Plastic bronchitis.

Plastic bronchitis is an uncommon disease of children characterized by the formation of long, branching bronchial casts. Of three children with such bronchial casts, one developed status asthmaticus and coughed out a complete cast of the tracheobronchial tree. One other child also had a course of desensitization for allergies. Two children presented with what was originally thought to be pneumonitis, but when chest x-rays were taken, one child was suspected of having an inhaled foreign body, and the other had complete opacification of one lung. When these two children were examined bronchoscopically the tracheobronchial tree was found to be filled with white, cheesy material. This material was extremely hard to remove bronchoscopically as the material was too soft to grab with forceps but too thick to suction. The material extended all the way down into the tertiary bronchi, and in one child multiple bronchoscopies were necessary to remove this material, and even so he developed bronchiectasis. The pathologic examination of these casts showed layers of inspissated mucus and inflammatory cells.