoscopy in the treatment of plastic bronchitis in children.
abstract: OBJECTIVE
  Plastic bronchitis (PB) is a rare disorder characterized by formation of bronchial casts (BC) in the tracheobronchial tree with partial or complete airway obstruction. Although lysis of casts with several fibrinolytic agents has been reported, removal of BC with bronchoscope provides better clearance of airways. A retrospective study was performed to evaluate the use of serial rigid bronchoscopy (RB) in the treatment of PB in children.
  
  
  METHODS
  Between 2011 and 2015, children with partial or complete airway obstruction with PB were evaluated for age, gender, underlying disease, clinical findings, results of bronchoscopic interventions and histopathologic findings.
  
  
  RESULTS
  Five patients with 14 RB interventions were evaluated. The mean age of the patients was 7.8years (min: 3years - max: 14years) and male-female ratio was 4:1. All of the patients were diagnosed as asthma and none of them had underlying cardiac disease. Suction of mucus plaques and bronchoalveolar lavage were performed in all patients with flexible bronchoscopy. Also, aerosolized tissue plasminogen activator was used in two patients. During follow-up serial RB was indicated in patients with persistent atelectasis and severe airway obstruction. The most common localization of BC was left main stem bronchus and bilateral cast formation was detected in 7 interventions. Although, removal of BC was challenging in two patients because of cast friability and fragmentation, most of the plugs were successfully removed with optical forceps and rigid suctioning. Two patients underwent repeated RB (min: 3 - max: 8) for recurrent symptoms. Histopathologic evaluation of BC revealed Charcot-Leyden crystals with inflammatory cells in all patients. The time interval between RB interventions was one to five months.
  
  
  CONCLUSIONS
  BC are tenacious mucus plugs which are firmly wedged to the tracheobronchial tree. The use of optical forceps with rigid suction provides adequate removal of BC during RB. Because of underlying disease, it is difficult to cure cast formation. Therefore, most of the patients require serial RB when they become unresponsive to standard therapy or develop partial or complete airway obstruction.
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey. Electronic address: soyer.tutku@gmail.com.
authors.forename: Tutku
authors.initials: T
authors.lastname: Soyer
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey.
authors.forename: Şule
authors.initials: Ş
authors.lastname: Yalcin
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Pediatric Pulmonology, Ankara, Turkey.
authors.forename: Nagehan
authors.initials: N
authors.lastname: Emiralioğlu
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Pediatric Allergy, Ankara, Turkey.
authors.forename: Ebru Arik
authors.initials: EA
authors.lastname: Yilmaz
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Pediatric Allergy, Ankara, Turkey.
authors.forename: Ozge
authors.initials: O
authors.lastname: Soyer
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Pediatric Pathology, Ankara, Turkey.
authors.forename: Diclehan
authors.initials: D
authors.lastname: Orhan
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Pediatric Pulmonology, Ankara, Turkey.
authors.forename: Deniz
authors.initials: D
authors.lastname: Doğru
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Pediatric Allergy, Ankara, Turkey.
authors.forename: Bülent Enis
authors.initials: BE
authors.lastname: Sekerel
authors.affiliation: Hacettepe University, Faculty of Medicine, Department of Pediatric Surgery, Ankara, Turkey.
authors.forename: Feridun Cahit
authors.initials: FC
authors.lastname: Tanyel
mesh_terms: D000293:Adolescent; D001991:Bronchitis / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D001999:Bronchoscopy / Q000295:instrumentation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D035583:Rare Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Asthma; Bronchial cast; Bronchoscopy; Children; Plastic bronchitis