Plastic bronchitis: large, branching, mucoid bronchial casts in children.

Expectoration of large, branching, bronchial casts, termed plastic bronchitis, is an uncommon condition in children. Asthma or allergy often is the cause of cast production, but in some instances no etiology is found. Five children produced large, obstructing bronchial casts that either were expectorated or were extracted at bronchoscopy. Four of the children had asthma or allergies and the fifth had congenital tricuspid atresia and chronic pericardial and pleural effusions. In two patients, expectorated casts initially were thought to be aspirated food material. Radiographic findings during periods of cast formation included atelectasis, obstructive emphysema, bronchiectasis, pleural effusion, and pneumomediastinum. Cast formation may be self-limited but generally ceases with appropriate treatment of the causative disorder. Bronchoscopic extraction of casts may benefit some patients.